Job Description of a "Clinical Ethicist"
The first question would be is a "job description" really necessary when involved with decisions regarding patient care? Shouldn't aspects of the job be already presumed? If one is a physician or a nurse, the job description is virtually presumed. The thread here is not about the role of the physician or nurse but that of those who call themselves "clinical ethicists".
Interestingly, to be called a "clinical ethicist" there is no professional body to provide the accreditation of teaching programs for learning that occupation, there is no professional body who is responsible to certify that the individual who calls him/herself a "clinical ethicist" has really met the educational and other professional standards (no agreed upon standards yet!) for that title and there is no "Code of Ethics" to set ethical standards of behavior. Beyond all that.. there is no established job description for the "clinical ethicist". Why do we need some sort of job description? Well, basically there is some controversy as to whether the "clinical ethicist" should be the advocate for the patient who is the focus of the ethical consultation and directly contribute to the final decision. Some say "yes" but some say the ethicist should not be considered a stakeholder in the deliberation. So, yes, a job description is certainly a first step in the development of criteria for a formal profession.
As former chairman of two different hospital ethics committees and currently a member of one, based on my experience and view of the issues that ethicists and ethics committees experience, I would like to state my idea of what a clinical ethicist should do and be doing as part of his or her occupation.
I look at the "job" of someone who calls themselves a "clinical ethicist" as a sub-specialty of being an ethicist (similar to being a cardiac surgeon while also responsible for the duties of being a physician). To me "clinical" sets the interest to the issues related to the care and treatment of a specific patient and is not describing any administrative nor organizational aspects of being an ethicist. It is that sub-specialty that I want to see a job description clarified.
To me, the difference between "patient advocate" and "teacher and mediator for all the stakeholders" is non-comparable. To me, the end result is either: the clinical ethicist or the ethics consultation committee selects and makes the final decision vs a final decision made by agreement of the stakeholders is also distinctively different. I would feel satisfied if the job description of a "clinical ethicist" participating (and I am not saying "leading") in a case of a patient is one that states "teaching current ethical consensus and law to the stakeholders, teaching methods of looking at conflicting values, mediating discussion by the stakeholders toward their goal of the stakeholders selecting a final decision." The "clinical ethicist" must then accept whatever decision is reached by the stakeholders as long as it does not grossly violate current ethics and current law. If it does, the violation, as judged by the ethicist, must be explained and the discussion by the stakeholders continued as they desire. To me, while the hospital and administration itself may be one of the stakeholders, the clinical ethicst or ethical consultation committee is not.
More on the job description:
In the case of making a life-death decision (such as turning off life-support) for an clearly established un-befriended patient who has no capacity to make medical decisions and for which the attending physician has solitary responsibility for the decision, the "clinical ethicist" performs the same role as with patients who have or have no capacity but who have family, friends or documents to provide surrogate decision-making or "best interest" decisions. The role is that of educating the physician regarding the ethics and law involved and to state and document the ethicist's conclusion as to whether the physician's decision was in keeping or violating the ethics and law.
If you were attending an ethics committee consultation meeting as a family member of a sick hospital patient and a serious medical decision had to be made, what role would you want the ethicist or ethics committee members to play in the meeting or in the final decision? ..Maurice.
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