Doing Ethics: Who are We and What Do We Do?
Would it seem surprising to my visitors to this bioethics blog that the answer to the question in the title of this post (“Doing Ethics: Who are We and What Do We Do”) is still an unsettled issue? But it is. In fact there is still discussion by ethicists when and for what reasons the discipline of bioethics was named and started. In fact there is debate as to the history of the concepts and the many terms usually used in bioethics.
I have found that the American Society of Bioethics and Humanities (ASBH), the national organization representing many of the individuals who “do ethics”, has tried to provide some guidance with respect to the question of this posting’s title. For example,in their initial publication on the subject in 1998, they produced a report titled “Core Competencies for Health Care Ethics Consultations”, which though not as yet legally considered the standard for ethics consultations, does provide a framework which could be followed as ethics consultations remain part of the healthcare system.
I would like to offer to my visitors an excellent detailed analysis of the posting’s title in the 2004 “ASBH Taskforce Report on Ethics Consultation Liability.” Of the 80 page document which speaks to the liability issue from a legal point of view, I think it is the first 17 pages, describing who is considered an ethics consultant and what are the various consultative processes that are practiced,would be of general interest. Thus, reading the first 17 pages should give my visitor some answers to this post's title question. Then if someone asks you “who is a medical ethicist and what are they doing?”, you will be able to come back with at least some realistic answer. ..Maurice.
posted by Maurice Bernstein, M.D. @ 9:34:00 PM
2 comments
2 Comments:
Dr. Bernstein, I had honestly never thought about ethics in the terms of who can be an ethicist, and what role he would play in the general scheme of things.
One of the earlier points left a question in my mind. Could you please tell me what is meant by the following:
"The opposing argument is that physicians should not perform ethics consults because they cannot be totally objective when operating within the confines of the doctor-patient relationship."
It seems to me that the physician has to be objective to be a good physician to begin with.
Thank you for posting that. It was immensely informative. None of it was anything I'd ever thougth of before.
"The opposing argument is that physicians should not perform ethics consults because they cannot be totally objective when operating within the confines of the doctor-patient relationship."
Moof, I totally agree with that argument.. and that's why I, as an M.D., as chair of our hospital's ethics committee and as one who leads our ad hoc ethics sub-committee meetings with patients, family and medical staff to listen and mediate ethics conflicts feel quite comfortable with my role. Why? Because I and any other physician on our ethics committee are not operating within the confines of the doctor-patient relationship. We doctors on the committee have no professional relationship with the patient or the family. We are not their physician. We don't take a history from the patient, we do not examine the patient, we do not try to make our own diagnosis from the facts of the case. We depend solely on the conclusions of the various physicians caring for the patient. If there is a question or conflict of standards of medical practice involved in the case, we look to the physician's M.D. superiors to address the standard issue. We don't make medical decisions and we don't write orders in the chart. If this doesn't indicate an absence of the doctor-patient relationship, I don't know what does. We physicians on the committee repeatedly remind ourselves that we must look at clinical ethical issues from the view of ethics and law as should all the other non-M.D. members. Of course all of us on the entire committee needs to have some degree of general medical knowledge, including our community members in order to understand the clinical issue but that's all the medicine that is necessary. And what the members don't know, they are educated by those who know.
The reason I put up this post on this topic of "who we are and what we do" is because it is quite clear that the public (including some physicians!) generally hav incomplete and erroneous opinions about hospital ethics committees and their function. Anything we can do to educate the public and healthcare workers is going to help us in both pro-active and reactive conflict resolution. ..Maurice.
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