The Nature of Ethics Expertise in Clinical Ethics and Implications for Training of Clinical Ethics Consultants

Abstract

This essay considers the nature of ethical expertise, threats to ethical expertise, and implications for the training and certification of clinical ethics consultants. First, the idea of ethical uncertainty within medicine is examined. An important source of uncertainty is ethical dilemmas. Second, the expertise required to resolve ethical uncertainty is explored. Such expertise must have two components: (a) analysis, which involves identifying and clarifying the underlying ethical dilemma, and (b) weighing, a process of deliberating and providing reasons for why one obligation or set of obligations should be preferred over another. To do these things, two competencies are required. One is a practical skill, a practical moral judgment, which requires experience within clinical environments and clinical medicine. A second is a body of theoretical knowledge, including knowledge of ethical theory, approaches to ethical deliberation, moral philosophy, and the norms of medicine. Finally, the implications of these components for training and accreditation of clinical ethicists are discussed. Training should develop both competencies, which requires a theoretical education in basic ethical knowledge, and a practical apprenticeship such as a residency or fellowship. Standardization and quality attestation are potentially important mechanisms to ensure that ethics consultants have the required competencies that make up ethics expertise and that they do not practice according to the methods that undermine ethics expertise.