Echo Calling Narcissus: What Exceeds the Gaze of Clinical Ethics Consultation?

Abstract

Guiding our response in this essay is our view that current efforts to demarcate the role of the clinical ethicist risk reducing its complex network of authorizations to sites of power and payment. In turn, the role becomes susceptible to various ideologies-individualisms, proceduralisms, secularisms-that further divide the body from the web of significances that matter to that body, where only she, the patient, is located. The security of policy, standards, and employment will pull against and eventually sever the authorization secured by authentic moral inquiry. Instead of asking "What do I need to know?", the question animating the drive to standardize will be "What is the policy or standard?" The claims of the authors in this issue of HEC Forum confirm these suspicions.

Responsibility After the Apparent End: ‘Following‐up’ in Clinical Ethics Consultation

“…Unfortunately, many of the current proposals to evaluate quality simply fail to establish any such correspondence. 24 These are vexing issues. We raise them, however, not as rhetorical devices but rather in acknowledgement of what occurs within the midst of actually doing ethics consultation such that concern for 'follow-up' acquires clinical impetus.…”

Phenomenology, Saudi Arabia, and an argument for the standardization of clinical ethics consultation

“…Describing this process, Bishop et al write, "the subject carries with him into every place that he goes the set of categories that he deploys. This gaze then can be deployed wherever he goes" ( [13], 79). These themes are used to critique the pro-credentialing proceduralistic view they claim is embedded in ASBH's attempt to standardize CEC.…”

“…For Bishop et al, the proceduralistic ethicist also avoids substantive moral claims and instead focuses on standardizing the process of performing an ethics consult-everything from what one does upon receiving a consultation request to developing a standard format for the note that is eventually placed in the patient's chart. Invoking Tristram Engelhardt, Bishop et al point out that this purported eschewing of substantive ethical content creates for a confusing equivocation when ethicists "claim normative expertise in matters moral and at the same time deny moral authority in actual cases" ( [13], 75-76). They write, "The expertise of the CEC, because she has been formed by a process that avoids substantive content, will be a master of process" ( [12], 284).…”

“…In their critique of standardization in clinical ethics consultation (CEC), Bishop et al frame the debate as one between pro-credentialing procedural and anticredentialing phenomenological views [11][12][13]. 1 The procedural view they describe is committed to quantifying the core aspects of CEC, developing a standardized process for performing CEC, and deploying abstract categories and concepts in consultations in order to transform the consultant into a confident, capable professional.…”

Conceptualizing Boundaries for the Professionalization of Healthcare Ethics Practice: A Call for Empirical Research

“…Other descriptors will appear in relation to a specific reference or point of discussion as appropriate. 2 See for example: Baker (2007Baker ( , 2009 ;Bishop et al (2010); Clinical Ethics Consultation and Affairs (2010); Engelhardt (2009); King (2007); Scofield (2008); Spike (2009); Simpson (2012); Steinkamp et al (2008). 3 Examples include: The Core Competencies for Healthcare Ethics Consultation greater attention to the need for epistemological reflection on the relationship between theory and practice in the healthcare ethics realm have also been growing.…”