Abstract
What kind of criticism does the term ‘moralism’ make? In this paper, I examine whether clinical ethics consultation is even moralistic, and the relevance to this question of the moral expertise of the clinical ethicist. More specifically, I pose two questions: why might clinical ethics consultation sometimes be perceived as moralistic, and does clinical ethics consultation ever require a certain kind of moralism? I begin by looking at the term moralism, providing an exposition of some relevant philosophical work. Moving to clinical ethics, I examine two concerns about clinical ethics, concerns at least partly underwritten by worries about moralism. I then address the issue of the perception of moralism in clinical ethics consultation, and suggest that the clinical ethics consultant’s moral expertise can (and ought to) reduce that perception. Finally, I examine the requirement of clinical ethics consultation of a certain kind of moralism, this in fact as a result of the clinical ethics consultant’s moral expertise.
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Notes
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Politicians tend to think about the notion of standing. Michael Ignatieff, former Canadian Prime Ministerial hopeful, writes about the notion of standing in connecting it to “forms of personal authority” (Ignatieff 2013, 126). He writes about what he takes to be the necessity of having standing to being elected to political office. Ignatieff speaks about how his main political opponent “denied him standing in his own country” (Ignatieff 2013, 126); Ignatieff’s campaign was plagued by charges that having been away from Canada for so long, he was overstepping certain boundaries by running for Prime Minister. In the eyes of the electorate, Ignatieff lacked the authority to speak on Canadian political issues, and thereby lacked standing with the Canadian electorate.
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Fullinwider 2005, 111.
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In the technician role, the ethicist might clarify the topic of the consultation, or elucidate relevant concepts, stopping short of telling people “what is right or wrong” (Churchchill and Cross 1986, 5).
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Thanks to Giles Scofield for directing me to the Hedlund piece.
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Adams (forthcoming) does not offer answers to these questions, though he takes himself to have initiated the relevant conversation. In his paper in this volume, he argues that the clinical ethics consultant’s expertise lies in “the deployment of skill in moral reasoning,” which suggests that his answer to such questions is no.
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Impact Ethics is an on-line forum for discussion of bioethical issues, which prioritizes the Canadian context. Its mission statement is: “(1) to promote critical discussion of bioethical/health policy issues relevant to Canadians; (2) to disseminate opinions on these issues from diverse perspectives to a wide academic and non-academic audience; and (3) to promote public engagement with and education on bioethical issues.” See https://impactethics.ca/about/
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Thanks to Lynette Reid for directing me to this blog post.
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The authors cite E. Fox, S. Myers, and R.A. Pearlman, “Ethics Consultation in United States Hospitals: A National Survey,” American Journal of Bioethics 7, no. 2 (2007): 13–25.
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Aulisio et al., “Health Care Ethics Consultation: Nature, Goals, and Competencies,” Ann Intern Med 2000; 133; 59–69.
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This is often my own experience in doing clinical ethics consultation, and that of many clinical ethics consultants with whom I have worked. It is also my experience that those involved with a consult are often grateful for the consult even when it does not match these expectations.
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Autumn Fiester emphasizes this concern. See Fiester, this volume (Chap. 14).
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It is true that some argue that no one is in a position to say what others ought to do, and that therefore there are no moral experts. See, for example, the discussion of the views of C.D. Broad (1952) and Bernard Williams (1993 and 1995), in Watson and Guidry-Grimes (2018) introduction to this volume.
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They might also involve worries about the current lack of standard training or professional status of clinical ethicists, though such a concern is perhaps more likely to come from within clinical ethics than outside of it. For an argument that clinical ethicists need clinical experience (and not merely academic training) for robust expertise, see Butkus, this volume (Chap. 13).
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This is the case for my colleagues and me. The upside of such arrangements is that not being employed by the organization for whom we facilitate ethics consultations, the perception (or reality) of a conflict of interest, one whereby there would be pressure to make a certain kind of recommendation on certain topics, for instance, is minimized. A possible downside is that in not being embedded in the health care organization, familiarity and trust relationships with those involved in a consult might be lacking.
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Thank you to volume co-editor Laura Guidry-Grimes for the suggestion of this example.
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Fiester (2015).
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For questions about the training of future clinical ethics consultants in the attitudes, attributes, and behaviors set out by the ASBH, see Flynn (2017).
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For a discussion of the virtues and drawbacks of various theoretical (and non-theoretical) approaches to bioethics, see Arras 2010.
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The question of when self-certainty is appropriate in moral philosophy and clinical ethics is complex. Speaking to clinical ethics, I would hold that it is a mistake for a clinical ethicist to act as though the ‘correct’ resolution is obvious. Based on my experience doing clinical ethics consultation, the resolution to a situation is often not obvious, and it is not always clear that one course of action is clearly morally superior to other options.
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Earlier versions of this paper were presented at the 2014 meeting of the Canadian Bioethics Society in Vancouver, and as part of the University of Toronto’s Joint Centre for Bioethics Seminar Series in October 2016. My thanks to all in attendance. Thank you also to the co-editors of this collection, Jamie Watson and Laura Guidry-Grimes, for their detailed and helpful comments.
References
Adams, David M. 2015. Clinical ethics consultation and physician assisted suicide. In New directions in the ethics of assisted suicide and euthanasia, ed. M. Cholbi and J. Varelius, 125–147. Switzerland: Springer.
———. Forthcoming. Are hospital ethicists experts? Taking ethical expertise seriously. Forthcoming, this volume.
American Society for Bioethics and Humanities (ASBH). 2011. Core competencies for health care ethics consultation. 2nd ed.
American Society for Bioethics and Humanities (ASBH), and PSI Services. 2017. Certification for health care ethics consultants: An update.
Archard, David. 2011. Why moral philosophers are not and should not be moral experts. Bioethics 25 (3): 119–127.
Arras, John. 2010. Theory and bioethics. In The Stanford encyclopedia of philosophy, ed. E.N. Zalta https://plato.stanford.edu/entries/theory-bioethics/.
Aulisio, Mark P., Robert M. Arnold, and Stuart J. Younger. 2000. Health care ethics consultation: Nature, goals, and competencies. Annals of Internal Medicine 133: 59–69.
Baier, Annette. 1993. Moralism and cruelty: Reflections on Hume and Kant. Ethics 103: 436–457.
Broad, C.B. 1952. Ethics and the history of philosophy. London: Routledge.
Casarett, David J., Frona Daskal, and John Lantos. 1998. Experts in ethics? The authority of the clinical ethicist. Hastings Center Report 28: 6–11.
Churchchill, Larry R., and Alan W. Cross. 1986. Moralist, technician, sophist, teacher/learner: Reflections on the ethicist in the clinical setting. Theoretical Medicine 7: 3–12.
Clouser, K. 1972. Philosophy and medicine: The clinical management of mixed marriage. In Proceedings, first session, institute on human values in medicine, 47–80. Philadelphia: Society for Health and Human Values.
Crary, Alice. 2009. Beyond moral judgment. Cambridge: Harvard University Press.
Crosthwaite, Jan. 1995. Moral expertise: A problem in the professional ethics of professional ethicists. Bioethics 9 (4): 361–379.
Diamond, Cora. 1997. Moral differences and distances: some questions. In Commonality and particularity in ethics, ed. Lilli Alanen, Sara Heinämaa, and Thomas Wallgren, 197–234. Great Britain: MacMillan Press.
Dubler, Nancy N., Mayris P. Webber, and Deborah M. Swiderski. 2009. Charting the future: Credentialing, privileging, quality, and evaluation in clinical ethics consultation. Hastings Centre Report 39: 23–33.
Fiester, Autumn. 2015. Teaching nonauthoritarian clinical ethics: Using an inventory of bioethical positions. Hastings Center Report 45 (2): 20–26.
Flynn, Jennifer. 2017. Clinical bioethics and core competencies of attributes, attitudes, and behaviors: Foundations in philosophy and literature. Ethics, Medicine, and Public Health 3: 335–342.
Fox, E., S. Myers, and R.A. Pearlman. 2007. Ethics consultation in United States hospitals: A national survey. American Journal of Bioethics 7 (2): 13–25.
Fullinwider, Robert K. 2005. On moralism. Journal of Applied Philosophy 22: 105–120.
Gesang, B. 2010. Are moral philosophers moral experts? Bioethics 24 (4): 153–159.
Hedlund, Maria. 2014. Ethics expertise in political regulation of biomedicine: The need of democratic justification. Critical Policy Studies 8: 282–299.
Ignatieff, Michael. 2013. Fire and ashes: Success and failure in politics. Toronto: Random House Canada.
Jonsen, Albert R. 1991. American moralism and the origin of bioethics in the United States. The Journal of Medicine and Philosophy 16: 113–130.
Kodish, Eric, Joseph J. Fins, Clarence Braddock, et al. 2013. Quality attestation for clinical ethics consultants: A two-step model from the American society for bioethics and humanities. Hastings Center Report 43: 26–36.
Sithole, Ndundu. 2014. South African anti-apartheid author, Nobel winner Gordimer dies. http://www.reuters.com/article/us-safrica-gordimer-idUSKBN0FJ1F320140714. Accessed 11 Aug 2017.
Snyder, Jeremy, and Valorie A. Crooks. 2014. How we learned not to drop the e-bomb. https://impactethics.ca/2014/09/15/how-we-learned-not-to-drop-the-e-bomb/. Accessed 20 Oct 2016.
Watson, Jamie, and Laura Guidry-Grimes. 2018. Introduction to this volume.
Williams, Bernard. 1993. Who needs ethical knowledge? Royal Institute of Philosophy 35: 213–222.
———. 1995. Truth in ethics. Ratio 8 (3): 227–236.
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Flynn, J. (2018). Clinical Ethics Consultation: Moralism and Moral Expertise. 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_15
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