George Bernard Shaw’s assertion that ‘the single biggest problem in communication is the illusion that it has taken place’ relates to, and resonates with, many of the papers in this issue of Clinical Ethics. Communication and communication skills are at the heart of the training of doctors, nurses and other health-care professionals, yet so often there seems to be an inconsistency between people’s understanding of the theory of communication and the reality of putting it into practice, particularly when dealing with difficult situations or challenging patients. The theme of communication in all its complexity runs through the papers, starting with the Case Study: a senior nurse on an elderly medicine unit seeks advice from a clinical ethics committee on whether or not to insert a percutaneous endoscopic gastrostomy (PEG) feeding tube to feed a patient who no longer has the mental capacity to make his own care decisions. The patient has been pulling out his nasogastric tube and appears to be communicating that he no longer wishes to be fed. The team caring for him is unanimous in feeling that a PEG would not be in their patient’s best interests, but they appear to be failing to communicate their reasons to the family who, in turn, feels that their concerns, and their relative’s needs, are neither being addressed nor properly understood. The issues at the heart of this scenario could be transported to many different health-care settings and apply to quite different treatment decisions. As the case study illustrates, effective communication is crucially important when decisions need to be made on behalf of someone whose own communication skills are severely compromised or, indeed, absent. In the case of parents who are invited to participate in non-therapeutic research that will involve blood being drawn from their newborn babies, one can immediately understand how important it will be to inform and engage with parents whose natural instinct will be to protect their baby from any avoidable harms. The exploration by Berrington et al. of parental experiences of being asked to participate in a neonatal research study involving venepuncture suggests that it is important to match communication styles and methods to the needs of different groups to ensure that they are in a position to decide what is best for them in terms of accepting or rejecting the request to participate in research. The paper highlights the need for clear information for parents of neonates on the purpose and necessity of blood tests for research. Appropriate and effective communication is at the heart of the paper by Wilson et al. which draws on a research study with people with Huntington’s disease, a disease which, in its later stages, can severely compromise an individual’s ability to make and communicate decisions. The paper describes the feasibility of a method for obtaining consent as an ongoing process using information sheets and consent forms specifically designed for people with potential cognitive and/or physical impairments. Sadly things can go badly wrong in a health-care setting and it is claimed that the problems are compounded, and the hurt to victims accentuated, if an error or a bad practice is followed by a lack of appropriate communication. The paper by Ottewill and Vaughan on being open with patients about medical error and Demian Whiting’s paper on serious professional misconduct and the need for an apology both address complex but highly practical issues regarding how, when and what information is communicated after something has gone wrong and how getting this bit right is crucial to a good outcome. Clinical Ethics prides itself on its commitment to highlighting the ‘ethics of the everyday’. The yawning divide between the theory and practice of communication was brought home to me during a recent stay in hospital, illustrated by this conversation on the eve of the amputation of my left leg: