The Issue of Expertise in Clinical Ethics
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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.
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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.
View in Google Scholar
Agich [1990] – G. Agich, Clinical Ethics: A Role Theoretic Look, “Social Science and Medi- cine” (30) 1990: 389-399.
View in Google Scholar
Agich [1995] – G. Agich, Authority in Ethics Consultation, “Journal of Law, Medicine, and Ethics” (23) 1995: 273-283.
View in Google Scholar
Agich [2005] – G. Agich, What Kind of Doing is Ethics Consultation?, “Theoretical Medicine and Bioethics” (26/1) 2005: 7-24.
View in Google Scholar
Agich [2009a] – G. Agich, Understanding Criticisms of Clinical Ethics and Ethics Consultation, “Formosan Journal of Medical Humanities” (10/1-2) 2009: 3-15.
View in Google Scholar
Agich [2009b] – G. Agich, Clinical Ethics as Practice, “International Journal of Bioethics” in press 2009.
View in Google Scholar
Agich, Spielman [1997] – G. Agich, B. Spielman, Ethics Expert Testimony: Against the Skep- tics, “Journal of Medicine and Philosophy” (22) 1997: 381-403.
View in Google Scholar
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.
View in Google Scholar
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.
View in Google Scholar
Avorn [1982] – J. Avorn, A Physician’s Perspective, “Hastings Center Report” (12/3) 1982: 11-12.
View in Google Scholar
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.
View in Google Scholar
Barnard [1992] – D. Barnard, Reflections of a Reluctant Clinical Ethicist: Ethics Consultation and the Collapse of Critical Distance, “Theoretical Medicine” (13) 1992: 15-22.
View in Google Scholar
Beauchamp [1982] – T. Beauchamp, What Philosophers Can Offer, “Hastings Center Report” (12/3) 1982: 13-14.
View in Google Scholar
Blake [1992] – D. Blake, The Hospital Ethics Committee Health Care’s Moral Conscience or White Elephant?, “Hastings Center Report” (22/1) 1992: 6-11.
View in Google Scholar
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.
View in Google Scholar
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.
View in Google Scholar
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.
View in Google Scholar
Cranford [1989] – R. Cranford, The Neurologist as Ethics Consultant and as a Member of the Institutional Ethics Committee, “Neurological Clinics” (7) 1989: 697-713.
View in Google Scholar
Cranford, Doudera [1984] – R. Cranford, A. Doudera (eds.), Ethics Committees and Health Care Decision Making, Health Administration Press, Ann Arbor, MI 1984.
View in Google Scholar
Delgado, McAllen [1982] – R. Delgado, P. McAllen, The Moralist as Expert Witness, “Boston University Law Review” (62) 1982: 869-926.
View in Google Scholar
Dreyfus, Dreyfus [1991] – H. Dreyfus, S. Dreyfus, Towards a phenomenology of ethical expertise, “Human Studies” (14) 1991: 229-250.
View in Google Scholar
Dubler, Marcus [1994] – N. Dubler, L. Marcus, Mediating Bioethics Disputes: A Practical Guide, United Hospital Fund of New York, New York 1994.
View in Google Scholar
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.
View in Google Scholar
Fletcher [1997] – J. Fletcher, Bioethics in a Legal Forum: Confessions of an “Expert” Witness, “Journal of Medicine and Philosophy” (22/4) 1997: 297-324.
View in Google Scholar
Fletcher, Hoffmann [1994] – J. Fletcher, D. Hoffmann, Ethics Committees: Tune to Experi- ment with Standards, “Annals of Internal Medicine” (120) 1994: 335-38.
View in Google Scholar
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.
View in Google Scholar
Graf, Cole [1995] – H. Graf, D. Cole, Ethics-committee authorization in Germany, “Journal of Medical Ethics” (21/4) 1995: 229-233.
View in Google Scholar
Gramelspacher [1991] – G. Gramelspacher, Institutional Ethics Committees and Case Consul- tation: Is There a Role?, “Issues in Law and Medicine” (7) 1991: 73-82.
View in Google Scholar
Grunfeld [1990] – D. Grunfeld, Non-MD Ethics Consultants?, “Journal of Clinical Ethics” (1) 1990: 325-326.
View in Google Scholar
Guerrier [2006] – M. Guerrier, Hospital based ethics, current situation in France: between “Espaces” and committees, “Journal of Medical Ethics” (32/9) 2006: 503-506.
View in Google Scholar
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.
View in Google Scholar
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.
View in Google Scholar
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.
View in Google Scholar
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.
View in Google Scholar
Jonsen [1992] – A. Jonsen, Casuistry as Methodology in Clinical Ethics, “Theoretical Medi- cine” (13) 1992: 295-307.
View in Google Scholar
JCAMA [1985] – Judicial Council of the American Medical Association, Guidelines for ethics committees in health care institutions, “JAMA” (253) 1985: 2698–2699.
View in Google Scholar
Kipnis [1997] – K. Kipnis, Confessions of an Expert Ethics Witness, “Journal of Medicine and Philosophy” (22/4) 1997: 325-343.
View in Google Scholar
LaPuma, Priest [1992] – J. LaPuma, E. Priest, Medical Staff Privileges for Ethics Consultants: An Institutional Model, “Quality Review Bulletin” (18) 1992: 17-20.
View in Google Scholar
LaPuma, Schiedermayer [1990] – J. LaPuma, D. Schiedermayer, Must the Ethics Consultant See the Patient?, “Journal of Clinical Ethics” (1/1) 1990: 56-59.
View in Google Scholar
LaPuma, Schiedermayer [1992] – J. LaPuma, D. Schiedermayer, The Clinical Ethicist at the Bedside, “Theoretical Medicine” (12) 1992: 285-292.
View in Google Scholar
LaPuma, Toulmin [1989] – J. LaPuma, S. Toulmin, Ethics Consultants and Ethics Committees, “Archives of Internal Medicine” (149) 1989: 1109-21.
View in Google Scholar
Lebeer [2005] – G. Lebeer, Clinical ethics support services in Europe, “Medicinska Etika a Bioetika” (11/Suppl.) 2005: 8-11.
View in Google Scholar
Lo [1987] – B. Lo, Behind Closed Doors: Promises and Pitfalls of Ethics Committees, “New Eng- land Journal of Medicine” (317) 1987: 46-50.
View in Google Scholar
Marsh [1992] – F. Marsh, Why Physicians Should Not Do Ethics Consultations, “Theoretical Medicine” (13/3) 1992: 285-92.
View in Google Scholar
McAllen, Delgado [1984] – P. McAllen, R. Delgado, Moral Experts in the Courtroom, “Hast- ings Center Report” (14/1) 1984: 27-34.
View in Google Scholar
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.
View in Google Scholar
Melley [2001] – C. Melley, Clinical ethics consultation in Germany: a philosopher’s prognosis, “HEC Forum” (13/3) 2001: 306-313.
View in Google Scholar
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.
View in Google Scholar
Mino [2000] – J. Mino, Hospital ethics committees in Paris, “Cambridge Quarterly of Health- care Ethics” (9/3) 2000: 424-428.
View in Google Scholar
Mishkin [1997] – D. Mishkin, Proffering Bioethicists as Experts, “The Judges’ Journal” (36/3) 1997: 50-51 and 88-89.
View in Google Scholar
Morreim [1983] – H. Morreim, The Philosopher in the Clinical Setting, “Pharos” (46) 1983: 2- 6.
View in Google Scholar
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.
View in Google Scholar
Parker [2002] – M. Parker, The development of clinical ethics support in the United Kingdom, “Politeia” (18/67) 2002: 82-86.
View in Google Scholar
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.
View in Google Scholar
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.
View in Google Scholar
Reiter-Theil [2001a] – S. Reiter-Theil, Ethics consultation in Germany: the present situation, “HEC Forum” (13/3) 2001: 265-280.
View in Google Scholar
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.
View in Google Scholar
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.
View in Google Scholar
Richter [2001] – G. Richter, Ethics consultation at the University Medical Center – Marburg, “HEC Forum” (13/3) 2001: 294-305.
View in Google Scholar
Robles [1999] – P. Robles, Evaluation of healthcare ethics committees: the experience of an HEC in Spain, “HEC Forum” (11/3) 1999: 263-276.
View in Google Scholar
Ross [1990] – J. Ross, Case Consultation: The Committee or the Clinical Consultant?, “HEC Forum” (2) 1990: 289-298.
View in Google Scholar
Rothman [1991] – D. Rothman, Strangers at the bedside: a history of how law and bioethics transformed medical decision making, Basic Books, New York 1991.
View in Google Scholar
Sass [2002] – H. Sass, Ethical decision making in committee. A view from Germany, “Politeia” (18/67) 2002: 65-81.
View in Google Scholar
Schlaudraff [1992] – U. Schlaudraff, Ethics committees in Germany, “Bulletin of Medical Eth- ics” (80) 1992: 40-44.
View in Google Scholar
Scofield [1993] – G. Scofield, Ethics consultation: The least dangerous profession?, “Cambridge Quarterly of HealthCare Ethics” (2) 1993: 417-448.
View in Google Scholar
Scofield [1994] – G. Scofield, Is the Medical Ethicist an “Expert”?, ABA Bioethics Bulletin (3) 1994: 1-2, 9-10, 28.
View in Google Scholar
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.
View in Google Scholar
Siegler [1986] – M. Siegler, Ethics Committees: Decisions by Bureaucracy, “Hastings Center Report” (16/3) 1986: 22-24.
View in Google Scholar
Siegler, Singer [1988] – M. Siegler, P. Singer, Clinical Ethics Consultation: Godsend or “God- squad?,” “American Journal of Medicine” (85) 1988: 759-60.
View in Google Scholar
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
View in Google Scholar
: 149-161.
View in Google Scholar
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.
View in Google Scholar
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.
View in Google Scholar
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.
View in Google Scholar
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.
View in Google Scholar
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.
View in Google Scholar
Steinkamp [2003] – N. Steinkamp, European debates on ethical case deliberation, “Medicine, Health Care and Philosophy” (6/3) 2003: 225-226.
View in Google Scholar
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.
View in Google Scholar
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.
View in Google Scholar
Thomasma [1991] – D. Thomasma, Why Philosophers Should Offer Ethics Consultations, “Theoretical Medicine” (12/2) 1991: 129-40.
View in Google Scholar
Thornton, Lilford [1995] – J. Thornton, R. Lilford, Clinical ethics committee, “BMJ” (311/7006) 1995: 667-669.
View in Google Scholar
Toulmin [1981] – S. Toulmin, The Tyranny of Principles, “Hastings Center Report” (11/6) 1981: 31-39.
View in Google Scholar
Toulmin [1982] – S. Toulmin, How Medicine Saved The Life of Ethics, “Perspectives in Biol- ogy and Medicine” (25/4) 1982: 736–749.
View in Google Scholar
Wikler [1982] – D. Wikler, Ethicists, Critics, and Expertise, “Hastings Center Report” (12/3) 1982: 12-13.
View in Google Scholar
Wildes [1997] – K. Wildes, Healthy Skepticism: The Emperor has Very Few Clothes, “Journal of Medicine and Philosophy” (22/4) 1997: 365-371.
View in Google Scholar
Williamson [2004] – T. Williamson, Armchair Philosophy and Counterfactual Thinking, “Pro- ceedings of the Aristotelian Society” (105) 2004: 1-23.
View in Google Scholar
Wray [2002] – E. Wray, The Padua bioethics service: a model of excellence in clinical ethics?, “Bulletin of Medical Ethics” (183) 2002: 13-15.
View in Google Scholar
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.
View in Google Scholar
Zaner [1984] – R. Zaner, Is “Ethicist” Anything to Call a Philosopher?, “Human Studies” (7) 1984: 71-90.
View in Google Scholar