Administrative-legal assurance of the reliability and ethics of medical decisions in wartime.

OBJECTIVE: Aim: This study aims to provide a comprehensive analysis of the administrative-legal assurance of the reliability and ethics of medical decision-making in wartime conditions, combining normative analysis with empirical data from a frontline Ukrainian hospital. PATIENTS AND METHODS: Materials and Methods: The normative framework includes international standards of the World Health Organization, the International Committee of the Red Cross, professional medical associations, the European Charter of Patients' Rights (2002), European Union legislation, and the national healthcare and wartime legislation of Ukraine. The empirical component comprised a cross-sectional anonymous survey conducted between May and September 2025 among 40 healthcare workers at a rural hospital located near the active frontline in the Dnipropetrovsk region. The questionnaire assessed decision-making complexity, perceived probability of errors, stress impact, resource availability, preparedness, and willingness to report incidents. RESULTS: Results: Wartime conditions significantly increase the perceived complexity of clinical decision-making, particularly in resource allocation, evacuation prioritization, and surgical interventions. Respondents reported elevated stress levels and increased risk of errors, primarily associated with limited resources, disrupted logistics, and administrative constraints. The reliability and ethical integrity of medical decisions were found to depend on the availability of updated clinical protocols, state monitoring mechanisms, organized evacuation systems, and guaranteed minimum healthcare services. CONCLUSION: Conclusions: Effective administrative-legal support is a prerequisite for ensuring both the reliability and ethical soundness of medical decisions in wartime. Strengthening institutional safeguards, resource allocation mechanisms, and clear regulatory guidance is essential to maintain medical standards under extreme conditions.