Experts in Ethics

Abstract

Madam: two articles on Experts in Ethics (HCR, November-December 1998) present an interesting view on the nature of expertise in the field of clinical ethics. first article (David J. Casarett, Frona Daskal, and John Lantos, The Authority of the Clinical Ethicist) stresses the importance of communication and consensus. second (Scot D. Yoder, The Nature of Ethical Expertise) defines expertise in terms of reasoning and providing justifications. As such, they make explicit some central aspects of clinical ethics work. Both articles try to give a foundation for clinical ethics by referring, respectively, to Habermas and Aristotle. Although the two contributions are certainly relevant, they also tend to be onesided, both in their view of clinical ethics practice and in their interpretation of philosophical theory. They tend to underestimate the fact that clinical ethics is highly contextual, and that its most important feature is the ethical assessment of concrete situations-an issue that makes the ethical theories of Habermas and Aristotle relevant for clinical ethics in ways the authors seem to overlook. According to Aristotle ethics is always about concrete situations. Clinical ethics is a splendid example of practical philosophy in the Aristotelian sense-that is, of a discipline that requires knowledge about particulars as well as knowledge about general rules and principles. essence of expertise in this field is to apply general rules to the concrete situation, to see how general principles fit to specific circumstances. This means that an expert in clinical ethics is not only able to establish relevant general rules, but also to see to it that they are applied in the right manner. This expertise can be called hermeneutic competence. Aristotelian perspective presupposes that ethics deals with truth. In this respect it is at odds with Yoder's suggestion that it is sufficient to provide a coherent justification for one's judgment. For Aristotle, coherence is not good enough; a recommendation is valid only if it is the best policy, given the concrete situation. It is, however, not easy to establish this. People need experience to apply rules and principles. Even experienced persons will have to know a lot about the details of the situation before they can give a sound judgment. This may explain the divergence in outcome when ethics consultants are asked to respond to hypothetical cases: such cases are probably too abstract and too thin for concrete recommendations. Habermas shares with Aristotle the presupposition that ethics is about truth. He claims that moral judgments can be right or wrong. He also agrees with Aristotle that ethics deals both with principles and with their application to concrete circumstances. Habermas gives ethics an intersubjective twist, however. Both the validity of general principles and the adequacy of their application to specific situations are not to be established through individual reasoning, but through dialogue and discussion. Habermas distinguishes between two kinds of institutionalized discussions regarding ethical issues: practical discourse and application discourse. Practical discourse is about the general validity of norms and principles; application discourse is about their application to a specific situation. Practical discourse aims at universalization, whereas application discourse aims at contextualization. In his theory of discourse ethics, Habermas puts most emphasis on the concept of practical discourse. This has given rise to the criticism that he tends to overlook the im-