By Doug Hardman and Phil Hutchinson.

The clinical ethics business is booming. Since the field’s emergence in the 1970s, ethicists have established research and teaching centres, taken control of teaching ethics to medical students, and more recently begun to establish a new applied role: the clinical ethics consultant. Academics in philosophy, law and the social sciences are now central in the oversight of issues previously the preserve of clinicians. Underpinning this rise is the assumption that the clinical ethicist has a distinct set of knowledge and skills that afford them an ‘epistemic advantage’ in discussing relevant ethical issues: critical analysis, argument mapping, and knowledge of moral theories are oft-cited. Despite all this evident success, however, there remains a persistent, if marginal, critique of clinical ethics as something one cannot really be an expert in. If this is right, then one might ask: what on earth is everyone doing?

Clinical ethicists principally ground their claims to expertise in philosophical ethics, which is largely focused on the development and discussion of various normative moral theories and abstract dilemmas. This distinct philosophical body of knowledge has informed a dominant framework of teaching and practising clinical ethics grounded in the interpretation and application of various mid-level theories – such as the four principles – to clinical cases. The value of this framework is immediately obvious to the clinical ethicist: it entails a body of knowledge clinicians do not have. Medical students and clinicians can thus be taught a range of theories, frameworks and tools that will, it is promised, make them more ethically expert. The problem with this approach, however, is that the ethical issues at play in any given situation are rarely made clearer by the application of an abstract theory or framework. Worse, such an approach risks introducing philosophical non-problems into a deliberation, and can obscure insights from common morality and a clinician’s hard-won personal relationship with their patient.

In a recent article, where we explore how ethical issues manifest in a range of clinical situations, we propose a different approach to understanding clinical ethics. We argue that the problem with the dominant framework of clinical ethics is grounded in thinking of ‘ethics’ as a special, philosophical word used in a theoretical or general way. Instead, we argue that clinical ethics should be conceived merely as an aspect of the clinical situation made clear by the everyday perspective afforded to us as individuals living with one another in society. Becoming ‘ethically expert’, therefore, is achieved not by increased knowledge and application of various moral theories and frameworks, but by cultivating a greater understanding of and sensitivity towards patients’ everyday lives. Such an approach to clinical ethics not only questions the way in which we teach ethics to medical students and clinicians, but the very legitimacy of the ethical expert in the clinic. On these terms, the clinical ethics business, although booming, does not seem to be good business for anyone except clinical ethicists.

Paper title: Where the ethical action is

Authors: Doug Hardman^a and Phil Hutchinson^b

Affiliations: ^aBournemouth University, ^bManchester Metropolitan University.

Competing interests: None

Social media accounts of post authors: @phil_hutchinson