An Ethics Expertise for Clinical Ethics Consultation

Abstract

The legitimacy of clinical ethics consultation is often implied to rest on the legitimacy of moral expertise. In turn, moral expertise seems subject to many serious critiques, the success of which implies that clinical ethics consultation is illegitimate. I explore a number of these critiques, and forward "ethics expertise," as distinct from "moral expertise," as a way of avoiding these critiques. I argue that "ethics expertise" succeeds in avoiding most of the critiques, captures what clinical ethics consultants might justifiably do, and expresses a subject matter which can be taught and assessed.

Clinical Ethics Support in Contemporary Health Care

“…There has also been resistance to the notion of an ethics "expert" from the inception of CES services (Bishop, Fanning, and Bliton, 2009) and this has been a significant obstacle for establishing CES and gaining patronage (Rasmussen, 2011a). The notion of expertise in ethics is a complicated matter that involves both metaphysical and epistemological questions of whether expertise in ethics is actually possible and moral and normative questions of whether such expertise and the authority it brings is desirable (Noble, 1982;Yoder, 1998;Rasmussen, 2011a).…”

The “Ethics” Expertise in Clinical Ethics Consultation

“…Three domains feature prominently in discussions of bioethics expertise: courts (McAllen and Delgado, 1984;Agich and Spielman, 1997;Kipnis, 1997;Wildes, 1997;Spielman and Agich, 1999); the clinical setting (Meyers, 2007;Steinkamp, Gordijn, and ten Have, 2008;Kovács, 2010;Rasmussen, 2011;Slowther and McClimans, 2012); and public policymaking and government commissions (Brock, 1987;Kamm, 1990;Powers, 2005). As with general ethics expertise, critical questions here include: what is bioethics expertise?…”

Expertise, Ethics Expertise, and Clinical Ethics Consultation: Achieving Terminological Clarity

“…Those who invoke the broader notion of both addressing uncertainty or resolving conflicts, as does the American Society for Bioethics andHumanities (1998 and2011), might focus on a collection of skills rather than focusing primarily on conflict resolution/mediation techniques. One example of the relevant skills and knowledge required for expertise is available in the Core Competencies for Healthcare Ethics Consultation (ASBH, 1998 and2011).…”

“…One example of the relevant skills and knowledge required for expertise is available in the Core Competencies for Healthcare Ethics Consultation (ASBH, 1998 and2011). These include the ability to "identify the nature of the value uncertainty or conflict," "access relevant ethics literature, policies, guidelines, and standards," "communicate and collaborate effectively with other responsible individuals, departments, or divisions within the institution," "facilitate moral meetings," and others (see full list in ASBH, 2011, Table 2).…”

“…Instead, the claim is that one cannot claim to be an ethics expert (an expert in knowing what ought to be done) without there being standards for getting it right or being better at knowing or judging what ought to be done. To understand the proper role of the clinical ethicists, we should first attend to the nature (and limits) of the domains over which CECs are experts (see, e.g., ASBH, 1998 and2011;National Center for Ethics in Health Care, 2015).…”