INTRODUCTION
While considering a problematic case in a case-based discussion we found ourselves asking the question, should GPs and other frontline clinicians allow themselves to become involved in ethical judgements? Given the position that every decision has a moral aspect of some kind, is this even possible? We surmise that the conscious avoidance of ethical judgement may take place in the following ways:
Consciously avoiding judgements other than those which are clearly ‘medical’ and therefore ending any discussion which is not about medical treatment. This position itself ignores the value-laden nature of medical decisions.
Deferring to guidelines and the law even when this seems wrong.
Relying solely on specialist advisors (for example, from an indemnity body, or some kind of ethics consultant).
We were aware that publications in the clinical ethics literature suggested that conscience and compassion were problematic concepts in health care for clinicians.1,2 While these address compassion and conscience, they are possibly interpreted as clinicians ought not to make ethical judgements, or enact human values beyond those strictly stipulated by the job.
Personal conscience (at least with regard to conscientious objection) has been challenged on the basis that ethical deliberation should not take place in the clinical encounter and clinicians should offer whatever the governing …