Table 4

Rationalisation, total count: 40

CountSubthemesIllustrative quotes from participants
21Heroic identification
  • ‘This is my time. This is our time as physicians. We are the main soldiers here.’ -P15

  • ‘In the end I believe that it is a crisis like in a war; somebody has to be the leader, and the last thing you want to do as a leader is to punish one of your foot soldiers.’ -P12

  • ‘I was [seen as] a hero because I volunteered early on.’ -P1

5Internal moral struggle
  • ‘I called the ICU staff and I told him in usual circumstances I wouldn’t sign a DNR [order] for this patient. But in this situation, I would say it is not my decision. So, you guys decide if you think [DNR is justified), you write, you sign, you decide, I am not going to decide on this…When they came by and saw the patient, they decided to write a DNR [order] … I did not agree on that to be honest, but I didn’t say no.’ -P9

  • ‘I would [manage] some patients [differently than] others based on the severity of their illness so that’s definitely… that was a challenge, and there was a feeling of guilt to be quite honest.’ -P4

  • ‘It’s very hard for me to deny a patient care when they’re quite sick. Yes, they are not dying right now. They can reach another hospital, but it’s very hard to say no, I am sorry, go.’ -P10

14Medical-moral distinction
  • ‘In COVID COVID-19, it was pure, pure, pure medicine…without the extras, there wasn’t any other cofactor other than medical’-P2

  • ‘Practitioners did not put the ethical principles at the forefront so they were merely trying to provide the service, the minimal viable service I have to say, without actually adhering to what we used to do in like regular practice.’ -P6

  • ‘That was one of the things [that were compromised). Basically, consenting people about procedures as well as discussing the results with them in a fully informed fashion.’ P3

    ‘You don’t have time, you intubate and extubate. [Contacting family] is really the least important. The family didn’t make any decisions, we updated them.’- P7