Abstract
I argue that it is possible to reframe the current debates over professionalization in a way that can account for disagreement without insisting that its advocates and opponents are adversaries. Giles Scofield, and critics like him, may be understood as engaging in the sort of theoretical disagreement that is an inescapable and vital part of our practice. The field could profit from the work of legal theorist Ronald Dworkin who has long argued that people of good will and great competence need not share foundational assumptions. They may, instead, be advancing rival interpretations of what the practice of healthcare ethics (PHE) requires.
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Notes
The 500 Hats of Bartholomew Cubbins by Dr. Seuss is the charming story of a hapless young peasant who attempts without success to comply with his king’s order to doff his hat. Each time he removes his hat another appears until the 500th hat is revealed. I will not spoil the ending for the curious reader but the point of the narrative, at least for my purposes, is that Bartholomew had no desire to violate the customs of the country. The task he was given was simply impossible to perform.
Scofield uses the phrase “medical ethics consultant” throughout his paper to describe ethicists working in healthcare settings. I employ the terms practicing healthcare ethicists (PHE) and ethics practitioners not only because they are more general but because I do not wish to give the impression that the field’s focus is solely, or even primarily, directed on the work that physicians do.
While this is true for many healthcare professionals, the challenge may be particularly great for PHEs. I hope the reasons for this will become clearer as my paper unfolds. I hold the view that the multiple paths we take on our way into the field accounts for only part of the complexity. Our diverse theoretical approaches and discomfort with that diversity may be more difficult to accept.
The American Society for Bioethics first approved its Core Competencies for Health Care Ethics Consultation in 1998. A second edition was released in 2011. The original document and this later one have elicited controversy but it seems reasonable to suggest that they have been influential in describing and shaping the practice of ethics consultation as one core aspect of the role that we are calling PHE in this paper and issue.
Consider, for example, the centrality of concepts like “justice” and “equality” to both ethics and the law.
See especially his book, Law’s Empire (1986).
Dworkin uses the language of principles, as do many ethicists, but for this purpose I use the term ‘standards’ to leave open a host of questions concerning method.
On a Dworkinian account an effort to operationalize even a canonical legal statement can be more challenging than we might imagine. For example, the statement that “no citizen will be deprived of his right to liberty, except in accordance with the principles of fundamental justice,” is less a directive than an invitation to engage in a type of moral reasoning. In order to decide what this provision requires the jurist must review precedent decisions, identify relevant interests and principles, and consider competing conceptions of political morality (albeit in a constrained and nonpartisan sense). When she does so, she always leaves herself open to the critiques and corrections of her peers. This is not, argues Dworkin, because the law has been flouted or ignored. It is because this is what the practice of law requires. Indeed, it is precisely what the practice of legal interpretation consists in.
This will be an unsatisfying suggestion for those who feel we need consensus in order to be able to begin to explore some aspects of our practice), as well as those who prefer foundational answers. Some, H. Tristram Engelhardt Jr. comes to mind, may reject an endorsement of Dworkinian—inspired interpretation (and its acceptance of theoretical disagreement) as yet another species of partisan politics. Such challenges are familiar to legal scholars yet lawyers still marshal arguments, courts still deliberate, and plaintiffs and defendants receive decisions. What is interesting from a consultation perspective, however, is that despite the fact that controversial judicial decisions receive considerable attention it is rare indeed to hear participants or members of the broader community (as opposed to the most skeptical of theorists) say that there is no law (or practice) at all. I want to argue that there is a lesson for PHEs in these controversies. To see a contrary view I recommend a recent article by Engelhardt which appeared in this journal: “Core Competencies for Health Care Ethics Consultants: In Search of Professional Status in a Post-Modern World” (2012).
References
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Heesters, A. 500 Hats: Exploring the Challenges of Boundary and Community—Reflections on Professionalization. HEC Forum 24, 171–178 (2012). https://doi.org/10.1007/s10730-012-9190-0
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DOI: https://doi.org/10.1007/s10730-012-9190-0