We stand up in this article for bioethics as practice, as attest since the 1980 the evolution of theoretical work in bioethics towards a growing need of contextualization. This development justifies for us to work out a context sensitive, pragmatist and reflective ethics as a learning process. Such an idea of ethics allows to understand the transition from hospital ethics committes and clinical ethics consultation towards a more integrative institutional perspective that we defend here. This institutionalization of clinical ethics support services has to be accompanied by a reflective governance of this process. The papers of this issue aim to take into account in a various way this evolution of the bioethical field, both practical, methodological, institutional, educational and theoretical.