Ethical Expertise, Maternal Thinking, and the Work of Clinical Ethicists

Abstract

This essay results from thinking about ethical expertise in relation to the goals of clinical ethics consultation and the challenges of teaching ethics. My thoughts have centered on two sets of issues. The first emerges from articles, published in philosophy journals in the mid-1970s to early 1990s, that debated the possibility and nature of ethical expertise, as well as the proper role of so-called moral experts in the public arena and institutional settings. The debate was timely because of what Annette Baier then described as the “recent expansion of the socially tolerated role of salaried moral philosophers beyond colleges into hospitals and into the work places of other professions” (Baier, 1984, p. 491). In the first section of this essay, I outline major threads of this debate and suggest various puzzles and inadequacies in the accounts of ethical expertise. I suggest that it may be fruitful to “begin at the end,” with the actual activities of putative ethics experts, in order to understand what traits, training, activities, and goals are appropriate for would-be ethics experts. In the essay’s second section, I discuss a set of issues emerging from my experience as one of those philosophers who, as Baier puts it, “do” applied ethics in clinical contexts and from discussions with colleagues similarly engaged. I show how the practical challenges and apparent paradoxes that we face as clinical ethics consultants and teachers relate to philosophical concerns raised in section one, and I propose that examination of a different sort of work — that of mothers — may shed light on this second set of issues. I argue that what Sara Ruddick terms “maternal thinking” helps to characterize aspects of the work of ethics experts in clinical settings and that the sort of ethical caring that must be undertaken in health care institutions suggests justifications for the roles of “professional ethicists” in them. In the essay’s final section, I employ analysis of maternal thinking to address additional concerns about ethical expertise raised in the philosophical and bioethics literature, particularly concerns centered on the appropriate role for ethics experts in a pluralistic society with regard to advising institutional and public policy making bodies and influencing public discourse.