Abstract

The feature article by Delany, Feldman, Kameniar and Gillam on the deliberative structure of a local Australian clinical ethics consultation programme is important for several reasons. It underscores Walker’s ‘moral spaces’ within healthcare settings and it increases conceptual freedom in dialogue through the bottom-up approach described.1 We concur with their commitment to the advancement of this form of clinical ethics deliberation and agree with many of the notions in the article. Due to limited space, we confine our commentary to the topics of (1) the goal of consultations and (2) the didactic aspect of consultations. We unequivocally second the authors’ critical stance towards principled resolutions and salute their wish to enhance clinicians’ moral understandings. However, our angle is somewhat different. The conceptual freedom of which they speak is, in our view, limited by the premise that clinical ethics issues must be ‘solved’ by a consensus decision. In our experience with cases, it may be more appropriate to seek mutual rather than shared understanding due to the inherent need to balance conflicting values. This approach opens for a dialogue that is not restrained by the imperative of reaching moral consensus. It may better serve to enhance the moral agency of clinical staff and it leaves the decision with …