Abstract
A clinical ethics consultant (CEC) may, at times, be called upon to make independent substantive moral judgments and then offer justifications for those judgments. A CEC does not act unprofessionally by utilizing background beliefs that are religious in nature to justify those judgments. It is important, however, for a CEC to make such judgments authentically and, when asked, to offer up one’s reasons for why one believes the judgment is true in a transparent fashion.
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Notes
While the arguments in this paper are meant to apply to many if not most religions, I will focus on theistic religions in general and Christianity in particular.
By methodological atheism I mean an intellectual framework in which the clinical ethics consultant attempts to deliberately exclude beliefs about God and God’s purported communication regarding morality from the ethical decision-making process. This would mean trying to articulate justifications for moral beliefs only in non-religious terms. In After God: Morality & Bioethics in a Secular Age, H. Tristram Engelhardt, Jr. (2017) comments on Jürgen Habermas’ use of the idea of methodological atheism as Habermas discusses Hegel’s embrace of an atheistic position “camouflaged by a discourse rich in theological terms and images” (p. 94). Mark Cherry (2016) amplifies this discussion in Sex, Family, and the Culture Wars. Cherry offers an insightful critique of methodological atheism. Rather than being illuminating, methodological atheism leaves one without an ultimate standard with which to compare competing notions. Cherry notes, “Without a God’s eye perspective from which to know fully objective Truth, there ceases to be a sociohistorically unconditioned position from which to know reality. All claims to know truly are already embedded within a culturally and historically conditioned perspective” (p. 101). The result is a radical relativism. Cherry writes, “Without God or a God’s eye perspective to secure reality and definitively to establish and enforce proper moral standards, the challenges to knowing how rightly to weigh harms and benefits, to rank human goods, or to choose among competing accounts of moral anthropology (whether traditional or post-traditional, religious or secular, patriarchal or feminist) to guide judgment of the proper structure and function of the family are insurmountable” (p. 112).
I will not defend the practice of giving substantive moral advice in this article. Some clinical ethics consultants may believe that they should not give any substantive moral advice, religious or non-religious, but rather, should simply engage in mediation attempts between disputants. For those who advocate a pure mediation approach to clinical ethics consultation, my argument can be viewed as hypothetical—if one gives substantive moral advice in clinical ethics consultation, there is no professional obligation to avoid utilizing background religious beliefs in formulating that advice.
A moral pluralist in this sense is someone who believes that there are multiple types of moral obligations that are not reducible to one type of moral obligation.
H. Tristram Engelhardt, Jr. discusses this activity in After God: Morality and Bioethics in a Secular Age. “Like lawyers, clinical ethicists can identify and characterize grey zones and then make suggestions about how to act with the least moral (read legal and public policy) risks. In addition, by means of consultations and through entering notes into the patients’ charts regarding controverted cases, clinical ethicists can help show that due diligence has been taken in reaching a decision. Establishing that due diligence has been taken tends to serve as a protection against malpractice suits and other legal adversities. Healthcare ethics consultants thereby support effective risk management” (p. 285). See also J. Clint Parker’s (2018) Clinical Ethics Consultation After God: Implications for Advocacy and Neutrality.
I am putting to one side Gettier problems at this point. If one thinks that the traditional definition of knowledge is inadequate due to Gettier problems, and one thinks that knowledge and not just justified, true belief is the goal of our moral judgments, then one can substitute the term warrant for justification to indicate whatever in addition to epistemic justification and truth is needed for knowledge.
This is not to suggest that a clinical ethics consultant is somehow better than anyone else at arriving at justified, true moral beliefs, but simply to point out that this would be the goal of any moral agent making moral judgments.
This goal, then, rejects purely noncognitivist approaches to ethics as incomplete. Certainly, our moral judgments may express negative or positive attitudes—but that is neither all nor the most important thing that they do. They also either fail or succeed to provide us with justified true belief about whether particular acts have particular properties (wrongness, obligatoriness, etc.).
At a minimum, we would want to avoid logical contradictions. However, I also think that we want our set of beliefs to cohere in a more substantial way. We want the core beliefs in our set to help us better understand and organize large numbers of our peripheral beliefs. I do not think coherence is sufficient for epistemic justification; however, it does seem to be necessary, at least at the basic level of avoiding logical contradictions.
Both non-religious and religious persons can have comprehensive doctrines that serve to integrate the answers one gives to fundamental existential questions such as the following: Who are we? Where do we come from? What happens to me after I die? How should I live?
There might be different types of testimony that serve to justify moral judgments. For example, if one encounters a difficult case, one might seek out the advice of a moral exemplar. The moral exemplar’s intuition about the case might serve as a reason to act one way rather than another. Testimony could also be revelation from God who, in theistic traditions, functions as both the source of morality and the ultimate moral exemplar.
Given this stalemate, one might argue that the clinical ethics consultant, regardless of their religious or nonreligious views, should refrain completely from making substantive moral judgments in cases and focus on mediation. As mentioned earlier, in this paper I will not argue that making substantive moral judgments in a case is an appropriate activity, only that if this activity is pursued, the CEC does not act unprofessional in using background religious beliefs to make such judgments.
I don’t think CECs are in any special position to decide these types of disputes, and I believe that utilizing coercive force in trying to make a person do what they believe is wrong is itself, in most cases, wrong. For further discussion on this topic, see Sulmasy’s (2017) “Tolerance, Professional Judgment, and the Discretionary Space of the Physician”.
When giving a substantive moral judgment a CEC may want to make note of this fact.
Those who hold a pure mediation view of clinical ethics consultation would likely reject this point. However, at some point the CEC has to acknowledge that they too are a moral agent and are responsible for their actions. If for example, the CEC successfully mediates a plan of action that is seriously morally wrong, then the CEC runs the risk of moral complicity with that wrong act. A pure mediation stance would make sense when the options on the table are all morally permissible or at least not seriously morally wrong.
Another problem with this objection is that it seems like it would be equally available to the religious believer. That is, if merely giving reasons that others might not accept is disrespectful, it seems that if a non-religious interlocutor gave non-religious reasons that conflicted with the religious believer’s basic religiously based reasons then this would also be disrespectful.
A CEC need not offer their substantive moral judgments in each case. Certainly, if the options being discussed are all morally permissible, and the CEC is not asked about their view, I see no reason to think there is an obligation for the CEC to offer up their views. A danger in giving substantive moral advice is that stakeholders may mistakenly think that the CEC has some special moral insight and give underserved deference to their opinions.
For an insightful discussion of strategies to use when trying to resolve moral conflict in medicine see John Moskop’s (2016) Chapter 1 “The Role of Ethics in Health Care” and Chapter 16 “Moral Conflicts in End of Life Care” in Ethics and Health Care: An Introduction.
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Parker, J.C. Religion, Authenticity, and Clinical Ethics Consultation. HEC Forum 31, 103–117 (2019). https://doi.org/10.1007/s10730-019-09375-7
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DOI: https://doi.org/10.1007/s10730-019-09375-7