This conclusion offers a summary of interrelated themes and ethical challenges that have emerged across chapters. Review of the content has identified five broad, emergent themes, the first of which explores ethical decision making utilising principles, models, professional codes and dialogue ethics in collaborative working across organisational boundaries and systems. A second theme, user–professional relationships and roles in the context of decision making, is focused on therapeutic relationships and virtuous practice, best interests, refusing treatment and end of life decisions, equity, resources and provider, professional and user relationships. A third theme, vulnerable people, summarises the challenges that can arise in charging vulnerable older adults for their care, vulnerability to loss of personhood, protecting the claims and entitlements of future people, child protection and protecting rights and welfare in research participation.
The theme of service users summarises the case for ethical involvement of users in health and social care and explores the benefits of services working together in relation to user involvement and outcomes. The exercise of choice, equity in access, balancing liberty and public safety and challenging ageism and discrimination are also explored from a user perspective. A final theme of governance and accountability links new forms of collaborative governance and their ethical justification, summarising current conflicts and challenges for governance frameworks in general and, more specifically, in relation to research. Our intention in writing this conclusion is to offer the reader both a summary and integrated synthesis of key themes and challenges; these themes are not intended to be comprehensive and there is much more in the chapter content that will repay exhaustive scrutiny by the reader.
Ethical decision making
Health and social care professionals can apply diverse theories (deontology, consequentialism, virtue ethics), rights, principles (autonomy, beneficence, non-maleficence, justice, fidelity, confidentiality), models and frameworks to inform decision making on ethical issues; legal precedents and professional codes of conduct are also relevant. All of the chapters in this text make reference to one or more of these approaches. In Chapter Two, Louise Terry reviews the application of ethical principles, for example autonomy, beneficence, non-maleficence and justice (Beauchamp and Childress, 2001), in a range of decision-making situations familiar to health professionals. However, in resolving ethical dilemmas, the point is made that sometimes principles can be in conflict and it is then necessary to determine which take priority.