Debating Ethical Expertise

Abstract

This paper explores the relevance of the debate about ethical expertise for the practice of clinical ethics. We present definitions, explain three theories of ethical expertise, and identify arguments that have been brought up to either support the concept of ethical expertise or call it into question. Finally, we discuss four theses: the debate is relevant for the practice of clinical ethics in that it (1) improves and specifies clinical ethicists' perception of their expertise; (2) contributes to improving the perception of moral competence of non-ethicists; (3) gives insight into complementary styles of argumentation of ethicists and non-ethicists; and (4) contributes to the awareness of the problem of profession-building of (clinical) ethicists.

Clinical Ethics Support in Contemporary Health Care

“…Advocates of CES argue that ethics expertise need not involve any metaphysical claim regarding moral truths or the claim that clinical ethicists have epistemic access to such truths (Yoder, 1998;Steinkamp, Gordijn, and ten Have, 2008;Rasmussen, 2011aRasmussen, , 2011b. According to Rasmussen (2011a), metaphysical objections largely stem from the ambiguity of the term "moral expertise".…”

“…Ethics expertise, as opposed to moral expertise, involves making "non-normatively binding recommendations grounded in a pervasive ethos or practice within a particular context" (Rasmussen, 2011a, 650). Steinkamp, Gordijn, and ten Have (2008) use a similar definition of ethics expertise, that is, the capacity to provide "strong justifications" to argue that the dialogue between the expert ethicist and clinicians is a cogently democratic means of reaching consensus on the moral norms at hand (Steinkamp, Gordijn, and ten Have, 2008). In this dialogue, the expertise of the ethicist complements and enhances the moral competence of the non-ethicists, clinicians (and patients) by clarifying what is ethically at stake (Steinkamp, Gordijn, and ten Have, 2008).…”

“…Steinkamp, Gordijn, and ten Have (2008) use a similar definition of ethics expertise, that is, the capacity to provide "strong justifications" to argue that the dialogue between the expert ethicist and clinicians is a cogently democratic means of reaching consensus on the moral norms at hand (Steinkamp, Gordijn, and ten Have, 2008). In this dialogue, the expertise of the ethicist complements and enhances the moral competence of the non-ethicists, clinicians (and patients) by clarifying what is ethically at stake (Steinkamp, Gordijn, and ten Have, 2008). Conceived as such, ethics expertise does not make a metaphysical claim that there are moral truths and that clinical ethicists have epistemic access to such truths, does not usurp the autonomy and agency of the non-expert and offers expertise but does not assume authority (Rasmussen, 2011a).…”

The “Ethics” Expertise in Clinical Ethics Consultation

“…Three domains feature prominently in discussions of bioethics expertise: courts (McAllen and Delgado, 1984;Agich and Spielman, 1997;Kipnis, 1997;Wildes, 1997;Spielman and Agich, 1999); the clinical setting (Meyers, 2007;Steinkamp, Gordijn, and ten Have, 2008;Kovács, 2010;Rasmussen, 2011;Slowther and McClimans, 2012); and public policymaking and government commissions (Brock, 1987;Kamm, 1990;Powers, 2005). As with general ethics expertise, critical questions here include: what is bioethics expertise?…”

Ethikberatung in der klinischen Praxis - Bisherige Erfahrungen und zukünftige Herausforderungen

“…Während Themen der klinischen Ethik zunehmend in die Ausbildung einfließen und es mittlerweile vielfältige Qualifizierungsangebote mit unterschiedlichen Abschlüssen gibt, bleibt es doch weiterhin eine Herausforderung, eine ethisch ausgewiesene Diskussion fachgerecht zu moderieren und ein KEK erfolgreich in einem Krankenhaus zu implementieren [36]. Es wird deshalb notwendig sein, dass zumindest die Moderatoren und Mitglieder der KEKs sich entsprechende Kompetenzen aneignen [37]. KEKMitglieder sollten damit auch problematischen Tendenzen entgegenwirken können, etwa wenn ethische Fallbesprechungen einseitig missbraucht werden; sie sollten eine kompetente ethische Fallbesprechung einfordern, in der sorgfältig zwischen sich widersprechenden Prinzipien abgewogen wird.…”