A Possible Solution, But Not the Last Word

Abstract

In 1998 the authors of Core Competencies for Health Care Ethics Consultation declined to endorse certification of individuals or groups who do ethics consultation, judging it was, best, premature. The professionalization of clinical ethics consultants has long been a subject of heated debate, with questions raised about accreditation of training programs, licensure and certification of practitioners, identification of competency standards, and development of a code of ethics. Many remain concerned about the quality of clinical ethics consultations because the level of knowledge, skill, and training seems to vary widely among practitioners. In this issue, Nancy Dubler and colleagues report on consensus recommendations from a national working convened to critique the products and processes of the Clinical Ethics Credentialing Project, whose goal is to create a model for credentialing and privileging clinical ethics consultants. In its statement, the group identified five characteristics, three components, and nine standards for clinical ethics consultation services and consultants. Two of the standards directly address consultants' credentialing and privileging. The CECP represents one possible solution to assuring quality in clinical ethics consultation. At the local level, the institution or hospital would grant privileges to qualified, credentialed ethics consultants, just as it does to clinical practitioners. These individuals would then be permitted to provide ethics consultation at the institution and to place notes in patients' medical records. A significant issue is what credentials are considered adequate for consultants who wish to apply for privileging. The CECP working group and faculty recommends completion of a formal in bioethics and clinical ethics, a supervised apprenticeship, and satisfactory written evaluations from teachers or mentors. Although the model CECP promotes contains positive elements, what qualifies as a substantial, formal program is unclear, especially given the absence of any existing accreditation process for training programs. A simpler proposal would be to assess candidate practitioners for competencies related to particular knowledge, skills, experiences, and attributes. Candidates demonstrating these competencies upon examination would be credentialed and could apply for institutional privileges. This model bypasses any requirement to participate in a training or apprenticeship. …