Reflective narrative writing on unfolding ethics case vignettes has the potential to promote values like empathy among medical students, which will prove useful in their future. The objective of this study was to explore the scope of guided reflective narratives on unfolding ethics case vignettes integrated into physiology teaching to promote empathy among first-year medical students. First-year medical students ( = 150) were presented with unfolding case vignettes exploring ethical issues, as part of their physiology curriculum, with questions and prompts for a guided reflective narrative. Feedback about the program was obtained through a semistructured questionnaire. The contents of the students' reflective narratives and feedback were analyzed. The narratives revealed that students empathized with the various individuals involved in medical treatment and research, which was also reflected in student feedback ( = 116; 79%) and high Likert scale scores (74%). The program was considered effective by students in broadening their perspective and promoting critical thinking ( = 129; 88%). Through analysis of reflections, a rubric that would enable the evaluation of students' empathy on a scale of increasing ability to look at a situation from another's point of view emerged. This rubric could be used to quantitatively assess the impact of similar programs. Although divided in their individual opinions, the study population was able to relate to all individuals involved in medical practice and research, recognizing the need for fair and ethical practices. The content analysis led to the development of a rubric to grade empathy. Unfolding case vignettes exploring ethical issues were introduced into the physiology curriculum of first-year medical students. The effectiveness of guided reflections following the case vignettes was explored. The analysis of the reflections and feedback on the program revealed that students became more empathetic. The reflections broadened their perspective and encouraged critical thinking. The analysis led to development of a rubric to grade the level of empathy, which can be used for quantitative assessment of empathy.