[Evoking ethics in care: a pentagram of modalities.]

The ways in which ethics is evoked in care and more generally in health policy decision-making are many and very different. Ideological ethics is based on the conviction that we know what is desirable and what is ethically reprehensible in health care. Legal-administrative ethics tends to seek legitimisation of behaviours. Exhortative ethics acts as a kind of moral suasion, while ethics of consultation tends to delegate decisions and choices on matters about which there is perplexity or uncertainty to committees of 'experts'. Finally, the author dwells on counselling ethics, which, with a three-dimensional view, calls for decisions to be made not about the sick person, but with the sick person, taking into account his or her values and conception of the quality of life, as well as the community's ability to use resources fairly and to respond to the needs not only of the wealthy, but of all those in need of care. Its starting point is listening, rather than rigid application of principles. Rather than importing ethics into clinical practice from outside, it encourages its explication by those involved, particularly clinicians.