And most hospitals are understandably leery about getting a hold of theory trained ethicists as opposed to clinically trained ethicists. My own experience as an ethicist in a hospital was that we were repeatedly told that the staff needs people to step up and give them something concrete to act on…not just pie in the sky discussions. The buzz word I’m learning at my current place of employment is that by the end of the day you have to deliver a usable product….something other than paper’s being published in academic journals. So, for example, we must provide resources for character development, consulting programs with people willing to stick their necks out and commit to a course of action, and theory based models of action.

I’m not sure I buy into the analogy of the accountant. The analogy of stepping out of professional practice by advising to break the law is a bit off. Accountants are, in many cases, paid precisely to help people avoid paying taxes or to at least minimize their tax burden making use of tricky law. Lawyers defend criminals all the time. They don’t have to step out of their professional role to do this, they do precisely because it is professionally required of them.

If “My ethicist told me i was in the clear” is a delegation of responsibility, then lawyers, doctors, and any professionals suffer the same. And we don’t allow that, do we? Or if we do, then why not allow similar leeway for ethicists giving advice? Why do people go to professionals? Because they are unable to do something on their own. It seems reasonable that if someone is in a moral bind, and is actively seeking competent advice (whatever that is), then it is morally praiseworthy to get advice and act on it.

Not sure i have the energy to comment on the rest of the comments, although there are some worthy insights. I think the underlying theme is that ethicists, as in, “I study moral theory” should not be clinicians. My own take is that this is correct as far as that goes. But throw in someone trained in moral psychology, counseling, and decision making and you would have a plausible candidate for a professional clinical ethicists.

Nneka - careful about inviting me across to your shop: I might just accept…

It seems to me that Mr. Brassington has objected to the role of the hospital bioethicist on the basis of an incoorect understanding of our purpose and functions. As a hospital bioethicist in the US, we do not quote law. We leave that to the lawyers. Nor do we tell the clinicians what to do. Rather, our primary mission is to assist our clinicians, patients, families and administrators think through the complexities of modern medical care and come up with solutions that are in the best interests of our patients and families, given real time decision-making needs. We do this, most notably, through assisting our attending physicians to teach our residents and through other educational outlets for all our clinicians. Through teaching, we arm our clinicians with the tools they need to meet standards of excellence in patient care.

The utility of the relatively new position of hospital bioethicist comes out of the modern complexity of decision-making, the rise of technology, value heterogeneity and the contemporary recognition of the rights of the individual and the implications of honoring these rights within the medical context (Aulisio et. al. Ethics Consultation: From Theory to Practice. The Johns Hopkins University Press. 2003).

That Mr. Brassington doesn’t fully appreciate this complexity or the ways in which hospital bioethicists contribute to reducing the problems such complexity produces, however, is not surprising. In an important study of ethics consultation in the US(Fox et al. Am J Bioeth.2007 Feb: (2):13-25, it was noted that those writing and speaking about bioethics are usually not those doing bioethics. Although the article was referring to the vast majority of those in the US doing hospital bioethics who are physicians, nurses and others from a hospital’s ethics committee, the comment speaks directly to hospital clinical bioethicists. For the amount written about the role of the hospital clinical ethicist one would expect our numbers to be bigger. Instead, there are really only a relative few who hold staff positions titled something like, “hospital bioethicist” or “hopsital clinical ethicist”. That may be why persons, like Mr. Brassington, who write about problems in the role of bioethicist are often off target. It is hard to write cogently about what one does not know. What is needed is for hospital bioethicists to write more about what it is we do so that the academics, like Mr. Brassington, can do the kind of academic work that is desperately needed by the field, ie conducting studies of which hospital bioethics activities produce the best outcomes, of how and where bioethics can be most useful to hospital systems functioning, or of what kinds of ethics training are most effective for clinicians and administrators to increase the quality of moral discourse throughout a hospital system and/or facility.

Our group is working towards conducting such studies and experimenting with novel educational models (eg. DeRenzo et. al. Rounding. Cambridge Quarterly of Healthcare Ethics. 2006;15(2):207-215), but we need our academic colleagues to address these issues from their perspective. That will be much more helpful than having academics write articles, in important and visible publications, criticizing what we do when they get what we do wrong. That is more than a disservice to the few hospital clinical bioethicists who exist. More importantly it confuses clinicians about what we do, reducing the prospect that hospitals will create positions for truly clinical hospital bioethicists who can assist the clinicians in taking better care of their patients.

Respectfully submitted,

Evan G. DeRenzo, Ph.D.
Senior Bioethicist
Center for Ethics
Washington Hospital Center
Washington, D.C.

Editor-In-Chief
Journal of Hospital Ethics

Disclaimer: The reader should know that Daniel Sokol, Ph.D., mentioned by Mr. Brassington at the beginning of his article, is the International Contributing Editor for the Journal of Hospital Ethics.