17 May, 16 | by BMJ
Guest Post by Abraham Schwab
During a recent meeting at a local hospital, I was asked what role a good Healthcare Ethics Consultant should play. I gave a more ambiguous answer than I would like. I pointed out that Healthcare Ethics Consultants can help patients, providers, and administrators come to a common understanding of the values at play in a particular health care situation. A Healthcare Ethics Consultant can also help them reach a decision that reflects the medical realities, the patient’s values, and, as appropriate, the families’ values. But I also pointed out that the role of the Healthcare Ethics Consultant is determined by the particular institution’s needs. One institution’s Healthcare Ethics Consult can look like another’s Family Care Conference or another’s Palliative Care Consult and so on. In short, the Healthcare Ethics Consultant’s role and responsibilities is not neatly defined across institutional boundaries.
The American Society of Bioethics and Humanities (ASBH) Code of Ethics and Professional Responsibilities for Healthcare Ethics Consultants aims to “set out the core ethical responsibilities of individuals performing healthcare ethics consultation.” If successful, it would provide guidance as clinical ethicists and others attempt to answer the question, “What is a Healthcare Ethics Consultant responsible for?”. Looking over the ASBH’s code, however, it’s hard to imagine using it to provide a content-rich and clear answer. As I argue in my paper, “The ASBH Code of Ethics and the Limits of Professional Healthcare Ethics Consultations”, the code falls short of its goal in two substantive ways. First, the Code implicitly relies on the category “professional”, despite the fact that this category lacks clear definition. Second, the code articulates only vaguely defined responsibilities.
The ASBH’s Code of Ethics is a short document – less than five pages – but invokes the word “professional” 14 times. That the word is not defined in the code is of no surprise: the use of “professional” is common coin in health care fields. And yet, the category “professional” is poorly defined. As I argue, the best available definition is a formal one: professionals share a common commitment to something. But that something remains undefined in general. The concept of “profession” is a placeholder indicating that practitioners of a particular occupation have taken on certain additional obligations, and those obligations are specific to the profession in question. When an occupation claims to be a “profession”, a necessary follow-up question is, “But what does that mean for your occupation?” Ideally, the ASBH’s Code of Ethics would answer this question for Healthcare Ethics Consultants.
In this regard, the ASBH’s code falls far short. Most of the broadly defined obligations could be the obligations of any occupation. The obligations also include conceptual confusions, from conflating privacy and confidentiality to invoking the requirement that Healthcare Ethics Consultants should meet professional standards – the very standards that the Code itself should be providing.
Despite these shortcomings, I write to criticise the ASBH code, not to bury it. Healthcare Ethics Consultants play important roles in the institutions in which they exist. Help in defining their responsibilities is needed. And so I also provide a suggestion for moving the ASBH code forward. Specifically, the relationships between “professionals” in health care has shifted. The isolated responsibilities of the isolated physician have gone the way of the country doctor. The work of health care “professionals” is now the work of a team and a system, and the responsibilities that attach to these “professionals” are team-based responsibilities. Further defining the responsibilities of Healthcare Ethics Consultants will require a more comprehensive collaboration across disciplinary boundaries.
If the ASBH’s Code of Ethics and Professional Responsibilities for Healthcare Ethics Consultants is to help answer the question, “What role does a Healthcare Ethics Consultant play?”, it’s next iteration will have to provide more narrowly and clearly defined responsibilities.
Read the full paper here.