Moral Infrastructure in Medicine: Conditions for Honest Work

What happens when clinicians know what good care requires, but the conditions of work make it difficult to realize? Through scenes from primary care, we describe moral infrastructure: the conditions that allow clinicians to notice what matters and respond to it in ordinary work. Compressed time, fragmented attention, and weakened continuity do not erase professional responsibility, but they can make it harder for clinicians to respond with integrity. Moral infrastructure does not label an organization moral or immoral, nor does it guarantee good outcomes. Rather, it complements organizational ethics by asking whether the conditions of work support or erode clinicians' capacity for moral attention, judgment, and response. Protecting those conditions matters for patients, clinicians, professional formation, and medicine's ability to remember what humane care requires.