On Ethical Decision-Making in Healthcare: The Tunisian Post-Revolution Context

This study examines ethical decision-making among physicians within the evolving Tunisian healthcare context, marked by rising healthcare expenditures, structural transitions, and the disruptive effects of the COVID-19 pandemic. Ethical challenges in medical practice are amplified by the complexity of patient–provider interactions, the urgency of clinical decisions, and the sociocultural environment in which practitioners operate. While international literature provides extensive insights into ethics in marketing and management, empirical research focusing on medical ethics, particularly in North African contexts, remains limited. To address this gap, a qualitative exploratory study was conducted with 11 physicians representing diverse specialties, sectors, and professional backgrounds. Semi-structured interviews were analyzed through thematic content analysis to identify the variables influencing ethical decision-making. The findings reveal that medical ethics is perceived as a set of intrinsic values guiding physicians in navigating dilemmas under time-sensitive and high-stakes conditions. Two overarching categories of determinants emerged. Individual variables include academic background, experience, religiosity, personal values, socioeconomic conditions, emotional states, moral power, and all dimensions of moral intensity. Situational variables encompass professional dynamics such as peer support and interpersonal relationships, organizational resources and culture, and external influences including patients, families, social norms, and the judicial and industrial environments. Several novel factors, particularly personal values, socioeconomic pressures, organizational resource constraints, and judicial influence, highlight the specificity of the Tunisian context. The study contributes a contextualized framework for understanding ethical decision-making among healthcare providers. It offers practical implications for communication strategies, organizational leadership, and ethical governance, while emphasizing the need for future quantitative investigations to validate and extend these findings.

Ethics, ethical decision-making

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