ABSTRACT
Background: The COVID-19 pandemic has sparked a widespread ethical dilemma of distributing scarce life-saving medical devices to critically ill patients and created a huge opportunity for virtual learning for medical students to exercise the principles of medical ethics. Methods: We arranged for medical students to interact with virtual patients with respiratory failure and asked them to apply ethical principles to justify their prioritization of who should receive life-saving facilities. We analyzed the reports and investigated the ethical principles chosen and the factors that may play important roles in making critical medical decisions. Results: A total of 67 medical students were recruited. Overall, 73% of them made decisions based on principles of justice. However, 66% of the participants applied multiple ethical principles to justify their clinical decisions. While facing conflicting choices regarding different ethical principles, 48% used the principle of justice to justify their final decisions. However, they had diverse interpretations of the principle of justice. Most students requested additional medical knowledge, laws, or guidelines from institutions to help them make decisions, and 43% of them were able to proposed a strategy to address this ethical dilemma. Conclusions: Justice is the first priority for medical students while allocating medical facilities to critically ill patients. Clear guidelines may help them make ethical decisions when facing this dilemma.