Table 2

Frequencies and sample excerpts of coping and evasive strategies

Strategies (type and details)NExamples
Coping
Deepening the dilemma by presenting other scenarios and distinguishing between the scenario from similar cases 102“…but maybe the situation would have been impacted the father differently if he would have known that all these complications would occur… So it might be the case that if he would have known that this does not end in umbilical cord blood, it could have been different”
Humour, smiles and slang 96“We are not required to employ various ‘horseshit’ of psychology”
“[The problem is that] the physician [in the film] did not see it when he was a med student”
Reframing the dilemma by repeating its essence in other words 66Reflecting on designer baby: “Do you want it [the new baby] because you just want it or because you want it for a specific goal?”
“When a doctor has to sketch a family tree he must know whether the mother is also a carrier and the mother says ‘I don’t want you to know whether I am a carrier, leave me alone… check the girl, think by yourself how you draw your tress’—that is the dilemma. ”
Information seeking and/or admitting not knowing the right solution 58“How old is she did we say?”
“Can’t a doctor refuse to treat a specific patient?”
Exploring the nature of the sickness and/or additional considerations 34“If this is the first pregnancy and she tried to conceive a long time and this is a sole child, so this is a consideration!”
Familiarisation by sharing a similar personal experience or treating the case as if it is a personal dilemma 16“I know a woman with a history of schizophrenia in the family who adopted a girl [instead of having her own baby], so that she will not pass the genes to future generations”
Evasion
Denial or reduction of the dilemma 116“…But imagine you have two 4-year-old twins—one is sick and the other is healthy. To take a kidney from the healthy child in order to implant in the other one, it’s the same for me”
[reflecting on whether to invite the patient’s pregnant sister in order to inform her about the patient’s BCRA gene] “I still don’t understand what’s the problem with inviting the sister”.
Offering an alleged easy solution 84“All that it needed is just telling the patient’s sister there is an option to do genetic testing”
Ignoring the tutor's guiding questions or mentioning and discussing irrelevant information 39The tutor asks: “What would you do, would you contact the sister’s doctor”?
The student ignores the tutor’s question and asks: “Why didn’t the mother do a genetic test?”
Emphasising the extreme difficulty of the dilemma or explicit refusal to proceed analysing it 23“I work in a hospital; I am not opening now a clinic on the moon where I am the sole doctor… I work under guidelines; personally I don’t care about the social norms.”
The tutor asks: “Do you think you should take this conflict of interests into consideration? If you could offer something beyond umbilical cord blood. Or not?”
Student: “I would not deal with that”
Seeking contrasting or illogical scraps of information or raising critique 20“It is not written here whether this is the first pregnancy and does she have some other kids”
“We did not come here to study ethics, we came to study medicine, if there is a problem, we will look it up at the book and learn”
Fear of taking moral responsibility for the ramifications of counselling the patient 11“Why do I make decisions which I am not supposed to make, this is not my child, it is not my family, they have to decide. All the data is provided, it mustn’t be hidden.”