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Previous Spheres of Moral Agency As you recall from Chapter 3, agency means that you have an authoritative voice in a matter and society affirms that you are in a position to legitimately exercise that authority. Because of the moral dimensions of a professional’s role, this agency is interpreted as moral agency. So that you do not think you are compelled to respond to every civic issue that comes your way, a helpful schema was developed by Gruen, Pearson, and Brenan to delineate spheres of moral agency, distinguishing different kinds of circumstances in which health professionals could become involved. Although their model was designed for physicians’ and physician organizations’ advocacy role in public life, we find it equally helpful for all health professionals (Figure 16-1).1

FIGURE 16-1 Health professional responsibility and good citizenship. (Modified from Gruen RL, Pearson SD, Brennan TA: Physician-citizens:

public roles and professional obligations. JAMA

29[1]:94–98, 2004.)

Sphere One pertains to direct patient care decisions that fall within your area of professional expertise. Understandably, this remains the major focus of your

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