How should our public hospitals respond to increasing ethical challenges?

Aim. To explore the considerations and influences on decision making of doc tors and managers when faced with ethical dilemmas. Method. Two hundred and eighty-four doctors and managers responded to a mai led survey. The questionnaire probed the types of considerations that were salient in the ethical dilemmas faced by doctors and by managers, the suppo rt these groups received for reflection on these difficult decisions, the s pecific influences on their decision making and their perception of future ethical issues in the health sector. Results. The study found that doctors and managers report encountering a si milar frequency of ethical dilemmas in their work but apply significantly d ifferent considerations and influences in their decision making. They repor ted similar levels of support from their colleagues but differing levels of support from their managers and the Crown Health Enterprise overall. Conclusions. This study highlights various areas of dissonance between diff erent stakeholders in the public health sector, in particular, between the manager representing the organisation's interest and the doctor representin g the patients' interests. Policy makers, purchasers and providers need to consider the infrastructure required to support doctors and managers in the ir work. Above all, with more ethically challenging decisions ahead, there needs to be clarity over the decision-making role of the government, the he alth manager and the doctor.