Ethics as process and practice.

The noun form of ethics suggests something substantive; this substance is located in both offices of institutionalized experts and a body of canonical solutions to recognizable troubles. The present article recommends thinking of ethics not as substance but as a process of lives and decisions affecting each other over time. No single decision stands alone and no single patient can be considered as a stand-alone entity. Examples include how people struggle with choices they should not have to make, how decisions at one time are affected by earlier decisions that are not considered within the purview of ethics, and how to deal with conflicts of legitimate interests. When institutional ethics becomes a prescribed activity, the goal of being ethical is easily forgotten.