Ethical Decision-Making in Medical Practice: The Role of Moral and Business Philosophies.

BACKGROUND: Ethical decision-making in medical care increasingly requires balancing clinical values, professional duties, and organizational reasoning. Understanding how healthcare professionals navigate moral dilemmas necessitates examining the philosophical orientations that shape their ethical judgments. Alongside traditional medical ethics, a business ethics perspective highlights organizational and managerial dimensions of healthcare, offering a more comprehensive understanding of ethical decision-making in modern clinical contexts. AIM: This study aims to examine how healthcare professionals reason about ethical dilemmas by mapping their moral orientations and decision-making patterns across five ethical frameworks-idealism, relativism, objectivism, legalism, and Machiavellianism-integrating both medical and business ethics perspectives. METHODS: A cross-sectional study was conducted with 277 participants (medical doctors and students). Two validated instruments were used: the Attitudes Toward Business Ethics Questionnaire (ATBEQ) to assess moral orientations and the Clinical Ethical Dilemmas Questionnaire (Richeux & Duquéroy) to evaluate ethical decision patterns. Data were analyzed using correlation, multiple regression, and k-means cluster analyses. RESULTS: Among the five orientations, Legalism negatively predicted "It depends" responses (i.e., higher Legalism scores were associated with fewer indecisive responses), indicating greater decisiveness in ethically ambiguous situations. Unexpected positive correlations were also found between traditionally opposing constructs-such as Ethical Relativism and Moral Objectivism-suggesting moral pluralism. The overall regression model was not statistically significant (R2 = 0.04, p = 0.08). Cluster analysis identified four distinct ethical reasoning profiles: High Machiavellian Idealists, Pragmatic Relativists, Context-Sensitive Objectivists, and Ethical Purists. CONCLUSIONS: Abstract philosophical orientations showed limited predictive power for contextual ethical decision-making, highlighting the complex and multidimensional nature of moral reasoning in healthcare. Findings inform the design of context-sensitive ethics education programs that integrate philosophical reflection with case-based learning to strengthen ethical competence among medical professionals.