The “Ethics” of Clinical Ethics: The Elephant in the Room

Abstract: Despite broad consensus in recent years that the purpose of clinical ethics consultation is to identify, analyze, and resolve ethical issues that arise in patient care, surprisingly little attention has been given to the question of what constitutes a distinctively ethical issue in this domain. What are we doing when we “do” clinical ethics? What does it mean to be engaged in ethics as a professional practice? When contacted by a clinician or patient, how should the ethicist understand her role qua ethicist? Is she being asked to analyze an issue of general morality, professional morality, conventional morality, or something else? At stake is the proper framing of our normative role as ethicists. Answering this meta question strikes at the core of our professional identity and remains conceptually prior to discussions of method and moral expertise.

Our panel will wade into this debate. Following an introduction, the first panelist will discuss the relationship between general ethics and clinical ethics, arguing that clinical ethics cannot remain neutral on substantive, contested moral issues and should to some extent engage with general ethics. The second panelist will argue that clinical ethics presupposes some metaphysical-moral framework, especially assumptions about human nature and personhood. The third panelist will contend that clinical ethics is a second-order discipline, identifying and applying prevailing conventional rules of good practice, with room for innovation in virgin territory by organic extension of existing moral rules. Concluding remarks will draw implications for the field in light of continued efforts at professionalization.