A comparison of *Canadian and Taiwanese physician ethical reasoning using clinical vignettes

Medical ethics and culture-sensitivity are now essential components in health care education. However, little is known on ethical reasoning. The research purposes are: to develop a set of clinical vignettes with common ethical dilemmas; to measure physicians' ethical decisions and to understand how they solve ethical dilemmas; to identify differences in ethical reasoning between Taiwanese and Canadian physicians; and to determine differences in ethical reasoning among expertise levels.;Results: This study recruited 17 Canadian and 32 Taiwanese participants. The results included: (1) there was a significant difference in ethical decisions between Taiwanese and Canadian physicians (the Canadians had higher scores than the Taiwanese), (2) there were no significant differences in "decision scores" among the three levels of expertise; and (3) the correctness of ethical decisions was content-specific; (4) The ERI Part I and II scores that reflected differences of ethical reasoning in knowledge structures/strategies were significantly different by level of expertise; (5) subjects who made ethical decision by guessing tended to give wrong responses; (6) there was no significant relationship between the level of expertise and the method used to solve the ethical dilemma; and (7) subjects tended to be unaware of their deficiencies in ethical reasoning. The differences between countries were identified in six areas, and which were contributed to the differences between cultures and reasoning abilities.;Conclusion: With further research and improved educational offerings, students' abilities in ethical reasoning will be enhanced in a manner that improves the humane and ethical behaviors.;Methodology: This is a qualitative and quantitative study design. A theoretical model of ethical reasoning was first created based on literature review, and later modified by research results. This study used a set of 15 clinical ethics vignettes (CEVs) and think-aloud interviews to explore how physicians of two countries with varying level of expertise solved ethical problems. Several variables were used to examine subjects' reasoning ability: decisions of ethical behaviors, confidence levels, problem-solving strategies, and quality of ethical reasoning (ERI Part I and Part II). Comparisons were made between countries (Canada and Taiwan) and across three expertise levels (expert, resident and student).