Between a Rock and a Hard Place: Exploring the Ethical Dilemmas Faced by Nurses and Physicians in Pangasinan
Authors
Virgen Milagrosa University Foundation (Philippines)
Article Information
DOI: 10.47772/IJRISS.2026.100500485
Subject Category: Social science
Volume/Issue: 10/5 | Page No: 7242-7252
Publication Timeline
Submitted: 2026-05-09
Accepted: 2026-05-14
Published: 2026-06-05
Abstract
This study explored the lived experiences of healthcare workers in Pangasinan regarding ethical dilemmas encountered in professional practice. Specifically, the study examined the ethical conflicts experienced by healthcare workers, the coping strategies used to manage these dilemmas, and the insights they developed through their experiences in healthcare settings. This study utilized a qualitative phenomenological research design to investigate the lived experiences of healthcare workers encountering ethical dilemmas in healthcare practice. Purposive sampling was employed to select participants who had direct experiences with ethical conflicts in healthcare settings. Semi-structured interviews were conducted, and the data were analyzed using Colaizzi’s phenomenological descriptive method. The findings revealed that healthcare workers commonly experience ethical dilemmas related to resource limitations, patient autonomy, end-of-life care, institutional pressures, confidentiality concerns, and financial constraints affecting patient care. Participants managed ethical conflicts through consultation with colleagues and supervisors, adherence to ethical guidelines, reflective practice, and open communication with patients and families. The study also highlighted the emotional and professional impact of ethical dilemmas, including moral distress, compassion fatigue, and emotional exhaustion, while demonstrating the importance of resilience, peer support, and ethics education. The study was limited to selected healthcare workers in Pangasinan and focused primarily on physicians and nurses. Future studies may include other healthcare professionals and broader geographic settings to further explore ethical dilemmas across diverse healthcare environments. Healthcare institutions may strengthen ethical decision-making and reduce moral distress by providing ethics education, establishing structured support systems, improving staffing conditions, and encouraging collaborative ethical discussions among healthcare professionals. Understanding healthcare workers’ ethical challenges may contribute to improved healthcare delivery, patient-centered care, and the development of supportive This study contributes to the growing body of literature on healthcare ethics by providing context-specific insights into the lived experiences of healthcare workers in provincial healthcare settings in the Philippines.
Keywords
ethical dilemmas, healthcare workers, moral distress, phenomenology, healthcare ethics
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References
1. A. Books [Google Scholar] [Crossref]
3. Creswell, J. W., & Poth, C. N. (2018). Qualitative inquiry and research design: Choosing among five approaches (4th ed.). Sage Publications. [Google Scholar] [Crossref]
4. Moustakas, C. (2020). Phenomenological research methods. Sage Publications. [Google Scholar] [Crossref]
5. Van Manen, M. (2016). Researching lived experience: Human science for an action sensitive pedagogy (2nd ed.). Routledge. [Google Scholar] [Crossref]
7. B. Published Materials [Google Scholar] [Crossref]
9. Abe, K., Tanaka, M., & Sato, H. (2023). Ethical decision-making in aging societies: Challenges in end-of-life care in Japan. Journal of Medical Ethics, 49(2), 115–122. [Google Scholar] [Crossref]
10. Abe, Y., Saito, T., & Watanabe, M. (2023). Ethical challenges in end-of-life care in Japan’s aging society: Balancing autonomy and family-centered values. Journal of Medical Ethics, 49(2), 123–130. [Google Scholar] [Crossref]
11. Al-Mutairi, S. S., et al. (2024). Ethical conflicts in nursing practice: End-of-life decision-making and balancing patient preferences with clinical recommendations. Journal of International Crisis and Risk Communication Research, 7(1), 45–63. [Google Scholar] [Crossref]
12. Ayebare, R. R., Rutagengwa, M. J., Dusabe, T., Mpunga, T., & Galukande, M. (2024). Ethical dilemmas in prioritizing patients for scarce radiotherapy resources: A qualitative study from Rwanda. BMC Medical Ethics, 25(1), Article 5. [Google Scholar] [Crossref]
13. Berdida, D., & Grande, R. (2023). Moral distress, moral resilience, moral courage, and moral injury among nurses in the Philippines during the COVID-19 pandemic: A mediation analysis. Journal of Religion and Health, 62(4), 2057–2074. [Google Scholar] [Crossref]
14. Bigand, T., Muntean, W., & Heyland, D. (2024). Ethical issues raised in the care of the elderly during the SARS-CoV-2 pandemic: A systematic review. BMC Medical Ethics, 25, Article 23. [Google Scholar] [Crossref]
15. Bosch, L., Pasman, H. R. W., Onwuteaka-Philipsen, B. D., & Schweitzer, B. P. M. (2023). Moral distress among ICU staff during the COVID-19 pandemic: A mixed-methods study. BMC Medical Ethics, 24, Article 8. [Google Scholar] [Crossref]
16. Buch, A., Thomsen, T. G., & Søndergaard, J. (2024). Organizational support and moral distress among healthcare professionals in high-pressure environments. BMC Health Services Research, 24, 311. [Google Scholar] [Crossref]
17. Buch, M. S., Vevatne, J., Brinchmann, B. S., & Sørlie, V. (2024). Moral distress and protective work environment for healthcare workers during public health emergencies. BMC Medical Ethics, 25, Article 27. [Google Scholar] [Crossref]
18. Buch, V. H., Lwin, Z., & Fergie, G. (2024). Ethical challenges in healthcare: A review of the impact of systemic pressures on clinical decision-making. Journal of Medical Ethics, 50(1), 45–52. [Google Scholar] [Crossref]
19. Cacace, M., & Nováková, D. (2024). Ethical challenges in clinical care during the pandemic: A Czech perspective on guideline ambiguity. BMC Medical Ethics, 25, Article 17. [Google Scholar] [Crossref]
20. De Guzman, A. B., Cruz, J. P., & Rosario, R. M. (2023). Ethical challenges among Filipino healthcare workers in resource-limited settings. Philippine Journal of Health Research and Development, 27(1), 45–56. [Google Scholar] [Crossref]
21. De Guzman, A. B., Roxas, A. B., & Morales, M. (2023). Ethical challenges and coping strategies among Filipino healthcare workers in resource-limited settings. Philippine Journal of Health Research and Development, 27(1), 45–54. [Google Scholar] [Crossref]
22. Deschenes, S., McCarthy, J., & Dallaire, C. (2024). Reducing moral distress through ethics education and structured communication interventions. Nursing Ethics, 31(2), 289–303. [Google Scholar] [Crossref]
23. Deschenes, S., Reynolds, E., & Kumar, S. (2024). Navigating moral distress: An interdisciplinary approach to ethical dilemmas in healthcare. Health Care Analysis, 32(1), 75–91. [Google Scholar] [Crossref]
24. Deschenes, S., Twomey, C., & Davies, D. (2024). Developing an evidence- and ethics-informed intervention to address moral distress in paediatric critical care: A relational ethics perspective. Nursing Ethics, 31(1), 180–194. [Google Scholar] [Crossref]
25. DiCicco-Bloom, B., & Crabtree, B. F. (2006). The qualitative research interview. Medical Education, 40(4), 314–321. [Google Scholar] [Crossref]
26. Felix-Medina, J. V., Sepúlveda-Haro, A. G., & Quintero-Soto, M. F. (2023). Stability of antioxidant and hypoglycemic activities of peptide fractions of maize (Zea mays L.) under different processes. Journal of Food Measurement and Characterization, 17, 362–370. [Google Scholar] [Crossref]
27. Fusch, P. I., & Ness, L. R. (2015). Are we there yet? Data saturation in qualitative research. The Qualitative Report, 20(9), 1408–1416. [Google Scholar] [Crossref]
28. García-Martín, M., López-García, C., & Romero-Sánchez, J. M. (2023). Moral distress among perioperative nurses: Organizational constraints and professional integrity. Journal of Advanced Nursing, 79(6), 2150–2162. [Google Scholar] [Crossref]
29. Ghorbanzadeh, B., Khoshmehr, N., & Sadeghian, E. (2024). The relationship between moral distress and clinical care quality among nurses in Gonabad, Iran: A cross-sectional study. BMC Nursing, 23, Article 72. [Google Scholar] [Crossref]
30. Giannetta, N., Villa, G., & Pennestrì, F. (2021). Ethical dilemmas and moral distress in primary care: Implications for healthcare staff well-being. International Journal of Environmental Research and Public Health, 18(14), 7523. [Google Scholar] [Crossref]
31. Graham, J., Wessel, J., & Ghahramani, A. (2023). Addressing moral injury in healthcare workers during COVID-19: Peer support and institutional strategies. Sociology of Health & Illness, 45(4), 789–804. [Google Scholar] [Crossref]
32. Guro, A., et al. (2024). Exploring moral quandaries: An interpretative phenomenological inquiry into the ethical dilemmas faced by Emergency Medical Technicians in the Southern Philippines. Journal of Healthcare Administration, 12(2), 77–91. [Google Scholar] [Crossref]
33. Hosseini, S. H., Karimi, R., & Mohammadi, E. (2024). Moral distress and quality of patient care among nurses: A cross-sectional study. BMC Nursing, 23, 118. [Google Scholar] [Crossref]
34. Hwu, H., & Pai, H. (2025). Exploring ethical dilemmas and coping strategies in nursing: A focus group study of nurses and nursing students. Nursing & Health Sciences, 27(1), 100–112. [Google Scholar] [Crossref]
35. Johansson, L., Nilsson, A., & Berglund, M. (2024). Ethical dilemmas in caring for vulnerable populations in long-term care settings. International Journal of Older People Nursing, 19(1), e12521. [Google Scholar] [Crossref]
36. Karlsson, M., Lindberg, E., & Sandman, L. (2024). Workload, staffing shortages, and moral distress in long-term care facilities. Nursing Ethics, 31(1), 82–95. [Google Scholar] [Crossref]
37. Knott, R., Mellahn, O. J., Tiego, J., Kallady, K., & Johnson, B. P. (2023). Age at diagnosis and diagnostic delay across attention-deficit hyperactivity and autism spectrums. Australian & New Zealand Journal of Psychiatry, 58(2), 142–151. [Google Scholar] [Crossref]
38. Kovanci, B., & Özbaş, A. (2025). Newly graduated nurses’ experiences of moral distress during transition process. BMC Nursing, 24(1), 12–25. [Google Scholar] [Crossref]
39. Lewis, P., Willis, E., & Smallwood, N. (2023). Emotional and professional impacts of ethical dilemmas on nurses during the COVID-19 pandemic. Nursing Ethics, 30(2), 210–225. [Google Scholar] [Crossref]
40. Liu, Y., Chen, J., & Zhang, L. (2024). Moral resilience as a buffer between moral distress and compassion fatigue among nurses. Journal of Clinical Nursing, 33(4), 1567–1576. [Google Scholar] [Crossref]
41. Liu, Y., Chang, J., & Li, H. (2024). Interprofessional collaboration and moral resilience during health crises: Insights from COVID-19. Nursing Ethics, 31(2), 215–230. [Google Scholar] [Crossref]
42. Mokoena, S. P., Nkosi, Z., & Mabaso, M. (2025). Ethical challenges in end-of-life care in resource-constrained hospitals. African Journal of Nursing and Midwifery, 27(1), 1–12. [Google Scholar] [Crossref]
43. Morley, G., Grady, C., McCarthy, J., & Ulrich, C. M. (2021). Covid-19: Ethical challenges for nurses. BMJ, 371, m3762. [Google Scholar] [Crossref]
44. Morley, G., Sese, D., Rajendram, P., & Horsburgh, C. (2021). Addressing caregiver moral distress during healthcare crises. Journal of Clinical Ethics, 32(3), 214–222. [Google Scholar] [Crossref]
45. Putri, R. A., Sari, D. K., & Widodo, A. (2023). Ethical uncertainty and psychological burden among nurses in clinical decision-making. Belitung Nursing Journal, 9(5), 431–439. [Google Scholar] [Crossref]
46. Salvador, J. T., Reyes, M. E., & Torres, G. V. (2024). Moral distress among nurses in provincial hospitals in the Philippines. Philippine Journal of Nursing, 94(1), 22–34. [Google Scholar] [Crossref]
47. Salvador, M. L., Reyes, J. P., & Garcia, C. R. (2024). Moral distress among nurses in public hospitals in the Philippines: Causes and coping mechanisms. Asian Bioethics Review, 16(2), 152–165. [Google Scholar] [Crossref]
48. Selman, L., Chao, D., Sowden, R., Marshall, S., & Chamberlain, C. (2023). Moral distress and systemic constraints in healthcare delivery. BMJ Supportive & Palliative Care, 13(2), 120–127. [Google Scholar] [Crossref]
49. Smith, G., Hébert, P. C., & Downar, J. (2022). Ethical challenges in Canadian healthcare practice. Canadian Medical Association Journal, 194(15), E540–E545. [Google Scholar] [Crossref]
50. Tan, K. H., & Lim, V. (2023). Ethical decision-making in Singapore healthcare systems. Asian Bioethics Review, 15(3), 267–281. [Google Scholar] [Crossref]
51. Udekwe, D., Mukamana, D., & Habimana, J. (2024). Allocation of radiotherapy services in low-resource settings: Ethical implications. Global Health Ethics, 19(1), 77–86. [Google Scholar] [Crossref]
52. Wen, X., Li, Y., & Huang,F. (2024). Career calling and moral distress among emergency nurses. Journal of Nursing Management, 32(2), 455–463. [Google Scholar] [Crossref]
53. Zoghi, M., Rahimi, A., & Ebrahimi, H. (2023). Effects of ethics education on moral sensitivity among nurses. Nursing Ethics, 30(6), 1032–1044. [Google Scholar] [Crossref]
55. C. Others [Google Scholar] [Crossref]
57. AP News. (2023). Canadian healthcare workers grapple with ethical challenges around Medical Assistance in Dying. [Google Scholar] [Crossref]
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