Medical ethics under economic pressure: physicians’ lived experiences in hospital settings

Abstract Background Medicine is traditionally guided by ethical commitments such as the Hippocratic Oath. However, modern hospital systems increasingly operate under economic constraints, which may challenge physicians’ adherence to ethical principles. This study explores physicians’ lived experiences of the conflict between ethical obligations and economic pressures, and its consequences on clinical decision-making, professional identity, and psychological well-being. Methods A qualitative study using an interpretive phenomenological approach was conducted with 12 physicians (general practitioners and specialists) working in public and private hospitals. Semi-structured, in-depth interviews were performed, audio-recorded with informed consent, and transcribed verbatim. Data were analyzed using van Manen’s phenomenological thematic analysis method, identifying meaningful units, subthemes, and overarching themes. Trustworthiness was ensured through credibility, dependability, and confirmability criteria. Results Analysis revealed four main themes: (1) conflict between ethical obligations and economic constraints, (2) psychological and emotional burden, (3) coping and adaptation strategies, and (4) impact on professional identity and the physician–patient relationship. Physicians reported dual-role dilemmas, moral distress, and challenges in balancing patient care with institutional financial pressures. Coping strategies included moral justification, clinical creativity, silent resistance, and acceptance of economic realities. These tensions influenced physicians’ ethical decision-making, emotional health, and perceptions of professional identity. Conclusions Economic pressures in hospital settings significantly affect physicians’ ability to practice ethically and maintain professional ideals. Addressing this conflict requires institutional and policy-level interventions that reduce financial pressures, support ethical decision-making, and promote a balance between economic efficiency and professional medical values. These findings highlight the importance of structural support for ethical medical practice and the broader implications for healthcare quality, patient trust, and physician well-being.