Unequal access to clinical ethics support across Sweden’s healthcare regions
Clinical ethics support can help staff, patients and families navigate ethical dilemmas.
Healthcare professionals often face ethical dilemmas in their work. Patients and their families also face ethically complex decisions. Case-based clinical ethics support can help navigate morally complex decisions, if it is available. Something the Swedish system cannot guarantee.
Pernilla Pergert is senior lecturer of caring science with a special focus on clinical ethics and intercultural care
According to an article recently published in HEC Forum, whether or not case-based clinical ethics support is available often depends on geography and organisational culture – raising questions about the Swedish healthcare system’s ability to manage moral complexity and in the end, uphold equity of care.
There are currently no legal requirements or financial incentives for healthcare organisations in Sweden to establish or offer clinical ethics support. As a result, the system is fragmented across our 291 municipalities, 21 regions, and 77 hospitals. Ambition and implementation vary widely across the country, with significant differences between regions, providers, and organisations.
“Access to case-based clinical ethics support is not driven by contextual ethical challenges, but primarily by the presence of local champions for these issues. This is a problem because if patients, families, and some professionals do not receive the support they need to deal with ethically complex issues, the Swedish system fails to guarantee equity of care,” says Pernilla Pergert, senior lecturer in caring science and associate professor of paediatric care science with a special focus on clinical ethics and intercultural care at Uppsala University’s Centre for Research Ethics & Bioethics.
Pernilla Pergert and her co-authors describe how some clinicians have access to ethics support, while others don’t. According to their findings, patients and families were rarely reported to attend or request this support. This is significant, as they are directly affected by ethical decisions, and their perspectives are essential for truly patient-centred care. Without their involvement, case-based clinical ethics support risks missing key values and concerns.
While informal support networks for staff who take a special interest in these issues do exist, there are currently no efforts to standardise access, responsibilities or competencies. To sustain trust in healthcare organisations’ ability to handle moral complexity in a responsible way, the authors raise the question of whether offering this support should be mandatory. And about who is responsible for ensuring that ethical challenges are addressed systematically. They also found a demand for efficiency and relevance in these interventions to avoid disengagement among healthcare professionals. Their findings suggest that a standardised system, similar to that of Norway, might be a good route forward.
“In the end, what’s at stake is the ethical integrity, fairness, and inclusiveness of healthcare decision-making in Sweden. Case-based clinical ethics support has the potential to strengthen all of these. But only if it’s made accessible, well-integrated and inclusive,” Pernilla Pergert concludes.
By Anna Holm Bodin
Pergert, P., Svantesson, M., Bartholdson, C., Bremer, A., Brännström, M., Fischer Grönlund, C., Juth, N., & Björk, J. (2025). Case-Based Clinical Ethics Support - A Description and Normative Discussion of Methodological Issues from the Swedish Perspective. HEC Forum, DOI: 10.1007/s10730-025-09566-5. Online first publication.