Is there an acceptable and feasible model for providing clinical ethics support in the primary care setting?

Kate Robins-Browne1, Nancy Sturman2, Kelsey Hegarty3, Christopher Dowrick4, Victoria Palmer5

1 Department of General Practice, Melbourne Medical School, The University of Melbourne, 200 Berkeley St, Carlton, Vic, 3053,
2 University of Queensland Medical School; 288 Herston Road, Herston, Qld, 4006
3 Department of General Practice, University of Melbourne, 200 Berkeley St, Carlton, Vic, 3053
4 University of Liverpool, Institute of Psychology, Liverpool; United Kingdom; L69 3BX
5 Department of General Practice, University of Melbourne, 200 Berkeley St, Carlton, Vic, 3053

High quality healthcare provision is an intrinsically ethical activity, the ethical nature of which often goes unnoticed until a problem arises.  Clinical ethics support services (CESSs) can assist to address these ethical problems and dilemmas that arise in healthcare.  A CESS can take a variety of forms, including an individual ethicist (ethics consultant) integrated within a care setting or acting as an external consultant, or, an ethics team/committee also integrated or external to a health care organisation. Current CESSs are largely designed for the hospital setting and there is no existing CESS for primary care services.  Yet, primary care presents its own ethical complexities which are often quite different to those that occur within the hospital setting; the very factors that are seen as protective, such as the ongoing relationship between primary healthcare professionals and their patients, can become a source of ethical tension.  A hospital based CESS cannot be directly translated to the primary care setting, as a primary care CESS needs accommodate the smaller nature of general practices and be responsive to the kinds of dilemmas that emerge in the primary care setting.  To develop a CESS model for primary care we needed to know what ethical problems general practitioners (GPs) and primary care practice nurses (PNs) encounter, how they currently address these, and their perception of the acceptability and feasibility of CESS models.  In this paper we present findings from 6 focus groups conducted with GPs (3) and PNs (3).  The focus groups aimed to identify the ethical concerns of these professionals and their responses to five existing CESS models. We outline the challenges and opportunities for individuals and systems that participants identified for each model, and consider whether it would be possible to develop a CESS for primary care.


Kate Robins-Browne is a general practitioner with an interest in clinical ethics.  Her PhD explored decision making when the patient’s ability to participate is compromised.  This drew her attention to the difficulties clinicians face when they encounter ethical dilemmas and the lack of formal ethics support for healthcare providers.

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