If we want to address the moral and ethical challenges of everyday health care, we will need to expand our vision beyond a narrowly constructed medical lens and adopt a wider and more lucid perspective, one that honors the mind but also encompasses the heart, the spirit, and the relational world in which we all live. In order to see the right things and not lose our focus, we will need to learn differently together than we have heretofore. The first step in unraveling many of our wicked “macro” problems will be to discern the “micro” ethics that will help to solve them—things like treating people respectfully, telling the truth, listening to oft-silenced voices, and valuing the knowledge of patients, family members, and health care workers who are lower on the totem pole of power.
“Microethical and Relational Insights from Pediatric Palliative Care”
Good practice in pediatric hospice and palliative care requires a grounded sense of connectedness with children and families who are going through some of the most difficult experiences life has to offer. When we practice well in this domain, we bring an everyday ethical sensibility to our relationships with patients, families, and our fellow professionals. Doing this work gives us knowledge and insights that are applicable to many of the more challenging problems in mainstream health care facing us in the twenty-first century.
The excerpt above is from a commentary I wrote for the July 2010 edition of Virtual Mentor, the ethics journal for the American Medical Association. If you would like to read the entire article, it is available online to download at
David M. Browning, MSW, BCD
Senior Scholar and Co-Director of Patient Safety and Quality Initiatives
Institute for Professionalism and Ethical Practice
Children's Hospital Boston & Harvard Medical School