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Hastings Center Report

The Microethics of Communication in Health Care: A New Framework for the Fast Thinking of Everyday Clinical Encounters

Abstract: In almost every clinical interaction, clinicians must navigate interpersonal challenges with near-instantaneous responses to patients. Yet medical ethics has largely overlooked these small, interpersonal exchanges, instead focusing on “big” ethical problems, such as euthanasia, brain death, or genetic modification. In 1995, Paul Komesaroff proposed the concept of microethics as a nonprinciplist approach to ethics that focuses on “what happens in every interaction between every doctor and every patient.” We aim to develop a microethics framework to guide everyday clinical encounters, with a special focus on communication with patients and family members. We will advance three core insights: First, communication is an ethical act in ways seldom considered. Second, microethics is an essential lens through which to view the ethics of communication. Third, virtue can bridge reflective and automatic processes. Our intuitionist framework for microethics is thus based on this understanding of the role of virtue, and we propose six virtues that contribute to the goal of healing communication. 

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