The Issue of Expertise in Clinical Ethics
Main Article Content
Abstract
The proliferation of ethics committees and ethics consultation services has engendered a discussion of the issue of the expertise of those who provide clinical ethics consultation services. In this paper, I discuss two aspects of this issue: the cognitive dimension or content knowledge that the clinical ethics consultant should possess and the practical dimension or set of dispositions, skills, and traits that are necessary for effective ethics consultation. I argue that the failure to differentiate and fully explicate these dimensions contributes to the confusion over the issue of expertise and fuels, at least partly, the controversies about expertise (or authority) in ethics and the legitimacy of the use of ethical knowledge in clinical ethics consultation.
Downloads
Article Details
By submitting his/her work to the Editorial Board, the author accepts, upon having his/her text recommended for publication, that Diametros applies the Attribution 4.0 International (CC BY 4.0) license to the works we publish. Under this license, authors agree to make articles legally available for reuse, without permission or fees. Anyone may read, download, copy, print, distribute or reuse these articles without asking prior permission from the publisher or the author, as long as the author and original source are properly cited. The author holds the copyright without any other restrictions. Full information about CC-BY: https://creativecommons.org/licenses/by/4.0/legalcode.
References
Ackerman [1987] – T. Ackerman, The Role of an Ethicist in Health Care, in: Health Care Ethics, ed. G. Anderson, V. Glesnes-Anderson, Aspen Publishing Company, Rockville, MD 1987: 308-320.
Agich [1990] – G. Agich, Clinical Ethics: A Role Theoretic Look, “Social Science and Medi- cine” (30) 1990: 389-399.
Agich [1995] – G. Agich, Authority in Ethics Consultation, “Journal of Law, Medicine, and Ethics” (23) 1995: 273-283.
Agich [2005] – G. Agich, What Kind of Doing is Ethics Consultation?, “Theoretical Medicine and Bioethics” (26/1) 2005: 7-24.
Agich [2009a] – G. Agich, Understanding Criticisms of Clinical Ethics and Ethics Consultation, “Formosan Journal of Medical Humanities” (10/1-2) 2009: 3-15.
Agich [2009b] – G. Agich, Clinical Ethics as Practice, “International Journal of Bioethics” in press 2009.
Agich, Spielman [1997] – G. Agich, B. Spielman, Ethics Expert Testimony: Against the Skep- tics, “Journal of Medicine and Philosophy” (22) 1997: 381-403.
Akabayashi et al. [2007] – A. Akabayashi, B. Slingsby, N. Nagao et al., An eight-year follow-up national study of medical school and general hospital ethics committees in Japan, “BMC. Journal of Medical Ethics” (8/8) 2007.
Aulisio, Arnold [2008] – M. Aulisio, R. Arnold, Role of the Ethics Committee: Helping to Ad- dress Value Conflicts or Uncertainties, “Chest” (134/2) 2008: 417-424.
Avorn [1982] – J. Avorn, A Physician’s Perspective, “Hastings Center Report” (12/3) 1982: 11-12.
Baker [1989] – R. Baker, The Skeptical Critique of Clinical Ethics, in: Clinical Ethics: Theory and Practice, eds. B. Hoffmaster, B. Freedman, G. Fraser, Humana Press, Clifton, NJ 1989: 27-57.
Barnard [1992] – D. Barnard, Reflections of a Reluctant Clinical Ethicist: Ethics Consultation and the Collapse of Critical Distance, “Theoretical Medicine” (13) 1992: 15-22.
Beauchamp [1982] – T. Beauchamp, What Philosophers Can Offer, “Hastings Center Report” (12/3) 1982: 13-14.
Blake [1992] – D. Blake, The Hospital Ethics Committee Health Care’s Moral Conscience or White Elephant?, “Hastings Center Report” (22/1) 1992: 6-11.
Borovecki et al. [2005] – A. Borovecki, S. Oreskovic, and H. ten Have, Ethics and the struc- tures of health care in the European countries in transition: hospital ethics committees in Croatia, “BMJ” (331/7510) 2005: 227-229.
Borovecki et al. [2006] – A. Borovecki, H. ten Have, and S. Oreskovic, Ethics committees in Croatia in the healthcare institutions: the first study about their structure and functions, and some reflections on the major issues and problems, “HEC Forum” (18/1) 2006: 49- 60.
Cohen [1992] – C. Cohen, Avoiding Cloudcuckooland in Ethics Committee Case Review: Matching Models to Issues and Concerns, “Law, Medicine & Health Care” (20/4) 1992: 294- 299.
Cranford [1989] – R. Cranford, The Neurologist as Ethics Consultant and as a Member of the Institutional Ethics Committee, “Neurological Clinics” (7) 1989: 697-713.
Cranford, Doudera [1984] – R. Cranford, A. Doudera (eds.), Ethics Committees and Health Care Decision Making, Health Administration Press, Ann Arbor, MI 1984.
Delgado, McAllen [1982] – R. Delgado, P. McAllen, The Moralist as Expert Witness, “Boston University Law Review” (62) 1982: 869-926.
Dreyfus, Dreyfus [1991] – H. Dreyfus, S. Dreyfus, Towards a phenomenology of ethical expertise, “Human Studies” (14) 1991: 229-250.
Dubler, Marcus [1994] – N. Dubler, L. Marcus, Mediating Bioethics Disputes: A Practical Guide, United Hospital Fund of New York, New York 1994.
Fleetwood et al. [1989] – J. Fleetwood, R. Arnold, R. Baron, Giving answers or raising questions: the problematic role of institutional ethics committees, “Journal of Medical Ethics” (15) 1989: 137–142.
Fletcher [1997] – J. Fletcher, Bioethics in a Legal Forum: Confessions of an “Expert” Witness, “Journal of Medicine and Philosophy” (22/4) 1997: 297-324.
Fletcher, Hoffmann [1994] – J. Fletcher, D. Hoffmann, Ethics Committees: Tune to Experi- ment with Standards, “Annals of Internal Medicine” (120) 1994: 335-38.
Forde et al. [2008] – R. Forde, R. Pedersen, V. Akre. Clinicians’ evaluation of clinical ethics consultations in Norway: a qualitative study, “Medicine, Health Care and Philoso- phy” (11/1) 2008: 17-25.
Graf, Cole [1995] – H. Graf, D. Cole, Ethics-committee authorization in Germany, “Journal of Medical Ethics” (21/4) 1995: 229-233.
Gramelspacher [1991] – G. Gramelspacher, Institutional Ethics Committees and Case Consul- tation: Is There a Role?, “Issues in Law and Medicine” (7) 1991: 73-82.
Grunfeld [1990] – D. Grunfeld, Non-MD Ethics Consultants?, “Journal of Clinical Ethics” (1) 1990: 325-326.
Guerrier [2006] – M. Guerrier, Hospital based ethics, current situation in France: between “Espaces” and committees, “Journal of Medical Ethics” (32/9) 2006: 503-506.
Hurst et al. [2007] – S. Hurst, A. Perrier, R. Pegoraro et al., Ethical difficulties in clinical prac- tice: experiences of European doctors, “Journal of Medical Ethics” (33/1) 2007: 51-57.
Hurst et al. [2007] – S. Hurst, S. Reiter-Theil, A. Perrier et al., Physicians’ access to ethics sup- port services in four European countries, “Health Care Analysis” (15/4) 2007: 321-335.
JCAHO [1992] – Joint Commission on the Accreditation of Healthcare Organizations, Pa- tient rights, in: Accreditation Manual for Hospitals, Joint Commission on the Accreditation of Healthcare Organizations, Chicago, IL 1992: 1–16.
Jonsen [1980] – A. Jonsen, Can An Ethicist Be a Consultant?, in: Frontiers in Medical Ethics, ed. V. Abernathy, Bollinger Publishing Co., Cambridge, MA 1980: 157-171.
Jonsen [1992] – A. Jonsen, Casuistry as Methodology in Clinical Ethics, “Theoretical Medi- cine” (13) 1992: 295-307.
JCAMA [1985] – Judicial Council of the American Medical Association, Guidelines for ethics committees in health care institutions, “JAMA” (253) 1985: 2698–2699.
Kipnis [1997] – K. Kipnis, Confessions of an Expert Ethics Witness, “Journal of Medicine and Philosophy” (22/4) 1997: 325-343.
LaPuma, Priest [1992] – J. LaPuma, E. Priest, Medical Staff Privileges for Ethics Consultants: An Institutional Model, “Quality Review Bulletin” (18) 1992: 17-20.
LaPuma, Schiedermayer [1990] – J. LaPuma, D. Schiedermayer, Must the Ethics Consultant See the Patient?, “Journal of Clinical Ethics” (1/1) 1990: 56-59.
LaPuma, Schiedermayer [1992] – J. LaPuma, D. Schiedermayer, The Clinical Ethicist at the Bedside, “Theoretical Medicine” (12) 1992: 285-292.
LaPuma, Toulmin [1989] – J. LaPuma, S. Toulmin, Ethics Consultants and Ethics Committees, “Archives of Internal Medicine” (149) 1989: 1109-21.
Lebeer [2005] – G. Lebeer, Clinical ethics support services in Europe, “Medicinska Etika a Bioetika” (11/Suppl.) 2005: 8-11.
Lo [1987] – B. Lo, Behind Closed Doors: Promises and Pitfalls of Ethics Committees, “New Eng- land Journal of Medicine” (317) 1987: 46-50.
Marsh [1992] – F. Marsh, Why Physicians Should Not Do Ethics Consultations, “Theoretical Medicine” (13/3) 1992: 285-92.
McAllen, Delgado [1984] – P. McAllen, R. Delgado, Moral Experts in the Courtroom, “Hast- ings Center Report” (14/1) 1984: 27-34.
McGee et al. [2001] – G. McGee, A. Caplan, J. Spanogle et al., A national study of ethics committees, “American Journal of Bioethics” 2001: 1:60–64.
Melley [2001] – C. Melley, Clinical ethics consultation in Germany: a philosopher’s prognosis, “HEC Forum” (13/3) 2001: 306-313.
Meulenbergs et al. [2005] – T. Meulenbergs, J. Vermylen, P. Schotsmans, The current state of clinical ethics and healthcare ethics committees in Belgium, “Journal of Medical Ethics” (31/6) 2005: 318-321.
Mino [2000] – J. Mino, Hospital ethics committees in Paris, “Cambridge Quarterly of Health- care Ethics” (9/3) 2000: 424-428.
Mishkin [1997] – D. Mishkin, Proffering Bioethicists as Experts, “The Judges’ Journal” (36/3) 1997: 50-51 and 88-89.
Morreim [1983] – H. Morreim, The Philosopher in the Clinical Setting, “Pharos” (46) 1983: 2- 6.
Noble [1982a] – C. Noble, Ethics and Experts, “Hastings Center Report” (12/3) 1982: 7-9. Noble [1982b] – C. Noble, Response, “Hastings Center Report” (12/3) 1982: 15.
Parker [2002] – M. Parker, The development of clinical ethics support in the United Kingdom, “Politeia” (18/67) 2002: 82-86.
Pellegrino, Sharpe [1989] – E. Pellegrino, V. Sharpe, Medical Ethics in the Courtroom: The Need for Scrutiny, “Perspectives in Biology and Medicine” (32) 1989: 547-564.
President’s Commission [1983] – President’s Commission for the Study of Ethical Prob- lems in Medicine and Biomedical Research, Deciding to forgo life-sustaining treat- ment: a report on the ethical, medical and legal issues in treatment decisions, Washington, DC: Superintendent of Documents, 1983.
Reiter-Theil [2001a] – S. Reiter-Theil, Ethics consultation in Germany: the present situation, “HEC Forum” (13/3) 2001: 265-280.
Reiter-Theil [2001b] – S. Reiter-Theil, The Freiburg approach to ethics consultation: process, outcome and competencies, “Journal of Medical Ethics” (27/Suppl. 1) 2001: i21-i23.
Reiter-Theil, Agich [2008] – S. Reiter-Theil, G. Agich, Research on clinical ethics and consultation. Introduction to the theme, “Medicine, Health Care and Philosophy” (11/1) 2008: 3-5.
Richter [2001] – G. Richter, Ethics consultation at the University Medical Center – Marburg, “HEC Forum” (13/3) 2001: 294-305.
Robles [1999] – P. Robles, Evaluation of healthcare ethics committees: the experience of an HEC in Spain, “HEC Forum” (11/3) 1999: 263-276.
Ross [1990] – J. Ross, Case Consultation: The Committee or the Clinical Consultant?, “HEC Forum” (2) 1990: 289-298.
Rothman [1991] – D. Rothman, Strangers at the bedside: a history of how law and bioethics transformed medical decision making, Basic Books, New York 1991.
Sass [2002] – H. Sass, Ethical decision making in committee. A view from Germany, “Politeia” (18/67) 2002: 65-81.
Schlaudraff [1992] – U. Schlaudraff, Ethics committees in Germany, “Bulletin of Medical Eth- ics” (80) 1992: 40-44.
Scofield [1993] – G. Scofield, Ethics consultation: The least dangerous profession?, “Cambridge Quarterly of HealthCare Ethics” (2) 1993: 417-448.
Scofield [1994] – G. Scofield, Is the Medical Ethicist an “Expert”?, ABA Bioethics Bulletin (3) 1994: 1-2, 9-10, 28.
Sharpe, Pellegrino [1997] – V. Sharpe, E. Pellegrino, Medical Ethics in the Courtroom: A Re- appraisal, “Journal of Medicine and Philosophy” (22/4) 1997: 373-379.
Siegler [1986] – M. Siegler, Ethics Committees: Decisions by Bureaucracy, “Hastings Center Report” (16/3) 1986: 22-24.
Siegler, Singer [1988] – M. Siegler, P. Singer, Clinical Ethics Consultation: Godsend or “God- squad?,” “American Journal of Medicine” (85) 1988: 759-60.
Singer [1982] – P. Singer, How Do We Decide?, “Hastings Center Report” (12/3) 1982: 9-11. Singer [1988] – P. Singer, Ethical Experts in a Democracy, in: Applied Ethics and Ethical Theory, eds. D. Rosenthal and F. Shehadi, University of Utah Press, Salt Lake City
: 149-161.
Slowther et al. [2001] – A. Slowther, C. Bunch, B. Woolnough, T. Hope, Clinical ethics sup- port services in the UK: an investigation of the current provision of ethics support to health professionals in the UK, “Journal of Medical Ethics” (27/Suppl. 1) 2001 1: i2-i8.
Slowther et al. [2001] – A. Slowther, T. Hope, R. Ashcroft, Clinical ethics committees: a worldwide development, “Journal of Medical Ethics” (27/Suppl. 1) 2001: i1.
Slowther, Underwood [1998] – A. Slowther, M. Underwood, Is there a demand for a clinical ethics advisory service in the UK?, “Journal of Medical Ethics” (24/3) 1998: 207.
Sorta-Bilajac et al. [2008] – I. Sorta-Bilajac, K. Bazdaric, B. Brozovic, G. Agich, Croatian physicians’ and nurses’ experience with ethical issues in clinical practice, “Journal of Medi- cal Ethics” (34/6) 2008: 450-455.
Spielman, Agich [1999] – B. Spielman, G. Agich, The Future of Bioethics Testimony: Guide- lines for Determining Qualifications, Reliability, and Helpfulness, “San Diego Law Review” (36/4) 1999: 1043-1075.
Steinkamp [2003] – N. Steinkamp, European debates on ethical case deliberation, “Medicine, Health Care and Philosophy” (6/3) 2003: 225-226.
Swenson, Miller [1992] – M. Swenson, R. Miller, Ethics Case Review in Health Care Institutions: Committees, Consultants, or Teams?, “Archives of Internal Medicine” (152) 1992: 694-697.
TFSBC [1998] – Task Force on Standards for Bioethics Consultations, Core Competencies for Health Care Ethics Consultation, American Society for Bioethics and Humanities, Glenview, IL 1998.
Thomasma [1991] – D. Thomasma, Why Philosophers Should Offer Ethics Consultations, “Theoretical Medicine” (12/2) 1991: 129-40.
Thornton, Lilford [1995] – J. Thornton, R. Lilford, Clinical ethics committee, “BMJ” (311/7006) 1995: 667-669.
Toulmin [1981] – S. Toulmin, The Tyranny of Principles, “Hastings Center Report” (11/6) 1981: 31-39.
Toulmin [1982] – S. Toulmin, How Medicine Saved The Life of Ethics, “Perspectives in Biol- ogy and Medicine” (25/4) 1982: 736–749.
Wikler [1982] – D. Wikler, Ethicists, Critics, and Expertise, “Hastings Center Report” (12/3) 1982: 12-13.
Wildes [1997] – K. Wildes, Healthy Skepticism: The Emperor has Very Few Clothes, “Journal of Medicine and Philosophy” (22/4) 1997: 365-371.
Williamson [2004] – T. Williamson, Armchair Philosophy and Counterfactual Thinking, “Pro- ceedings of the Aristotelian Society” (105) 2004: 1-23.
Wray [2002] – E. Wray, The Padua bioethics service: a model of excellence in clinical ethics?, “Bulletin of Medical Ethics” (183) 2002: 13-15.
Youngner et al. [1983] – S. Youngner, D. Jackson, C. Coulton et al., A national survey of hos- pital ethics committees, “Critical Care Medicine” (11) 1983: 902–905.
Zaner [1984] – R. Zaner, Is “Ethicist” Anything to Call a Philosopher?, “Human Studies” (7) 1984: 71-90.