Abstract
This essay considers the nature of ethical expertise, threats to ethical expertise, and implications for the training and certification of clinical ethics consultants. First, the idea of ethical uncertainty within medicine is examined. An important source of uncertainty is ethical dilemmas. Second, the expertise required to resolve ethical uncertainty is explored. Such expertise must have two components: (a) analysis, which involves identifying and clarifying the underlying ethical dilemma, and (b) weighing, a process of deliberating and providing reasons for why one obligation or set of obligations should be preferred over another. To do these things, two competencies are required. One is a practical skill, a practical moral judgment, which requires experience within clinical environments and clinical medicine. A second is a body of theoretical knowledge, including knowledge of ethical theory, approaches to ethical deliberation, moral philosophy, and the norms of medicine. Finally, the implications of these components for training and accreditation of clinical ethicists are discussed. Training should develop both competencies, which requires a theoretical education in basic ethical knowledge, and a practical apprenticeship such as a residency or fellowship. Standardization and quality attestation are potentially important mechanisms to ensure that ethics consultants have the required competencies that make up ethics expertise and that they do not practice according to the methods that undermine ethics expertise.
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Notes
- 1.
Pellegrino argues in many of his works that medicine is a moral endeavor and its practitioners a moral community, committing the practitioner to a set of virtues. As an example, see: Pellegrino, Edmund D. The Medical Profession as a Moral Community. Bulletin of the New York Academy of Medicine 1990;66(3): 221–232.
- 2.
For an analysis of this idea, the relationship between contemporary ethics and the Hippocratic tradition, and an argument for the need for a philosophical exploration of the values internal to medicine, see: Jotterand, Fabrice. The Hippocractic Oath and Contemporary Medicine: Dialectic between Past Ideals and Present Reality? Journal of Medicine and Philosophy 2005;30(1): 107–128.
- 3.
Although I take this as obvious, it is worth noting that some may see this as a controversial claim. For example, an act utilitarian may say that although there seems to be a moral conflict, once we’ve weighed all the relevant consequences and moral content, there is actually only one right thing to do, and that the appearance of moral conflict is illusory.
- 4.
See the discussion on value conflicts and uncertainty in: ASBH Core Competency Task Force. 2011. Core Competencies for Healthcare Ethics Consultation. Chicago: American Society for Bioethics and Humanities (p. 2,3).
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Bester, J.C. (2018). The Nature of Ethics Expertise in Clinical Ethics and Implications for Training of Clinical Ethics Consultants. In: Watson, J., Guidry-Grimes, L. (eds) Moral Expertise. Philosophy and Medicine, vol 129. Springer, Cham. https://doi.org/10.1007/978-3-319-92759-6_10
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