Discretionary Compromises: How Clinicians Navigate Competing Values in Cardiovascular Patient Prioritisation

Formal criteria and evidence-based guidelines commonly frame healthcare prioritisation, yet everyday prioritisation often occurs in organisational 'grey zones' where competing values coexist. Drawing on interviews with clinicians in two Norwegian cardiology wards, we examine how prioritisation is justified and enacted under institutional pluralism and moral ambiguity. Using Boltanski and Thévenot's framework of 'orders of worth', we show how clinicians develop discretionary compromises: situated adjustments that combine competing evaluative principles into hybrid justifications, making contested decisions actionable and morally defensible. Instead of switching between institutional logics, clinicians blend professionalism, managerialism, and economic rationality into 'good enough' moral narratives that uphold discretion and authority under constraint. These compromises rely on ethical decoupling, whereby conflicting moral concerns are acknowledged but temporarily set aside to enable action. By explaining how legitimacy is created through context-dependent justification, the article contributes to debates on valuation, professional change, and moral agency, while highlighting the often invisible moral labour of healthcare prioritisation.