Lifeboat Frameworks, Certification, and the Work of Clinical Bioethics

Abstract

This chapter argues that the American Society for Bioethics and Humanities (ASBH) certification program is yet another indication of the pervasiveness of lifeboat framing within bioethics. Sample questions and cases from the ASBH certification exam are critiqued for their portrayal of ethics consulting as offering advice in highly truncated, slice-of-life situations. This portrayal further discourages attention to the broader moral and social context of problematic clinical cases, where many of the most lasting resolutions can be found. Detailed reports are offered on how bioethicists in successful programs routinely work, including the skill sets they employ. These reports reveal that the ASBH exam offers greatly simplified and inaccurate situations for analysis, and therefore that passing the exam has little or no relevance for the real on-the-ground expertise needed to do clinical ethics consultations. Three kinds of humility in bioethics consultative work are described: epistemic, moral, and ontological. Recommendations for a better approach for certification in this important and challenging field are offered. These recommendations emphasize not only the factual knowing that aspect of bioethics, but also the skills of knowing how, acquired only through on-site apprenticeship, mentoring, and reflection.