Abstract
The norms and practices of clinical ethics took form relative to the environment and relationships of hospital care. These practices do not easily translate into the outpatient context because the environment and relational dynamics differ. Yet, as outpatient care becomes the center of health care delivery, the experiences of ethical tension for outpatient clinicians warrant greater responses. Although a substantial body of literature on the nature of the doctor–physician relationship has been developed and could provide theoretical groundwork for an outpatient ethics, this literature is not sufficient to support outpatient caregivers in practical dilemmas. For physicians who are employed by or affiliated with a larger organization, a stronger alliance between clinical ethics and organizational ethics, identity, and mission will promote expansion of ethics resources in outpatient settings and address structural constraints in outpatient clinical care.
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Notes
The degree to which bioethics constitutes a discipline of “moral expertise” and the grounding for its “moral expertise” are, of course, debated.
This is somewhat odd, given that the original leaders in bioethics were theologians. In spite of this irony, I still find Engelhardt’s claim to be true. The secularization of the West did lead to the need for a kind of public morality. The need for a public and shared morality that took the secularization of the West as a given was a primary factor in shaping the kinds of bioethical arguments that theologians made. Although they arose out of their traditions, the early theologians commenting on medical ethics and bioethics made arguments that were largely accessible and applicable to a wider community. Their arguments were content-full, but the particularities of their arguments were made less explicit through a rhetoric of non-theological argumentation.
One major exception to this claim may appear to be dialysis. Dialysis was an “out-patient” procedure that did instigate the formation of a quasi-ethics committee; however, insofar as dialysis was considered by the quasi-ethics committee, it was a matter of abstract policy about the criterion by which dialysis was to be rationed.
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Barina, R. Ethics Outside of Inpatient Care: The Need for Alliances Between Clinical and Organizational Ethics. HEC Forum 26, 309–323 (2014). https://doi.org/10.1007/s10730-014-9238-4
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DOI: https://doi.org/10.1007/s10730-014-9238-4