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.

BACKGROUND: 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.