For decades a debate has played out in the literature about who bioethicists are, what they do, whether they can be considered professionals qua bioethicists, and, if so, what professional responsibilities they are called to uphold. Health care ethics consultants are bioethicists who work in health care settings. They have been seeking guidance documents that speak to their special relationships/duties toward those they serve. By approving a Code of Ethics and Professional Responsibilities for Health Care Ethics Consultants, the American Society (...) for Bioethics and Humanities (ASBH) has moved the professionalization debate forward in a significant way. This first code of ethics focuses on individuals who provide health care ethics consultation (HCEC) in clinical settings. The evolution of the code's development, implications for the field of HCEC and bioethics, and considerations for future directions are presented here. (shrink)

In the last few decades, the ethics of care as a feminist ethic has given rise to extensive literature, and has affected moral inquiries in many areas. It offers a distinctive challenge to the dominant moral theories: Kantian moral theory, utilitarianism, and virtue ethics. This chapter outlines the distinctive features and promising possibilities of the ethics of care, and the criticisms that have been made against it. It then examines the ethics of care’s recognition of human dependency and of the (...) importance of responding to needs; its interpretation of the roles of emotion and reason in moral understanding; and its critique of liberal individualism and development of a conception of the person as relational. The ethics of care contrasts care with justice, tries to integrate them, and reconceptualizes public and private life and morality. (shrink)

The moral expertise of clinical ethicists is not a question of mastering codelike theories and lawlike principles. Rather, ethicists are architects of moral space within the health care setting, as well as mediators in the conversations taking place within that space.

In this paper I seek to distinguish a feminist virtue ethics of care from (1) justice ethics, (2) narrative ethics, (3) care ethics and (4) virtue ethics. I also connect this contemporary discussion of what makes a virtue ethics of care feminist to eighteenth and nineteenth century debates about male, female, and human virtue. I conclude that by focusing on issues related to gender - primarily those related to the systems, structures, and ideologies that create and sustain patterns of male (...) domination and female subordination - we can begin to appreciate that true care and bona-fide virtue can flourish only in societies that treat all persons with equal respect and consideration. (shrink)

Volume 20, Issue 3, March 2020, Page 44-46.

Volume 20, Issue 3, March 2020, Page 46-50.

Efforts to professionalize the field of bioethics have led to the development of the Healthcare Ethics Consultant-Certified (HEC-C) Program intended to credential practicing healthcare ethics consultants (HCECs). Our team of professional ethicists participated in the inaugural process to support the professionalization efforts and inform our views on the value of this credential from the perspective of ethics consultants. In this paper, we explore the history that has led to this certification process, and evaluate the ability of the HEC-C Program to (...) meet the goals it has set forth for HCECs. We describe the benefits and weaknesses of the program and offer constructive feedback on how the process might be strengthened, as well as share our team’s experience in preparing for the exam. (shrink)

This paper responds to a proposal for an intersectional approach to the clinical encounter between patient and medical provider. We agree that an intersectional framework offers new insights and information in the clinical encounter. Intersectionality involves awareness of the physician-patient dynamic, and understanding the various privileges and disadvantages of all parties involved, at a micro and macroscopic level. Yet, this analysis alone is insufficient to aid in the clinical encounter and risks harm. We worry about a clinician making assumptions about (...) her patient’s race, gender, economic status, and how these influence the patient’s own views of her life and health. We argue that a narrative supplement is a necessary element of intersectional clinical encounters. Prioritizing patient narrative curtails assumptions, builds trust, and improves care. (shrink)

Context: Although ethics consultation is commonplace in United States (U.S.) hospitals, descriptive data about this health service are lacking. Objective: To describe the prevalence, practitioners, and processes of ethics consultation in U.S. hospitals. Design: A 56-item phone or questionnaire survey of the "best informant" within each hospital. Participants: Random sample of 600 U.S. general hospitals, stratified by bed size. Results: The response rate was 87.4%. Ethics consultation services (ECSs) were found in 81% of all general hospitals in the U.S., and (...) in 100% of hospitals with more than 400 beds. The median number of consults performed by ECSs in the year prior to survey was 3. Most individuals performing ethics consultation were physicians (34%), nurses (31%), social workers (11%), or chaplains (10%). Only 41% had formal supervised training in ethics consultation. Consultation practices varied widely both within and between ECSs. For example, 65% of ECSs always made recommendations, whereas 6% never did. These findings highlight a need to clarify standards for ethics consultation practices. (shrink)

Clinical ethics consultations are sometimes deemed complete at the moment when the consultants make a recommendation. In CECs that involve actual ethical conflict, this view of a consult's endpoint runs the risk of overemphasizing the conflict's resolution at the expense of the consult's process, which can have deleterious effects on the various parties in the conflict. This overly narrow focus on reaching a decision or recommendation in consults that involve profound moral disagreement can result in two types of adverse, lingering (...) sequelae: moral distress or negative moral emotions. The problem, succinctly named, is that such consults have insufficient “closure” for patients, families, and providers. To promote closure, and avoid the ills of moral distress and the moral emotions, I argue that CECs need to prioritize assisted conversation between the different stakeholders in these conflicts, what is often referred to as “bioethics mediation.”. (shrink)

Volume 20, Issue 3, March 2020, Page 6-8.

Volume 20, Issue 3, March 2020, Page 1-5.

Currently, there is no authoritative credentialing process for individuals engaged in ethics practice, no accreditation system that sets minimum education standards for programs aiming to prepare these individuals for their work, and little evidence available that any particular training model is actually achieving its pedagogical goals. At the same time, a number of healthcare organizations and universities now routinely offer post-graduate programs, clinical fellowships and in-house training specifically devised to prepare graduates for ethics practice. However, while their numbers appear to (...) be growing, information about these programs is limited. In this paper, we describe the goals, content and strategies of three educational programs offered in Ontario, Canada. These case studies highlight the diversity of ethics education available to those who engage in ethics practice and underscore the need to take this variety into account in the development of future education standards that would specify minimally acceptable educational requirements. (shrink)

Much has been written about the importance of narrative in teaching ethics and humanities to medical students and residents, as well as the value of narratives in clinical care. Relatively little has been said about the essential role of narrative in bioethics consultations. For most consults, the interpretation of narratives is the central moral feature, and the ethics consultant is inevitably one of the narrators. In a recent consult in which I participated, at least three narratives were in play. The (...) medical record itself was a narrative, or really, a variety of narratives. A second distinct narrative was the story of why this case had come to be categorized as an ethical concern for the medical team. A third narrative was the tentative sketch running through my mind as a consultant‐partly factual, partly anticipatory and conjectural, inevitably personal‐about what was going on here. (shrink)

Although clinical ethicists are becoming more prevalent in healthcare settings, their required training and education have not been clearly delineated. Most agree that training and education are important, but their nature and delivery remain topics of debate. One option is through completion of a clinical ethics fellowship. In this paper, the first four fellows to complete a newly developed fellowship program discuss their experiences. They describe the goals, structure, participants and activities of the fellowship. They identify key elements for succeeding (...) as a clinical ethicist and sustaining a clinical ethics program. They critically reflect upon the challenges faced in the program. The one-year fellowship provided real-time clinical opportunities that helped them to develop the necessary knowledge and skills, gain insight into the role and scope of practice of clinical ethicists and hone valuable character traits. The fellowship enabled each of the fellows to assume confidently and competently a position as a clinical ethicist upon completion. (shrink)

This article describes, analyzes, and advocates for management of clinical healthcare conflict by a process commonly referred to as bioethics mediation. Section I provides a brief introduction to classical mediation outside the realm of clinical healthcare. Section II highlights certain distinguishing characteristics of bioethics mediation. Section III chronicles the history of bioethics mediation and references a number of seminal writings on the subject. Finally, Section IV analyzes barriers that have, thus far, limited the widespread implementation of bioethics mediation.

What is at the basis of moral action? An altruism acquired by the application of rule and principle? Or, as Noddings asserts, caring and the memory of being cared for? With numerous examples to supplement her rich theoretical discussion, Noddings builds a compelling philosophical argument for an ethics based on natural caring, as in the care of a mother for her child. The ethical behavior that grows out of natural caring, and has as its core care-filled receptivity to those involved (...) in any moral situation, leaves behind the rigidity of rule and principle to focus on what is particular and unique in human relations. Noddings's discussion is wide-ranging, as she considers whether organizations, which operate at a remove from the caring relationship, can truly be called ethical. She discusses the extent to which we may truly care for plants, animals, or ideas. Finally, she proposes a realignment of education to encourage and reward not just rationality and trained intelligence, but also enhanced sensitivity in moral matters. (shrink)

On July 4, 1990, while on a morning walk in southern France, Susan Brison was attacked from behind, severely beaten, sexually assaulted, strangled to unconsciousness, and left for dead. She survived, but her world was destroyed. Her training as a philosopher could not help her make sense of things, and many of her fundamental assumptions about the nature of the self and the world it inhabits were shattered.At once a personal narrative of recovery and a philosophical exploration of trauma, this (...) book examines the undoing and remaking of a self in the aftermath of violence. It explores, from an interdisciplinary perspective, memory and truth, identity and self, autonomy and community. It offers imaginative access to the experience of a rape survivor as well as a reflective critique of a society in which women routinely fear and suffer sexual violence.As Brison observes, trauma disrupts memory, severs past from present, and incapacitates the ability to envision a future. Yet the act of bearing witness, she argues, facilitates recovery by integrating the experience into the survivor's life's story. She also argues for the importance, as well as the hazards, of using first-person narratives in understanding not only trauma, but also larger philosophical questions about what we can know and how we should live.Bravely and beautifully written, Aftermath is that rare book that is an illustration of its own arguments. (shrink)

Narratives have always played a prominent role in both bioethics and medicine; the fields have attracted much storytelling, ranging from great literature to humbler stories of sickness and personal histories. And all bioethicists work with cases--from court cases that shape policy matters to case studies that chronicle sickness. But how useful are these various narratives for sorting out moral matters? What kind of ethical work can stories do--and what are the limits to this work? The new essays in Stories and (...) Their Limits offer insightful reflections on the relationship between narratives and ethics. (shrink)

Violence and the Remaking of a Self Susan J. Brison. Political activism (including lobbying for new legislation, speaking out, educating others, helping survivors) can also help to undo the double bind of self-blame versus helplessness.

In Black Feminist Thought, Patricia Hill Collins explores the words and ideas of Black feminist intellectuals as well as those African-American women outside academe. She not only provides an interpretive framework for the work of such prominent Black feminist thinkers as Angela Davis, Alice Walker, and Audre Lorde, but she shows the importance of self-defined knowledge for group empowerment. In the tenth anniversary edition of this award-winning work, Patricia Hill Collins expands the basic arguments of the first edition by adding (...) several important new themes. A new discussion of heterosexism as a system of power, an expanded treatment of images of Black womanhood, U.S. Black feminism's connections to Black Diasporic feminisms, and more attention to the importance of social class and nationalism all appear in the new edition. In addition, the new edition includes recent developments in black cultural studies, especially black popular culture, as well as recent events and trends such as the Anita Hill hearings and the backlash against affirmative action. (shrink)

Why mediation? -- What makes bioethics mediation unique? -- Before you begin a bioethics mediation program -- The stages of bioethics mediation -- Techniques for mediating bioethics disputes -- How to write a bioethics mediation chart note -- Mediation with a competent patient : Mr. Samuels's case -- Mediation with a dysfunctional family : Mrs. Bates's case -- A complex mediation with a large and involved family : Mrs. Leonari's case -- Discharge planning for a dying patient : a role-play (...) -- An at-risk pregnancy : a role-play -- HIV and postsurgical complications in the ICU : a role-play -- Treating the dying adolescent : a role-play -- She didn't mean it : a role-play -- Don't tell mama : a role-play -- An at-risk pregnancy : a role-play transcript -- HIV and postsurgical complications in the ICU : a role-play transcript -- She didn't mean it: a role-play transcript -- Don't tell mama : a role-play transcript. (shrink)

Where society is viewed as an association of equal and autonomous persons, the work of caring for dependents, "love's labors", figure neither in political ...

Nel Noddings argues that hers is not an ethics of agape. I want to argue, on the contrary, that it is, and that this is a problem. My central thesis is that the unidirectional nature of the analysis of one-caring reinforces oppressive institutions.