Ethical issues are inherent in clinical encounters and only a small number of difficult ethical issues ever reach clinical ethics support services. Within the discipline of surgery, empirical research on ethical issues in daily care is sparse. Aiming to understand more about dealing with inherent ethical issues in vascular surgery, we explored elements of moral reasoning during vascular surgeons’ discussions of clinical management during case conferences.

Data comprised observations, field notes and audio recordings of seven case conferences as well as interviews with 21 vascular surgeons at three Swedish university hospitals. The data was analyzed with systematic text condensation.

The moral reasoning on the vascular case conferences implied the jointly anchoring of norms for a responsible balance between risk and benefit. The process implied the narrating of vascular suffering and general health, deliberating benefits by scrutinizing the clinical details, and assembling these in a reasonable proposal for further care of the patient. Additionally, the case conference signified amplifying perceptions and promoting transparency, promoting professional and moral learning, as well as supporting complex decision-making.

The process of moral reasoning on the case conferences highlights the dual authority between the team’s deliberations of surgical care and the authority from the surgeons’ clinical encounter with the patient. In the process of moral reasoning, clinical, ethical and existential issues are embodied, and this complexity demands conditions for deliberating the framing of patients’ care by providing clinical ethical support that is targeted and relevant to the ethical challenges faced by vascular surgeons.