Whether practiced by ethics committees or clinical ethicists, medical ethics enjoys a solid foundation in acute care hospitals. However, medical ethics fails to have a strong presence in the primary care setting. Recently, some ethicists have argued that the reason for this disparity between ethics in the acute and primary care setting is that primary care ethics is distinct from acute care ethics: the failure to translate ethics to the primary care setting stems from the incorrect belief that acute care ethics can be applied to the primary care setting. In this paper, I argue that primary care ethics and acute care ethics are species of the same ethical genus, and that the ethical differences are not ones of kind but of circumstance. I do this by appealing to the role obligations that underlie acute care and primary care clinicians’ medical ethical obligations and the shared institutions that ground those obligations.

无论是由伦理委员会还是临床伦理学家实践，医学伦理在急症护理医院都享有坚实的基础。然而，医疗道德未能在初级保健环境中发挥重要作用。最近，一些伦理学家认为，急性和初级保健环境中伦理学之间存在这种差异的原因是初级保健伦理学与急性护理伦理学不同：未能将伦理学转化为初级保健环境源于错误的信念，即急性护理伦理可以应用于初级保健环境。在本文中，我认为初级保健伦理和急症保健伦理是同一伦理属的物种，伦理差异不是种类的差异，而是环境的差异。