Abstract
In After God: Morality and Bioethics in a Secular Age, H. Tristram Engelhardt, Jr. explores the broad implications for moral reasoning once a culture has lost a God’s-eye perspective. In this paper, I focus on the implications of Engelhardt’s views for clinical ethics consultation. I begin by examining the question of whether clinical ethics consultants (CECs) should advocate a particular viewpoint and/or process during consultations or adopt a neutral stance. I then examine the implications of Engelhardt’s views for this question. Finally, I discuss some of Engelhardt’s foundational ontological, metaphysical, meta-ethical, and epistemological commitments and how these commitments connect to his views on clinical ethics consultation.
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Notes
One might argue that by excluding the family and nursing staff the mediator is not being neutral. My response would be that a neutral mediator only mediates disputes between parties that want their dispute mediated. In the case above, the physician and surrogate are only willing to have the dispute between them mediated. If they are not willing to have potential disputes between the family members or nursing staff mediated, the neutral mediator does not impose this obligation on them. The maximally neutral mediator only comes into disputes when invited, allows the participants to set the process rules, and simply helps facilitate discussion and a mutually acceptable outcome.
In fact, the American Society of Bioethics and Humanities (ASBH) has published a second edition of Core Competencies for Healthcare Ethics Consultation and is now actively engaged in the exploration and development of a certification scheme for clinical ethics consultants. For an interesting exploration of issues surrounding accountability in ASBH’s second edition of Core Competencies see Rasmussen (2013).
For a version of the parable of the blind men and the elephant, see Wang (1995).
See Plato (1997, 10a).
It is unclear exactly how the epistemic justification of this direct noetic insight works. Is the noetic insight about general principles that then must be applied to particular cases or is it direct insight into one’s moral obligation in a particular case—a type of God given intuition into what one should do when there may be competing prima facie moral considerations? Can the direct noetic insight tell us the canonical way to rank cardinal human values? Is the insight self-authenticating—that is, does the belief that comes about as a result of the noetic experience have some sort of self-authenticating property that confers its epistemic status for the believer? Or is the epistemic justification externalist—perhaps a rightly ordered spiritual life is a prerequisite for a properly functioning moral belief-forming mechanism which in turn confers the positive epistemic status on the beliefs formed? Is there indirect moral knowledge that results as well—that is, if someone with direct noetic insight into moral truths then communicates this knowledge to others, can they in turn acquire moral knowledge based on this testimony? And what criteria should one use to judge whether an individual has had a genuine noetic insight?
References
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Parker, J.C. Clinical Ethics Consultation After God: Implications for Advocacy and Neutrality. HEC Forum 30, 103–115 (2018). https://doi.org/10.1007/s10730-017-9340-5
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DOI: https://doi.org/10.1007/s10730-017-9340-5