A Methodology for Consensus in Clinical Ethics Consultation

Abstract: In this presentation, we discuss controversies surrounding the professionalization of clinical ethics consultation, explain three common models of consensus building, and propose a consensus methodology aimed at establishing foundational clinical ethics recommendations.

There remain controversies regarding what competence or authority the Healthcare Ethics Consultation Certification (HEC-C) confers. The ASBH represents only a fraction of the people engaged in clinical ethics consultation work and reflects only consultation as practiced in the United States. There is widespread criticism of the certification process. And some reject the very concept of “ethics expertise” implied by certification. Attempts to address these concerns through standard scientific or democratic consensus procedures continue to meet substantial resistance from the bioethics community. Thus, clinical ethicists seem, on the one hand, committed to robust professionalization and, on the other, resistant to processes that would establish the uniform standards needed to achieve it.

While the field of clinical ethics contains several important points of consensus, there is work to be done to determine the nature, strength, and extent of consensus on issues that serve as the knowledge base for the field. Here, we review three prominent consensus methodologies—the NIH model, the medical consensus conference model, and the white paper model—highlighting strengths and weaknesses related to the epistemic authority of their outcomes. We then sketch a new consensus methodology for establishing foundational clinical ethics recommendations.

Abram Brummett – Assistant Professor, Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine