January 16, 2013 | Posted By Bruce White, DO, JD

Those involved in healthcare ethics consultation professionalism efforts face many challenges. Many – particularly academics involved in bioethics education – have been working on the notion that those who offer clinical ethics consultation services as individuals be appropriately credentialed, certified, or accredited in someway.

In re-reading an article by Diane Hoffmann, Anita Tarzian, and Anne O’Neil which appeared in the Journal of Law, Medicine & Ethics in 2000, one striking challenge is readily apparent: ethics committee members – with little or no formal training in clinical ethics, little or no actual consultation experience, some with not much more than a sufficient interest in biomedical ethics issues and a willingness to serve – already feel competent to participate in offering consultation services. Moreover, from the Hoffmann-Tarzian-O’Neill data set, ethics committee members who self-report that they are competent to participate in clinical ethics consultation – and in hospitals which average only three consultations per year – believe that they are meeting their obligations to patients, families, staff, and institutions reasonably well.

Perhaps those who read the article should not be surprised by these findings? After all, it is probably certain that the respondent members of these ethics committees were just doing what other similarly situated colleagues across the U.S. are doing. In fact, the study results prove that. Regrettably, as part of their conclusions, the authors state:

These findings alone leave us with the impression and support the contention that many ethics committees function based on the belief that no special expertise is necessary to perform an ethics consult. This conclusion was also confirmed by the comments of one committee member who said (s)he was offended by a survey question that asked whether (s)he had any educational preparation for performing consults (e.g., a certificate in bioethics, or a degree in philosophy or a discipline related to ethics. (S)he further stated that the question “implies that this [ethics consultation] requires some sort of degree certificate.” This, (s)he said, “may be necessary for being a developer of ethical principles but not for day-to-day elucidation. Don’t professionalize ethics committees.”

It may be hard (maybe impossible) to convince good and reasonable persons – most of them expertly skilled as physicians, nurses, lawyers, social workers, chaplains, hospital administrators – that any specific training or mentorship in clinical ethics consultation topics or practice is really that necessary. From the survey results, even suggesting that unique training or expertise is required, after many ethics committee members have served their local institutions adequately for several years, and even decades (and with no one ever questioning whether or not they should have a special expertise or competency in clinical ethics), may be seen as adding insult to injury. But on the other hand, the study also finds that the vast majority of those involved in clinical ethics consultation did have some additional training in bioethics, clinical ethics, or a related discipline. One is left to wonder why these individuals sought additional education or mentorship? Were they just more interested in the topics and materials, or did they sense that additional education might be helpful in meeting their ethics committee consultation duties?

Further, as some state legislatures formalize ethics committee responsibilities and functions (such as the Texas Advance Directives Act with its medical futility provisions that involve ethics committees, and the New York Family Health Care Decisions Act with its binding authority and referral provisions involving ethics review committees), there must be the expectation that ethics committee members bring some sort of expertise – surely more than passing interest and willingness to serve – to the table to deal with complex ethical dilemmas?

In the end, it may not really be the academics or educators that press for credentialing, certification, or accreditation of persons or programs related to clinical ethics consultation, as much as it is those who are offering the services now in institutions across Amcrica, or regulators who have come to believe that special education and skills may be necessary if ethics committee members are meet obligations to patients and society competently.

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.

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BIOETHICS TODAY is the blog of the Alden March Bioethics Institute, presenting topical and timely commentary on issues, trends, and breaking news in the broad arena of bioethics. BIOETHICS TODAY presents interviews, opinion pieces, and ongoing articles on health care policy, end-of-life decision making, emerging issues in genetics and genomics, procreative liberty and reproductive health, ethics in clinical trials, medicine and the media, distributive justice and health care delivery in developing nations, and the intersection of environmental conservation and bioethics.