Ethical Prioritization of Healthcare Access During Pandemics in Jordan: A Cross-Sectional Study of Physician Awareness, Confidence in Ethical Decision-Making and the Role of COVID-19–Specific Training

Faris M Tbayshat,1 Omar F Khabour,2 Karem H Alzoubi,3,4 Wael K Al-Delaimy51Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan; 2Department of Medical Laboratory Sciences, Jordan University of Science and Technology, Irbid, Jordan; 3Department of Pharmacy Practice and Pharmacotherapeutics, University of Sharjah, Sharjah, United Arab Emirates; 4Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan; 5Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, CA, USACorrespondence: Karem H Alzoubi, Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan, Tel +962-799908536, Email [email protected]: The COVID-19 pandemic posed unprecedented ethical challenges to healthcare professionals, particularly in resource-limited settings. This study aimed to assess physicians’ awareness of ethical dilemmas, confidence in ethical decision-making, and the impact of training during the COVID-19 pandemic in Jordan.Methods: A cross-sectional survey was conducted among 300 physicians who worked in Jordanian hospitals during the COVID-19 pandemic. Data were collected on experience, perceived workload, COVID-19–specific training, awareness of ethical dilemmas, and confidence in decision-making. Chi-square tests, one-way ANOVA (Welch’s), and multivariable ordinal logistic regression analysis were used for analysis.Results: Workload was significantly associated with confidence in ethical decision-making in bivariate analysis (Welch’s F (4, 63.0) = 3.26, p = 0.017), with heavier workload groups reporting higher confidence; however, workload was not independently associated with confidence in the adjusted ordinal logistic regression model. General practitioners and specialists reported higher awareness than physicians who are sub-specialists or work in non-clinical or other healthcare-related roles (χ2(6) = 13.9, p = 0.031). In addition, physicians who received COVID-19–specific training were significantly more aware of ethical dilemmas than those who did not (χ2(2) = 8.58, p = 0.014). Finally, physicians with more than 10 years of experience reported significantly greater confidence in ethical decision-making than those with 5– 10 years of experience (β = 1.71, p = 0.010).Conclusion: COVID-19–specific training was associated with higher ethical awareness, while clinical experience was associated with confidence in ethical decision-making. These findings underscore the need for structured COVID-19–specific training and support systems to prepare healthcare workers for future public health emergencies through targeted preparedness training and institutional support strategies in Jordan and similar low- and middle-income settings, including integration into crisis standards of care, aimed at promoting equitable, transparent, and ethically consistent patient prioritization during future public health emergencies.Keywords: COVID-19, ethics, patient prioritization, healthcare workers, pandemics, Jordan