ABSTRACT
Comparing macro- and micro-ethics, it seems to me that there is a parallel with the differences between how specialists and primary care generalists approach their clinical decision-making. Specialists like to deal in certainties; specialist practice is the rigorous pursuit of a definitive diagnosis, on the basis of which a clear-cut, evidence-based management decision can be made. Conventional ethical wisdom distinguishes 'principlism' – the pursuit of moral clarity based on axiomatic a priori moral principles – from 'consequentialism', which assesses the moral rectitude of an action according to the overall good or harm it leads to. The freedom to be ethically self-sufficient at the micro level lays upon doctors a responsibility to ensure that their personal values are reliably compatible with patients' well-being. Micro-ethical issues cannot be explored or resolved in real time. They are only open to examination before or after they have been expressed in real-life consultations with distinctly non-hypothetical patients.
