ABSTRACT
This chapter discusses the ethical aspects of clinical decision-making, using the consultation and clinical guidelines as a springboard to dive into the whirlpool of complexity theory. While top-down ethics might frame expected behaviour, it is argued that an ethics of complexity, linked closely to moral sensitivity, arises locally in a continual process as an emergent and relational property of a complex system, such as a doctor-patient-guideline interaction. Complex behavior arises from the interrelationship, interaction and interconnectivity of elements within a system, and between a system and its environment. In human systems, coevolution emphasizes the relationships between the coevolving entities. The importance of communication in the clinical encounter is obvious and it also highlights the different belief systems sometimes held by doctor and patient. This case illustrates complexity of ethical decision-making in an apparently straightforward case. Guidelines may be seen as instructions for action and apply equally to social interaction as medical intervention.
