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Philosophy of Healthcare Ethics Practice Statements: Quality Attestation and Beyond

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Abstract

One element of the American Society for Bioethics and Humanities’ recently-piloted quality attestation portfolio for clinical ethics consultants is a “philosophy of clinical ethics consultation statement” describing the candidate’s approach to clinical ethics consultation. To date, these statements have been under-explored in the literature, in contrast to philosophy statements in other fields such as academic teaching. In this article, I argue there is merit in expanding the content of these statements beyond clinical ethics consultation alone to describe the author’s approach to other important “domains” of healthcare ethics practice (e.g., organizational policy development/review and ethics teaching). I also claim such statements have at least three additional uses outside quality attestation: (1) as a reflective practice learning tool to increase role clarity among practicing healthcare ethicists and bioethics fellows; (2) assisting practicing healthcare ethicists in clarifying role expectations with those they work with; and (3) helping inform developing professional practice standards.

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Notes

  1. In this article, I use the term “clinical ethics consultant” to refer to an individual who performs clinical ethics consultation. I adopt the definition of clinical ethics consultation put forward by Greenberg and colleagues; namely, “the act of conferring with, seeking clarification about, requesting deliberation concerning, asking [for] guidance/advice about ethical issues, relating to, broadly, patient-care and/or staff support from a bioethicist [or clinical ethics committee]. A consultation may involve (but is not necessarily limited to) the bioethicist [or members of the clinical ethics committee] listening, providing information, facilitating communication, advising and/or meeting with one or more persons involved” (Greenberg et al. 2014, p. 138).

  2. While professionalization of the field of healthcare ethics practice is still contested by some authors, there now appears to be a general consensus within the academic literature that the movement towards professionalization is warranted. Consequently, the discussion seems to have shifted away from whether or not there should be professionalization of the field to how exactly this professionalization ought to take place. Thus, a discussion of the merits and limitations of professionalization of the field of healthcare ethics practice is beyond the scope of this article and has been addressed elsewhere. See, for example, Cline et al. (2012), d’Agincourt-Canning 2012, Frolic and Practicing Healthcare Ethicists Exploring Professionalization (PHEEP) Steering Committee (2012), Reel (2012), Scofield (2008), and Spike (2009).

  3. In this article, I employ the definition of “Practicing Healthcare Ethicist” put forward by Simpson (2012), namely an individual with “dedicated work responsibilities within a healthcare organization to provide a variety of ethics-related services which include one or more of the following: clinical and/or organizational ethics consultation; policy development and/or review; ethics education for staff; management of ethics programs (including clinical ethics committees); mentoring of staff/learners; and conducting research ethics consultations” (p. 150, emphasis added).

  4. The ultimate goal of healthcare ethics consultation, according to the ASBH, is to “improve the quality of health care through the identification, analysis, and resolution of ethical questions or concerns” (ASBH 2011, p. 3). Intermediate goals to be met in order to achieve this ultimate goal are to “identify and analyze the nature of the value uncertainty or conflict that underlies the consultation” and “facilitate resolution of conflicts in a respectful atmosphere with attention to the interests, rights, and responsibilities of all those involved” (ASBH 2011, p. 3). The ASBH also identifies a number of additional goals of healthcare ethics consultation, including: assisting in the promotion of practices that are consistent with ethical standards and norms; informing the organization’s attempts to develop policy, implement quality improvement initiatives, and appropriately utilize resources through identifying the underlying causes of ethical concerns; and assisting individuals and the organization in addressing current and potential future ethical problems through providing healthcare ethics education (ASBH 2011). The ASBH’s emphasis on ethical standards and norms is of particular interest, given the ASBH QAPTF’s requirement that philosophy of clinical ethics consultation statements must also provide insight into areas of controversy within the field of healthcare ethics consultation. This raises the question of whether there can indeed be norms amid controversy.

  5. For example, if a physician misunderstood the legal MAID eligibility criteria and incorrectly deemed a patient eligible.

  6. A description of the quality assurance process for medical educators is beyond the scope of this article and has occurred elsewhere (e.g., Adkoli 2015; MacCarrick 2013).

  7. This fellowship has been described in detail elsewhere—for example, see Chidwick et al. (2004) and Secker et al. (2014).

  8. Similar observations have been made by others in the field—see, for example, Brinthaupt et al. (2014), Haggerty (2010), Pratt (2005).

  9. I have adopted the definition of “practice standards” put forward by Reel (2012), namely: “Authoritative statements that describe minimum practice performance expectations of a healthcare ethicist in any relevant vocational role or setting for which practitioners are accountable, reflect the values and priorities of the field, and provide direction for professional practice and a guideline for the evaluation of practice” (p. 205).

  10. Personal communication with JCB Fellowship Director.

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Acknowledgements

Special thanks to Kevin Reel, Barbara Secker, Jennifer Gibson and the two anonymous reviewers for their helpful comments on an earlier version of this manuscript. I would also like to thank Carolyn Ells and members of the University of Toronto Joint Centre for Bioethics for discussing with me some of the key ideas behind this manuscript. I also acknowledge the infrastructure funding received from the Victorian State Government through the Operational Infrastructure Support (OIS) Program.

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  1. Lauren Notini

    Present address: Level 9, Melbourne Law School, University of Melbourne, 185 Pelham Street, Carlton, VIC, 3053, Australia

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  1. Joint Centre for Bioethics, University of Toronto, Suite 754, 7th Floor, 155 College Street, Toronto, ON, M5T 1P8, Canada

    Lauren Notini

  2. Biomedical Ethics Research Group, Murdoch Children’s Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia

    Lauren Notini

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Notini, L. Philosophy of Healthcare Ethics Practice Statements: Quality Attestation and Beyond. HEC Forum 30, 341–360 (2018). https://doi.org/10.1007/s10730-018-9354-7

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