Clinical ethics support services are an established feature of health care in the US and Canada and are becoming so in the UK, France, Belgium and elsewhere in Europe. They are yet to be widely established in NSW or elsewhere Australia. Clinical ethics support typically involves the provision of expert ethics input into clinical education, policy development and the care of individual patients, particularly where this involves value, rather than clinical, or scientific, conflict. Ethics support is generally provided by an individual consultant, an ethics committee or some combination of the two. In its case consultation function, expert support is intended to clarify the values that are in tension and through promoting open and inclusive discussion, facilitate consensus on the appropriate next steps. Internationally, the guidance and recommendations issued by a support service on a particular case are, in most cases, advisory and not binding. Advocates argue that clinical ethics support is necessary because contemporary clinical work takes place in a technologically, socially and ethically complex environment. The medical encounter has become far more open to scrutiny and is accountable to a more diverse public holding often quite different interests, ideas and values. In a more pluralist society, professional training, professional codes and institutional polices aren’t sufficient to establish ethical practices and procedures or resolve the ethical dilemmas that arise in the care of individual patients. The ethics expertise provided by an ethicist or a panel of ethically trained clinicians is necessary to astutely appraise the values and arguments and generate consensus. Without such expertise the ethicality of practices cannot be assured. Clinical ethics support is intended to promote ethically sound clinical and organisational practices and decision-making and thereby contribute to health organisation and system quality improvement. The under-developed state of clinical ethics support in Australia and NSW prompted NSW Health, in partnership with the Centre of Values Ethics and Law in Medicine and the Centre for Health Law and Governance , to ask: 1. Do changes to the environment in which clinical practice occurs mean there is a need to change the way we deal with ethical dilemmas? 2. Is more formalised support for clinicians, when making difficult and possibly controversial ethical decisions, desirable or warranted? 3. If it is agreed that clinical ethics support should be enhanced, what model is most appropriate for local conditions?funding provided by the Centre for Epidemiology and Evidence, NSW Ministry of Healt
