{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T21:00:25Z","timestamp":1793048425183,"version":"4.5.0"},"reference-count":33,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2023,9,4]],"date-time":"2023-09-04T00:00:00Z","timestamp":1693785600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Agency for Research and Development of the Republic of Moldova"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objective: Doctors should have full loyalty to their patients, while patients should be able to trust that physicians will act only in their best interests. However, doctors may be faced with situations where they must choose between the patient\u2019s interests and those of a third party. This article presents the results of a study that aimed to identify situations of duality in the decision-making process of medical workers, which can compromise their ethical behavior. Materials and Methods: A cross-sectional study was carried out on a sample of 1070 participants, employed in 120 healthcare facilities in the Republic of Moldova. An online questionnaire was completed anonymously. Descriptive statistics for discrete data were performed by estimating absolute and relative frequencies. To perform the multivariate analysis, the logistic regression was applied. Results: A large number (74.4%) of respondents admitted that they had faced situations of conflicts of interest. Every third respondent (35.3%) had experienced ethical dilemmas when access to expensive treatments should be ensured. Every fourth respondent experienced a conflict between the patient\u2019s interests and those of the institution (26.1%) or the insurance company (23.3%). As age increases, the probability of reporting the dilemma decreases. Physicians reported such dilemmas almost 3 times more often than nurses. A low rate of staff sought support when faced with dilemmas. Half of the respondents (50.6%) preferred to discuss the problem only with a colleague, and 40.1% preferred to find solutions without anyone\u2019s help. There were significant gaps within organizations in terms of the ethical dimension of the decision-making process. Conclusions: Managers should adopt clear institutional policies and tools to identify and prevent situations of dual loyalty. Ethical support should be offered to employees facing such situations. The need to promote an institutional climate based on trust and openness becomes evident.<\/jats:p>","DOI":"10.3390\/medicina59091598","type":"journal-article","created":{"date-parts":[[2023,9,5]],"date-time":"2023-09-05T09:46:20Z","timestamp":1693907180000},"page":"1598","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Potential Conflicts of Interest Arising from Dualism of Loyalty Imposed on Employees of Medical Institutions\u2014Findings and Tools for Ethics Management"],"prefix":"10.3390","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2875-0252","authenticated-orcid":false,"given":"Rodica","family":"Gramma","sequence":"first","affiliation":[{"name":"Doctoral School, State University of Medicine and Pharmacy Nicolae Testemi\u021banu, 2004 Chisinau, Moldova"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bianca","family":"Hanganu","sequence":"additional","affiliation":[{"name":"3rd Medical Sciences Department, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5483-8672","authenticated-orcid":false,"given":"Oleg","family":"Arnaut","sequence":"additional","affiliation":[{"name":"Doctoral School, State University of Medicine and Pharmacy Nicolae Testemi\u021banu, 2004 Chisinau, Moldova"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatrice Gabriela","family":"Ioan","sequence":"additional","affiliation":[{"name":"3rd Medical Sciences Department, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,9,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1111\/1468-0009.12052","article-title":"Conflicts of interest in medical practice and their costs to the nation\u2019s health and health care system","volume":"92","author":"DeAngelis","year":"2014","journal-title":"Milbank Q."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Allhoff, F. (2008). Physicians at War, Springer. International Library of Ethics, Law, and the New.","DOI":"10.1007\/978-1-4020-6912-3"},{"key":"ref_3","unstructured":"(2023, February 10). World Medical Association, Declaration of Geneva. Available online: https:\/\/www.wma.net\/policies-post\/wma-declaration-of-geneva\/."},{"key":"ref_4","unstructured":"(2023, February 10). World Medical Association, International Code of Medical Ethics. 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