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A moral or an ethical issue?
  1. Mary Dawood
  1. Correspondence to Mary Dawood, Emergency Department, Imperial College NHS Trust, Praed St, Paddington, London W2 1NY, UK; Mary.dawood{at}imperial.nhs.uk

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Emergency care by its very nature is challenging where questions of ethics commonly arise. Issues such as crowding, access, urgency, sick patients and threat to life all combine to create uniquely fertile grounds for ethical dilemmas.1–4 Ethics in healthcare means doing the right thing for the patient, doing no harm, providing care and treatment that benefits the patient while at the same time respecting the patient's autonomy and right to self-determination. Our sense of right and wrong and the duty of care we owe our patients are central to this. Determining the right course of action in complex circumstances can be difficult and ethical decision making demands much more than a decision of what is right or wrong; it requires critical reflection. Beauchamp and Childress suggest that this reflection needs to guide what we ought to do in a specific situation by asking us to consider and reconsider ordinary actions, the rationales for those actions and the judgements we make.5

Such an ethical debate in clinical settings can be positive, instructive and can contribute to quality patient care, but moral issues that often arise simultaneously can muddy the waters. A person's moral code is usually constant, but the ethical codes governing practice may be dependent on the context and setting and be at odds with moral feelings. In the great diversity that is healthcare and the limitations of our working environment it is often moral rather than ethical issues that give rise to angst and disequilibrium. The difference between ethics and morals is subtle, …

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