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Doctors’ perspectives on the ethics of general practice


There is a gap between bioethical theories and everyday moral decision making in general practice. A recent paper in BMC Medical Ethics makes sense of how GPs frame problematic situations in moral terms, exploring common denominators behind every day moral decision-making. The paper is using grounded theory to develop a new theoretical approach to general practice ethics.

Linus Johnsson is a general practitioner with a PhD in bioethics
Linus Johnsson, GP & PhD in bioethics

The paper builds on interviews and observations of Swedish general practitioners and GP residents. In every day practice, problems rarely present themselves as given. For example, asking routine questions to a patient seeking care for one problem might reveal another, sometimes GP’s are asked to intervene in ways that they believe could harm the patients, and sometimes the GP’s lack the competence to safely handle a patients condition. Observations of daily work reveal that much of the dilemmas, or moral labour, takes place in the process of identifying the problem, and not in the process of finding a solution.

According to the authors, this moral labour occurs when the GP is assessing the problem, making three judgements within fractions of a second : Shall I see what is before me, or take a bird’s-eye view? Shall I intervene, or stay my hand? And do I need to speak up, or should I rather shut up? Depending on how the GP answers these questions, the problem will fall into one of eight frames: The patient is my first concern; I stand back and observe when there is time; I speak frankly and clearly; I refuse to do harm; I apply myself with discretion; I enjoy being good enough; I demand a better work environment; or I uphold the integrity of my profession. Each of these frames brings out specific aspects of the problem and follows its own moral logic.

“When the GP sets the moral problem, their professional moral experience appears to function as a lens that refracts a more general ethical demand—to take care of the patient, as one sees fit”, says Linus Johnsson is a general practitioner and associated researcher at Uppsala University’s centre for Research Ethics & Bioetihcs (CRB).

Want to read the paper in full? Johnsson, L., Höglund, A.T. & Nordgren, L. The voice of the profession: how the ethical demand is professionally refracted in the work of general practitionersBMC Med Ethics 24, 75 (2023).

By Josepine Fernow

Last modified: 2024-03-19