LAUSR

When the first author (SS, years ago) taught ethics clinically in Harvard-affiliated hospitals, he encountered an oddity about how people stored “ethical” information. If he asked doctors, individually or in groups, whether there were any ethical problems that they were worried about, the answer was almost universally no. But if he asked doctors whether there were any cases or situations that were bothering them, the answer would be an immediate and resounding yes. For example:Mrs. Jones and her children were demandingmedication that she didn’t need and that would likely worsen her condition;Mr. Smith was resisting the care of nurses, developing bed sores, and then complaining that he was being ignored and not receiving adequate care; the chief resident was depressed and finding it difficult to keep up with his responsibilities; the nursing staff was finding it difficult to work with a newly recruited doctor; and one of the senior doctors, renowned for his creative problem solving, had become ungrounded, with the consequence that his interventions were unlikely to work and likely, instead, to present liability issues for the hospital. All of the above situations raise what are, in effect, ethical issues even though they are not generally identified (or, in practice, analyzed) as such. They’re just “problems.” Importantly, these problems are also not experienced and perceived as technical, medical, or scientific problems; they have human, interpersonal, or institutional components that are not open to technical, determinate solutions. These problems are embedded in the setting and, indeed, in the professionals who work in it. If one tried to separate out these problems