Ethics Consultation: From Theory to Practice
Williams, R. Henry, Ethics & Medicine
Ethics Consultation: From Theory to Practice Mark P. Alusio, Robert M. Arnold, Stuart J. Youngner, eds. Baltimore, MD: The Johns Hopkins University Press, 2003. ISBN 978-0801871658; 241 PAGES, CLOTH $45
It has been said that the practice of medicine is a moral enterprise. Yet, for those who do ethics consultations in hospitals, this idea must be approached with caution, according to the authors of this provocative and instructive volume. Achieving 'moral consensus' in specific situations is what ethics consultants are charged to do, regardless of their own preferred moral frameworks within bioethics. However controversial this charge may be, this book provides many realistic and practical insights for approaching clinical ethical dilemmas.
With the American Society for Bioethics and Humanities report on Core Competencies for Health Care Ethics Consultation as a background, several chapters expand on the following questions: Is there really a need for ethics consultation? If so, how should it be structured? What training is needed? What approach will fit in a pluralistic, liberal democracy? Should ethics consultants be licensed or certified?
The authors open by establishing the need for ethics consultation in the first chapter, citing three salient features of modern health care: complexity of decision making (related both to technology and to fragmentation of care), 'value heterogeneity' (people 'just don't agree'), and the growing recognition of the rights of individuals (autonomy, or self-determination). The consultant is advised to avoid authoritarianism by knowing 'what's best' and striving for a particular outcome, or by 'riding roughshod' over an inclusive process while failing to fully open lines of communication. On the other hand, consultants should also avoid pure facilitation, getting folks to come to any consensus as the only goal. Rather, 'ethics facilitation' is the preferred approach, where the goal is consensus within the context of social and political realities - societal values, law, and institutional policy. …