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

Objectives: To describe how ethics is practised in a health care setting, and to ascertain whether there was interest in establishing clinical ethics support services. Design and setting: Observations and interviews undertaken between April and November 2012 in a large NSW urban hospital with newborn care, maternity and oncology departments and analysed by coding and categorising the data. Main outcome measures: Key themes in the participants' attitudes to professional ethics were identified. Results: Ethics is not typically an explicit feature of clinical deliberations, and clinicians tend to apply basic ethical principles when ethical problems are identified. They also discuss difficult decisions with colleagues, and try to resolve ethical differences by discussion. Participants judged the ethics of clinical practice to be “mostly right”, primarily because ethics is “part of the fabric” of everyday clinical work that aspires to “optimising care”. Nevertheless, most clinicians would welcome ethics support because ethics is integral to health care practice, is not always “done well”, and may be the source of conflict. Conclusions: 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 Australi