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Much of the orthodox literature on medical ethics and law emphasises hospital care. This is because many of the classic dilemmas chosen for analysis are drawn from acute medicine in a secondary care setting. Do patients have the right to refuse life saving treatment? In the face of scarcity in intensive care, who should be treated and for what reason? Should adolescent young women be allowed to have abortions without parental consent? In what circumstances should life sustaining treatment be withdrawn? The list goes on. One might infer from this focus on secondary care that primary care clinicians face fewer and less interesting dilemmas and, indeed, have an easier moral and legal time of it. In fact, there are good arguments to the contrary.12 It is these quandaries, and the personal demands that they make on general practitioners (GPs), that is the topic for this issue’s section on ethics and law.
A “SLICE OF TIME”
While the drama and stress of ethico-legal dilemmas in acute care should not be underestimated, they occur in what might be called a “slice of time”. To use the jargon of linguistics, they are synchronic. Within a hospital, doctors and patients are usually strangers who will rarely meet again outside the context of outpatient follow-up. Even then patients may not see the same doctors. This has important implications for the ethico-legal texture of associated interactions.
For example, patients who refuse life sustaining treatment—or any other treatments deemed to be in their best clinical interest—may be a source of regret for clinicians. However, the clinicians know that in respecting the patient’s …