doi:10.1111/imj.14990 ETHICS IN MEDICINE Understanding the ethical implications of the rituals of medicine Mark H. Arnold , 1 Paul Komesaroff 2 and Ian Kerridge 3 1 Sydney Medical Program, Faculty of Medicine and Health, University of Sydney Camperdown, 3 Sydney Health Ethics, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, and 2 Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia Key words rituals, ethics, clinical practice, patient-doctor relationship, context effects. Correspondence Mark H. Arnold, Sydney Medical Program, Faculty of Medicine and Health, University of Sydney, PO Box 1043, Dubbo, NSW, Australia. Email: mark.arnold@sydney.edu.au Received 5 May 2020; accepted 3 July 2020. Abstract Rituals may be understood broadly as stereotyped behaviours carrying symbolic mean- ings, which play a crucial role in defining relationships, legitimating authority, giving meaning to certain life events and stabilising social structures. Despite intense interest in the subject, and an extensive literature, relatively little attention has been given to the nature, role and function of ritual in contemporary medicine. Medicine is replete with ritualistic behaviours and imperatives, which play a crucial role in all aspects of clinical practice. Rituals play multiple, complex functions in clinical interactions and have an important role in shaping interactions, experiences and outcomes. Longstanding medical rituals have been disrupted in the wake of coronavirus disease 2019 (COVID-19). Medical rituals may be evident or invisible, often overlap with or operate alongside instrumentalised practices, and play crucial roles in establishing, maintaining and guaranteeing the efficacy of clinical practices. Rituals can also inhibit progress and change, by enforcing arbitrary authority. Physicians should consider when they are undertaking a ritual practice and recognise when the exigencies of contempo- rary practice are affecting that ritual with or without meaning or intention. Physicians should reflect on whether aspects of their ritual interactions are undertaken on the basis of sentiment, custom or evidence-based outcomes, and whether rituals should be defended, continued in a modified fashion or even abandoned in favour of new behav- iours suitable for and salient with contemporary practice in the interests of patient care. Internal Medicine Journal 50 (2020) 1123–1131 © 2020 Royal Australasian College of Physicians 1123