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Every clinical contact presents an array of ethical challenges and dilemmas. All clinical practice is subject to country specific national regulation. While a handbook or ‘check list’ can never address all possible challenges, our workshop participants identified key principles that can be a compass to help us respond to new and unique situations when we don’t have a map to guide us.

Principles to guide us

  • Our practice as clinicians impacts lives. Ethical action is compassionate and accountable in equal measure.
  • Ethical challenges are not always obvious and finding solutions can be challenging. Partnerships can be strengthened when this work is undertaken together.
  • There is often more than one ethical solution to the same problem. Sometimes it is a question of choosing ‘the most ethical, albeit, imperfect, option, for now’.
  • Both challenges and solutions exist in a dynamic interplay – what works this time may not work next time – our solutions need to be responsive to unfolding circumstances.
  • Openness to new ideas can drive innovation at unexpected moments. Often creative solutions can be ethical solutions.

The Big Picture: Being Guided by the Sustainable Development Goals

We all want our clinical practice to enable positive impact for our clients and for society.

When working in a global, or complex context, the Sustainable Development Goals (SDGs) can provide us with some clear direction about how to achieve this – both in the way we approach our work as well as in the outcomes and transformation our clinical practice can enable.

More information about Sustainable Development Goals

A Pledge for Clinical Practitioners

Participants in our roundtable conversations included clinical practitioners and clinical researchers – they felt that the following commitments can help to guide us:

Do no harm* Recognise the gravity and ethical implications of doing harm. We are interconnected. Harm to people, animals, plants and the environment – even unintended – affects individuals, communities and planetary wellbeing.
Enable flourishing Enable necessary and urgently needed change.
Connect: People and planet first Invest in relationships – recognise they are the heart of ethical clinical practice – listen carefully, be trustworthy, transparent and accountable, and behave honourably, including in relation to the earth’s resources.
Be aware. Be brave. Be safe Identify and respond vigilantly to ethical challenges, being alert to safety considerations.
Invest in our own learning Be self-aware and actively strengthen interpersonal skills and reflective practice.
Prioritise context and compassion  Work in a contextually appropriate compassionate way.
Maintain Commitment Be reflective, accountable and persistent, particularly when faced with challenges.

* All clinical practice and clinical research is subject to country specific national regulation. Check with your clinical and research regulatory bodies. For instance, in the UK, there are national regulations for clinical practice including specialist regulations for working with children and young people in recognition of their greater vulnerability.

What ethical solutions do (and don’t) look like

Ethical solutions
  • are designed to encourage client wellbeing, social equity and thriving communities
  • can be found in many places
  • are built on shared humanitarian and communitarian values
  • take the whole clinical practice or research journey into account, including legacy issues
  • should be aligned with essential principles and relevant regulation
  • are enabled through collaboration, reflective practice and openness to innovation
  • are mindful of the impact of power differentials on clinical practice agendas, processes and reporting
  • are supported by institutional processes and ongoing support
  • may require that we (and our partners) are prepared to ‘take the long road’
Ethics in clinical practice and in global challenges research is not
  • adopting and following a standardised process or rigid procedure
  • a ‘one time’ action (e.g. completing a form or an approval process)
  • driven primarily by funding decisions or political agendas
  • conducted in isolation from the communities involved