"Who am I to Say?" Why Clinical Ethics Consultants Should be Trained to Give Directive Counsel.

Abstract

Although clinical ethics consultation once involved the ethicist exercising practical reason to make moral judgments and recommendations, today clinical ethicists largely attempt to keep their “personal” moral judgments on the sidelines (Bell, 2022). Practical reason gives way to reliability, reproducibility, and patient autonomy. As a result, healthcare ethics (HE) consultants operate more as proceduralists negotiating conflicts than as counselors offering substantive recommendations. This pattern mirrors a similar mode of “de-moralization” among medical practitioners, in which clinicians eschew moral evaluation and judgment in favor of facilitating patient access to requested “health care services.” Medicine, like healthcare ethics consultation (HEC), becomes characterized by proceduralism, and clinicians’ moral assessments come to seem irrelevant if not threatening to the twin goals of bureaucratic efficiency and patient autonomy. In this essay, we argue that HE consultants should resist this bent toward procedure over moral substance. A “de-moralized” clinical ethics will neither fulfill its practitioners nor help the patients and clinicians it serves. Against the tide of standardization, bureaucratization, and efficiency-based care driving medical and ethical decision-making, HE consultants, like physicians, should seek to discern the goods/benefits and evils/harms at stake in different contexts and make recommendations toward the former and away from the latter. Those forming the professional identities of HE consultants should encourage them to approach their training as “moral formation” in which they hope to develop the skills and wisdom to offer sound moral counsel to those reckoning with morally complex clinical decisions.