Nurses’ Ethical Decision-Making During the COVID-19 Pandemic in a Muslim Community: A Qualitative Study

Background: Ethical decision-making was a major challenge for healthcare professionals during the COVID-19 pandemic, particularly in contexts where religion and law strongly influence clinical practice. Both deontological and consequentialist ethical frameworks guide medical decisions; however, balancing these approaches is especially difficult during crises. Objective: This study aimed to explore the ethical decision-making experiences of intensive care nurses during the COVID-19 pandemic within a Muslim community in Iran. Materials and Methods: A qualitative content analysis was conducted based on in-depth, semi-structured interviews with 14 intensive care nurses. Results: Three main themes emerged: (a) Humanitarian commitment involving actions beyond formal duties; (b) Nursing practice influenced by legal and organizational frameworks; and (c) Application of a consequentialist perspective in decision-making. Nurses described acting ethically under legal constraints, sometimes prioritizing patients' welfare when physicians were unavailable, and balancing religious, ethical, and legal considerations in their practice. Conclusion: Nurses' ethical decision-making was shaped by both professional and contextual factors, including law, religion, and cultural values. Their actions reflected a balance between deontological and consequentialist ethics rather than strict adherence to rigid legal or institutional rules. The findings highlight the need for context-sensitive ethical guidelines and support systems for nurses working under crisis conditions.