The moral basis for competent, clinical ethics consultation, I would like to argue, is largely derived from the moral premises of our normative understanding of what it means to be a “good doctor” as reflected in a self-conscious commitment of a good physician to treat patients as best as one can according to prevailing standards of professionalism and medical ethical principles. The good doctor stands in relationship to a patient, within a well-defined framework of moral rights and professional obligations. This linkage between the activity of clinical ethics consultation and our understanding of a good physician further defines the work of the ethics consultant squarely in framework of clinical, medical competencies.
To further see this linkage, it is useful to consider how and when value conflicts arise in the physician-patient relationship. For the vast majority of physician-patient encounters, there is agreement and absence of conflict. But in the less frequent cases of moral conflict, there are competing visions of what should happen—regarding the goals of care and who has the moral authority to define those goals. In short, how are competing rights and obligations to be balanced between the patient and physician, but also the surrogate, the hospital and potentially many other interests, especially in the midst of the emotion and stress that illness and impending death can induce both to patients and their families? It is the latter contextual aspect of grounding value conflicts within a patient’s and family’s illness experience, and the necessary ability to function effectively in clinical encounters, that requires the competent ethics consultant to also possess the general qualities of a caregiver, and to understand the moral perspective of a good physician.
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