Using an ethical lens in frontline alcohol and other drug services: Enhancing access to care

There are significant clinician, policy and systemic barriers to accessing Alcohol and Other Drug (AOD) services. Although frontline clinicians have very limited impact on the systemic barriers, there is a zone of clinical discretion within policy interpretation and implementation. Work within this zone can enhance access to services. Although not consistently recognised as such, this is ethical work; and facilitating access to services within the boundaries of these restrictions is a major ethical role of AOD clinicians. In this paper, we argue that using an ethical lens can enhance frontline clinicians' ability to critically engage with existing policy and to improve access to services. We describe practical means of enhancing ethical literacy which are feasible within busy frontline services: extending the language used within everyday clinical work; ethical mindfulness; and an ethical decision-making framework. Using four case studies drawn from clinical practice, we illustrate how enhanced ethical literacy can assist clinicians to recognise ethical challenges, and to engage in ethical work which can enhance the access of an extremely vulnerable community to AOD services.