A Compromised and Ineffectual Field?

Those seeking to understand what practising healthcare ethicists do, or may reasonably be expected to do, might fruitfully begin their enquiries by reviewing employment advertisements or by reviewing the role descriptions that have been developed by practitioners in order to clarify the character and scope of their work. The nature of the practice will vary somewhat depending on institutional context: an ethics consultant working in a mental health facility may find herself employing slightly different skills, knowledge, or expertise than her colleague across town at a children’s hospital but, for the most part, their daily tasks will be much the same. As the literature on professionalization reveals, the work of the PHE generally falls within four broad categories: healthcare ethics consultation (which responds to requests for assistance in resolving value conflicts arising in the care of patients), organizational ethics support (which includes policy development and review as well as assistance with one-off decisions which do not pertain specifically to the care of individual patients), supplying education to staff and others on ethical topics, and conducting and evaluating research. It is the first of these that has attracted the most attention and controversy, although it can convincingly be argued that these are not entirely separable domains. Practising healthcare ethicists generally find fodder for their educational efforts, and inspiration for their research, in the cases that come before them. Similarly, policy development is almost always motivated by a desire to address clinical or organizational gaps, and rarely can be useful if it is uninformed by research and unaccompanied by an appropriate educational plan. The policies of healthcare institutions cover incredibly wide-ranging topics such as organ donation after cardio-circulatory death, disclosure of medical error, and the appropriate management of relationships with pharmaceutical industry representatives. They are rarely authored by healthcare ethicists alone (indeed, it is routine for representatives of a dozen or more professional practice areas to have a hand in their writing), and they nearly always undergo multiple layers of committee review, but a PHE often can exert a tremendous influence with respect to the content and disposition of the final product. Even the most independent chief executive officer, or confident medical advisory committee, may be reluctant to grant approval to a policy or guidance document that has been described as ethically deficient by the institution’s own healthcare ethicist or ethics consultation service.