Decision-making in healthcare demands consideration of not only the clinical, operational or financial aspects of care but increasingly complex ethical issues. Meeting the physical and emotional needs of patients ethically, while acknowledging the distress and conflicting expectations and needs of staff, can be extremely difficult for all involved. It is vital that staff be provided with a 'safe space' to speak of the ethical challenges they are encountering if we are to take staff safety as seriously as we take patient safety. A Clinical Ethics Service (CES) established in accordance with the recently released National Health and Medical Research Council (NHMRC) consensus statement and the 'NHMRC Clinical Ethics Resource Manual' can provide such a space.

This paper explores the who, what and why questions embedded in ethical decision-making. The work of a CES will be outlined. Drawing of the Roger L Martin's concept of heroic leadership, stakeholder roles and moral orientations will also be explored. In addition, the often unspoken attitudes towards certain patients, 'likeable' and 'unlikable' for instance, which threaten to influence views of 'worthiness' of care will also be explored.