Ethics of the ordinary: a meeting run by the Royal Society of Medicine with the Royal College of General Practitioners

Abstract

Ethics has long been recognised as an integral element of primary healthcare.1 Despite the ubiquity of ethical challenges and dilemmas in primary care, it remains a neglected domain in the world of bioethics. Accordingly, there have been calls to explore the ethical dimensions of primary healthcare.2,3 On 15 February 2011 the Royal Society of Medicine ran a conference in association with the Royal College of General Practitioners in order to fulfil this need. The conference aspired to create a lively discourse between interested practitioners such that they had the opportunity to share ideas, research and literature in the context of primary healthcare ethics. This aspiration was fully met and 70 people convened, including medical students, academics and seasoned practitioners who made use of the opportunity to share their thoughts and experiences, research ideas and projects. The focus was on ‘everyday ethics’ – the moral dimensions underpinning interactions and relationships between clinicians, patients and their families and the subtle but complex ethical dimensions of everyday life. The recent changes to GP training and requirements for revalidation, and changes in societal attitudes provide an urgent need for a solid foundation of a body of knowledge (both theoretical and empirical) and a community of scholars who are concerned with the ethics underpinning a vast majority of healthcare interactions. Two keynote speakers opened the event. Iona Heath, RCGP president, and Deborah Bowman, senior lecturer in medical ethics and law. Iona Heath's inspirational talk highlighted the experience of the particular and how the uniqueness of individuals, their encounters and their narratives cannot be forced into a procrustean framework of rules and generalities. She outlined her view of the challenges facing ethical practice in primary care and emphasised the key role of compassion. Deborah Bowman, drawing from her own qualitative research, highlighted the extraordinary in the ordinary and how bioethics has not captured the ethics of the ordinary. She emphasised the centrality of relationships and the roles of the GP as advocate, holistic practitioner and healer. We explored three themes in the workshops: research in primary care ethics, issues affecting training and issues in practice. There were also 15 poster presentations. These could be categorised into two broad themes: the clinician–patient (or teacher–student) relationship and ‘micro-ethics’,4 exploring personal and professional boundaries, the role of power, families, values and emotions in the relationship. The second theme was the exploration of the greater relevance and appropriateness of ethical paradigms other than the four principles, such as virtue ethics and feminist ethics for understanding and illuminating ethical problems, including rationing in healthcare.