Twenty: Conclusion

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This concluding chapter offers a summary of interrelated themes and ethical challenges that have emerged across the previous chapters. A review of the content identifies five broad, emergent themes, the first of which explores ethical decision making utilising principles, models, professional codes, and dialogue ethics in collaborative working across organisational boundaries and systems. A second theme, user–professional relationships and roles in the context of decision making, is focused on therapeutic relationships and virtuous practice; best interests; refusing treatment, and end-of-life decisions; equity; resources; and provider, professional, and user relationships. A third theme, vulnerable people, summarises the challenges that can arise in charging vulnerable older adults for their care, vulnerability to loss of personhood, protecting the claims and entitlements of future people, child protection, and protecting rights and welfare in research participation. The theme of service users summarises the case for ethical involvement of users in health and social care, and explores the benefits of services working together in relation to user involvement and outcomes. A final theme of governance and accountability links new forms of collaborative governance and their ethical justification, summarising current conflicts and challenges for governance frameworks in general, and, more specifically, in relation to research.

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