March 3, 2014 | Posted By Marleen Eijkholt, PhD

If someone asked me: What is my philosophy of clinical ethics? I would initially be dumbstruck for an answer. In response, I would probably try to define an answer from my background in bioethics and philosophy. I would pick frameworks in philosophy that represent my approach. For example, I would be inclined to refer to pragmatism and casuistry, as frameworks that determine my clinical ethics approach. My last blog post about Marlise Munoz, the brain dead woman in Texas is a good example of this. My philosophy as a clinical ethicist is based on the facts of the case, a subsequent calculation of rights and wrongs. The outcome of this sum guides my ethics advice about what is practically possible, conform short-handed pragmatism. In responding to a case, I start with the specifics of a case and formulate answers that may be acceptable by multiple stakeholders, instead of relying on general theoretical outcomes, as a short-handed casuist. Finally, I reason along the lines of several relevant principles, such as autonomy, beneficence, non-maleficence, justice and dignity, and seek to apply these principles to the specifics of a case.

However, given that the background of clinical ethicists lies over a broad spectrum, I doubt that this answer would be satisfactory.  If I hadn’t had a background in bioethics, what would I have answered to this question? Does the fact that I am an ethicist in the clinic mean that I have to frame my answers along philosophical and ethical theories? Would a social worker, an accountant or an attorney equally have a philosophy in their work? Asking myself this latter question, I think that those professions do have a professional philosophy, but that they would be less likely to phrase it in philosophical language. Instead, probably they would describe their philosophy in more layman’s terms and would narrate about their approach in the different cases they see. So how do I approach my cases as a clinical ethicist?

I believe the philosophy of clinical ethics to be determined by the goals of clinical ethics. I see its goals related to problem solving and conflict resolution in clinical cases. In addition clinical ethics is about giving all stakeholders a voice, and making them feel heard, regardless of their background. Often problems arise where the participants are in conflict, sometimes at an impasse, because of value-laden goals and understandings, or when stakeholders believe that their voices are not being heard/their values appreciated. Within this context, my philosophy of clinical ethics is to frame advice and solutions in a way that is ethically supportable and around which stakeholders may reach consensus. Ideally, solutions should be supported bottom-up and preferably stem from stakeholder initiatives. Clinical ethicists should not act as final judges about what is right or wrong in a specific case. Instead, they should function as informers and guides about the case’s ethical dimensions, as well as the ethical supportability of different solutions. 

In order to achieve my goals I seek to listen, rephrase, synthesize, analyze and uncover the stakeholder’s (differing) positions and values. Communication and information are key methods to show concern and to achieve my goals of clinical ethics. Listening to the different stakeholders helps me to appreciate their perspectives and enables me to provide them with a voice. Rephrasing stakeholder perspectives aims to make their positions transparent and assists in achieving clarity.  Subsequent synthesis of these positions clarifies their interrelation. Synthesis and transparency also serve for outsiders, to appreciate the different positions and makes stakeholders accountable. Finally, I seek to use analysis of the different positions to uncover the different values at stake.

The adagio for a clinical ethics consultant in my hospital is: help them to help themselves. The clinical competencies of the ASBH suggest that a clinical ethicist is not supposed function as an authoritarian consultant and to impose his/her viewpoints. My philosophy of clinical ethics is therefore to enlighten the stakeholder’s perspectives in a particular case, and to help them help themselves in approaching the cases according to my philosophy set out above.

I believe that there is a philosophy of clinical ethics in what I described above. I doubt that my approach differs from the general approach of others engaged in clinical ethics. Our philosophy pivots around the goals of clinical ethics, which would be the same for everyone.  

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

1 comments | Topics: Clinical Ethics , Philosophy


Athene Aberdeen

Athene Aberdeen wrote on 03/03/14 7:11 PM

Very well expressed MARLEEN EIJKHOLT, PHD. I wonder though what would happen with a stakeholder who has very different views from yours and refuses to budge.

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