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Moral flux in primary care : the effect of complexity
  1. John Spicer1,
  2. Sanjiv Ahluwalia2,
  3. Rupal Shah2
  1. 1 Institute for Medical and Biomedical Education, St George's, University of London, London, UK
  2. 2 Health Education England, London, UK
  1. Correspondence to Dr John Spicer, Institute for Medical and Biomedical Education, St George's, University of London, SW17 0RE, UK; johnspicer{at}


In this article, we examine the inter-relationship between moral theory and the unpredictable and complex world of primary health care, where the values of patient and doctor, or groups of patients and doctors, may often clash. We introduce complexity science and its relevance to primary care; going on to explore how it can assist in understanding ethical decision making, as well as considering implications for clinical practice. Throughout the article, we showcase aspects and key concepts using examples and a case study developed from our day-to-day experience working as clinical practitioners in primary care.

  • primary care
  • applied and professional ethics
  • clinical ethics

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  • Contributors All authors contributed to the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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