Table 4 Barriers to taking action

Difficulty reaching out to specialists

“I think it’s difficult… rather impossible in the medical culture. It’s an institutional problem. It is strange, indeed, this relationship (between non-specialists and specialists). The specialists sometimes don’t think of themselves as teachers.” (G003)

Resistance from clinical departments

“Maybe because they (clinicians) are old, so they have a different way of thinking. And the problem is that many of them do not like ethics; so (they would say) ‘why should we bother with such thing?’ I think.” (G010)

Being feared or less worthy

“Well, I would (do something) if I could! But the problem is… I’m not sure, maybe this is just a coincidence, but I think I’m not a likeable figure here… maybe they are afraid of me, or just reluctant, I don’t know…” (G014)

Difficulty reaching out to specialists

Resistance from clinical departments

“We need to remind the students, that is most important! Ask them what they think about it. But If we want to intervene in the (clinical) departments, it would be very difficult, because as you know, they are like these ‘kings in small kingdoms’, right?” (G015)

Lack of authority

Limited number of staffs

Lack of institutional recognition

“I think I cannot do it alone. I was no longer head of the bioethics team, so I have to say that the case was rather neglected because I need a partner to work with, someone who is also interested in ethics. At this moment, we only have six people in this department (which is not an ethics department), each with a different specialisation… If there are not any separate body/unit and at least 1–2 people focused on ethics, then it becomes difficult” (G017)