Abstract
Irrespective of whether the practice of clinical ethics consultation (CEC) is generally accepted or not, the nature of moral expertise behind it continues to be a contestable concept. In this essay, instead of arguing for whether clinical ethics consultants possess such expertise or not, I envision a third way of understanding the nature of moral expertise in ethics consultation: as the locus of an inherent paradox. I argue that moral expertise in clinical ethics consultation is built on an inner ideological struggle between pluralism and expertise—inclusion and exclusion—and that this inbuilt tension forms the core of the paradox. However, I claim that this paradox does not have to lead into a paralyzing contradiction, but instead, it could be embraced positively as a guarantee of keeping the moral space open. Moreover, I argue that putting too strong emphasis on consensus as a professional ideal of CEC may, surprisingly, threaten the fostering of open social space for moral discussions. As the baseline of this argument I utilize Mouffe’s theory of agonistics. In the end of the chapter, I conclude that recognizing the division of values, and opening social space for struggle, can in itself be seen as both a goal and a justification for clinical ethics consultation.
“The opposite of a correct statement is a false statement. But the opposite of a profound truth may be another profound truth.”
Niels Bohr
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Notes
- 1.
I acknowledge that the line between values and knowledge is blurred and theoretically more complex than is suggested here.
- 2.
For example, Yoder (1998) argues that while a medical specialist embodies specialist expertise, expertise can also be generalist in its essence. Put simply, while the expertise of the specialist is defined by the depth of her knowledge, the expertise of the generalist is defined by the breadth of her knowledge.
- 3.
As Aulisio et al., for example, write in “Ethics Consultation—From Theory to Practice” (2003, 7): “[T]here is no particular privileged substantive moral view. (…) We are religious and nonreligious, utilitarians and Kantians, egoists and natural lawyers, atheists and theists, and we have a right to be so.” Overall, I believe this statement to capture the spirit of CEC.
- 4.
The argument I make is based on a generalization of my empirical findings and what I find to be the ethos of CEC literature. One could ask the more in-depth philosophical question of what version of pluralism is the most productive baseline for healthcare decision-making. In order to focus sharply on my point of introducing a way to view moral expertise as a paradox, I will not address this topic in this essay. Therefore, the absence of a more detailed analysis of the concept of pluralism is a limitation of this text.
- 5.
In short, agonistics is a theory that accepts antagonisms and value divisions to be permanent, and presumes that conflict can only be disguised, but not overcome, by social manufacturing of consensus. The theory seeks to show how the existence of this conflict can be channeled in a positive way. “Adversaries fight against each other because they want their interpretation of the principles to become hegemonic, but they do not put into question the legitimacy of their opponent’s right to fight for the victory of their position. This confrontation between adversaries is what constitutes the ‘agonistic struggle’ that is the very condition of a vibrant democracy” (Mouffe 2013, 7).
- 6.
“Each society has its regime of truth, its ‘general politics’ of truth: that is, the types of discourse which it accepts and makes function as true; the mechanisms and instances which enable one to distinguish true and false statements, the means by which each is sanctioned; the techniques and procedures accorded value in the acquisition of truth; the status of those who are charged with saying what counts as true.” Foucault in Rabinow 1984, 73.
- 7.
Again, a discussion of its own—which is out of the scope of this chapter—is what kind of understanding of pluralism is the most functional and justified to serve as the basis of CEC practice.
- 8.
A concept close to Foucault’s “regimes of truth,” hegemony refers to an established idea that has become so normalized in a given cultural setting that it is seldom openly questioned (Gramsci 1971 as cited by Fairclough 1992, 91–96). Many poststructuralist social research traditions, such as critical discourse analysis, presume that hegemonic social constructions that shape and constrain thinking in a given culture can be discovered by studying the use of language. While hegemonies present some culturally embedded ideas as normal, as “common sense,” they silently marginalize other ways of thinking. (Ibid.)
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Saxén, S. (2018). To Stretch toward without Reaching: Moral Expertise as a Paradox in Clinical Ethics Consultation. 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_16
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