Part of the fabric and mostly right: an ethnography of ethics in clinical practice

Abstract

Ethics is very much a part of the fabric of clinical practice, and the ethical challenges that arise in patient care in this particular setting are generally managed adequately. However, many clinicians have concerns about the ethical aspects of some practices and decisions, and believe that access to expert ethics support would be useful. Helping clinicians to provide ethically sound patient care should be a priority for health care providers across Australia.

The value of clinical ethics support in Australian health care

“…If they were competent clinicians, should they not be able to do this kind of reasoning as part of their everyday work? This exemplifies the “settled morality” discussed by Doran and colleagues 2 in which ethics becomes “part of the fabric” of clinical work, leading to its invisibility. This works when there is no silent moral disquiet, but, as Doran et al claimed, we should be wary of “overlooking rather than tackling difficult but important ethical issues”.…”

“…This does not mean that Australian clinicians are unethical, or that they are ignorant about ethics. In this issue of the Journal, Doran and colleagues explore ethical practices and decisions, 2 and suggest that ethical practice in Australian health care is “mostly right”. However, their research also detected a phenomenon that can be termed silent “moral disquiet”.…”

Evaluation of a paediatric clinical ethics service

“…There are increasing calls to evaluate CES, credential the people that work within them and develop standards for practice . Several centres have published papers describing CES, and one explored clinicians' experience of ethics in practice, but there is a lack of reports on the evaluation of existing services using normative standards. The aim of this paper is to evaluate a newly established paediatric CES, incorporating both normative and empirical analysis.…”