It is suggested that creating trust in guidelines could be more important than more efforts to improve guideline format and accessibility. It may also be worth considering whether guidelines should be implemented using different processes in generalist and specialist care.

ObjectivesDoctors increasingly experience high levels of burnout and loss of engagement. To address this, there is a need to better understand doctors’ work situation. This study explores how doctors experience the interactions among professional fulfilment, organisational factors and quality of patient care.DesignAn exploratory qualitative study design with semistructured individual interviews was chosen. Interviews were transcribed verbatim and analysed by a transdisciplinary research group.SettingThe study focused on a surgical department of a mid-sized hospital in Norway.ParticipantsSeven doctors were interviewed. A purposeful sampling was used with gender and seniority as selection criteria. Three senior doctors (two female, one male) and four in training (three male, one female) were interviewed.ResultsWe found that in order to provide quality care to the patients, individual doctors described ‘stretching themselves’, that is, handling the tensions between quantity and quality, to overcome organisational shortcomings. Experiencing a workplace emphasis on production numbers and budget concerns led to feelings of estrangement among the doctors. Participants reported a shift from serving as trustworthy, autonomous professionals to becoming production workers, where professional identity was threatened. They felt less aligned with workplace values, in addition to experiencing limited management recognition for quality of patient care. Management initiatives to include doctors in development of organisational policies, processes and systems were sparse.ConclusionThe interviewed doctors described their struggle to balance the inherent tension among professional fulfilment, organisational factors and quality of patient care in their everyday work. They communicated how ‘stretching themselves’, to overcome organisational shortcomings, is no longer a feasible strategy without compromising both professional fulfilment and quality of patient care. Managers need to ensure that doctors are involved when developing organisational policies, processes and systems. This is likely to be beneficial for both professional fulfilment and quality of patient care.

The debate on responsibility for health takes place within political philosophy and in policy setting.

Drawing on more than eight years working to implement Responsible Research and Innovation (RRI) in the Human Brain Project, a large EU-funded research project that brings together neuroscience, computing, social sciences, and the humanities, and one of the largest investments in RRI in one project, this article offers insights on RRI and explores its possible future. We focus on the question of how RRI can have long-lasting impact and persist beyond the time horizon of funded projects. For this purpose, we suggest the concept of 'responsibility by design' which is intended to encapsulate the idea of embedding RRI in research and innovation in a way that makes it part of the fabric of the resulting outcomes, in our case, a distributed European Research Infrastructure.

Doctors experience a large range of ethical dilemmas, of which many have been given little attention by academic medical ethics. The less-discussed dilemmas are characterised by a low degree of consensus in the profession about how to handle them. There is a need for medical ethicists, medical education, postgraduate courses and clinical ethics support to address common dilemmas in clinical practice. Viewing dilemmas as role conflicts can be a fruitful approach to these discussions.

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It is well documented that the higher the socioeconomic status (SES) of patients, the better their health and life expectancy. SES also influences the use of health servicesdthe higher the patients' SES, the more time and specialised health services provided. This leads to the following question: should clinicians give priority to individual patients with low SES in order to enhance health equity? Some argue that equity is best preserved by physicians who remain loyal to 'ordinary medical fairness' in non-ideal circumstances when health disparities persist; ie, doctors should allocate care according to needs only and treat everyone with equal regard by being neutral with respect to patients' SES. This paper furthers a discussion of this view by questioning how equitable needs relate to SES. To clarify, it distinguishes between four versions of 'healthcare need' and approaches an acceptable conceptualisation of the notion supported by Norman Daniels' theory on health equity. It concludes that doctors should remain neutral to patients' SES in cases in which several patients require the same health care. However, equitable health care requires considerations of the impact of socioeconomic factors (SEF) on patients' capacity to benefit from the care. Remaining neutral towards patients' SES in this respect does not promote equal regard. It follows that priority setting on the basis of SEF is required in fair clinical distribution of care, eg, through allocating more time to patients with low SES. In order to advance equity accurately, the concept of ordinary medical fairness should be amplified according to this clarification.

Research in neuroscience traditionally relies on rather small groups that deal with different questions on all levels of neuronal organization. Recent funding initiatives-notably the European "Human Brain Project" (HBP)-aim to promote Big Neuroscience for integrating research and unifying knowledge. This approach is characterized by two aspects: first, by many interacting researchers from various disciplines that deal with heterogeneous data and are accountable to a large public funding source; and second, by a decisive role of information and communication technology (ICT) as an instrument not only to perform but also to structure and guide scientific activities, for example, through simulations in the case of the HBP. We argue that Big Neuroscience comes along with specific ethical challenges. By examining the justification of Big Neuroscience and the role and effects of ICT on social interaction of researchers and knowledge production, we provide suggestions to address these challenges.