“The Notion of Neutrality in Clinical Ethics Consultation”

Abstract

Clinical ethics consultation (CEC), as an activity that may be provided by clinical ethics committees and consultants, is nowadays a well-established practice in North America. Although it has been increasingly implemented in Europe and elsewhere, no agreement can be found among scholars and practitioners on the appropriate role or approach the consultant should play when ethically problematic cases involving conflicts and uncertainties come up. In particular, there is no consensus on the acceptability of consultants making recommendations, offering moral advice upon request, and expressing personal opinions. We translate these issues into the question of whether the consultant should be neutral when performing an ethics consultation. We argue that the notion of neutrality 1) functions as a hermeneutical key to review the history of CEC as a whole; 2) may be enlightened by a precise assessment of the nature and goals of CEC; 3) refers to the normative dimension of CEC. Here, we distinguish four different meanings of neutrality: a neutral stance toward the parties involved in clinical decision making, toward the arguments offered to frame the discussion, toward the values and norms involved in the case, and toward the outcome of decision making, that is to say the final decision and action that will be implemented. Lastly, we suggest a non-authoritarian way to intend the term “recommendation” in the context of clinical ethics consultation.

The need for clinical ethics consultation: a monocentric observational survey study in the intensive care unit (Consul.E.T.I. study)

“…A CEC who interfaces with the ICU HCPs should act both on call and as needed. The ethicist should not be a neutral “mediator.” He/she should work to improve both the decision-making process and the outcome of the process, given the moral responsibility linked to said process and the complex clinical choices to be made [ 32 ]. These choices often involve ethical dilemmas which cannot be “categorized” in a pluralistic cultural context.…”

Ethics experts and fetal patients: a proposal for modesty

“…The first ethics consultants started 40 years ago, when they delivered verdicts, gave advice or recommended certain courses of action [ 13 ]. In doing so, they acted more like “a clinical professional who possesses a specific expertise” and on that basis gave advice about the ethically best course of action or the solution of a conflict [ 14 ]. The more recent ethics facilitation approach, in contrast, which is recommended by the American Society for Bioethics and Humanities as an “appropriate approach to ethics consultation” [ 8 ], aims at working towards a “principled ethical resolution” [ 15 ] in case of conflict or uncertainty regarding values or norms that emerge in health care.…”

Klinische Ethik systemisch betrachtet – Vom Einfluss systemischer Grundannahmen und Methoden auf die Gestaltung einer effektiven Ethikberatung

“…Zweitens, in welchem Umfang es zulässig und notwendig sei, seitens der Ethikberater:innen normative Positionierung einzubringen (Reiter-Theil 2009). Und drittens, ob im Zweifelsfalls die Anwaltschaft für vulnerable Interessen übernommen werden müsse (Rasmussen 2012;Tarzian et al 2015;Parker 2018;Gasparetto et al 2018). Aus dem Blickwinkel der Systemik lautet die Antwort, dass auch bei ausgewiesener Expertise für die Begründung ethischer Urteile diese in eine Beratung im Grundsatz nur als normative Angebote eingebracht werden sollten, um damit die Anwesenden bei der Formulierung einer eigenen Einschätzung im Sinne der autopoietischen K Selbstregulation zu unterstützen.…”