Online research in philosophy

A study of clinical medical ethicists was conducted to determine the various philosophical positions they hold with respect to ethical decision making in medicine and their various positions' relationship to the subjective-objective controversy in value theory. The study consisted of analyzing and interpreting data gathered from questionnaires from 52 clinical medical ethicists at 28 major health care centers in the United States. The study revealed that most clinical medical ethicists tend to be objectivists in value theory, i.e., believe that value judgments are knowledge claims capable of being true or false and therefore expressions of moral requirements and normative imperatives emanating from an external value structure or moral order in the world. In addition, the study revealed that most clinical medical ethicists are consistent in the philosophical foundations of their ethical decision making, i.e., in decision making regarding values they tend not to hold beliefs which are incompatible with other beliefs they hold about values.

This essay draws on Ludwig Wittgenstein?s work to argue for a practice-oriented concept of expertise. We propose that conceptualizing types of expertise as having a family resemblance, relative to the problems such expertise addresses, escapes certain limitations of defining expertise as primarily epistemic. Recognizing the pragmatic purchase on actual problems a Wittgensteinian approach provides to discussions of expertise, we seek to understand the nature of expertise in situations where the people who need to make a difficult decision do not possess or have access to the epistemic status that traditionally confers expertise. These are situations where people need to answer difficult questions that, while they may be informed by expertise in the epistemic register, are ultimately decided by expertise that weighs certified knowledge against the intractable characteristics of a particular situation. We suggest that there is not?even deep down on a conceptual level?only one kind of expertise, but multiple kinds of expertise that resonate with diverse kinds of problems.

This article addresses the problem of expertise in a democratic political system: the tension between the authority of expertise and the democratic values that guide political life. We argue that for certain problems, expertise needs to be understood as a dialogical process, and we conceptualize an understanding of expertise through and as argument that positions expertise as constituted by and a function of democratic values and practices, rather than in the possession of, acquisition of, or relationship to epistemic materials. Conceptualizing expertise through argument leads us to see expertise as a kind of phronetic practice, oriented toward judgments and problems, characterized by its ability to provide inventional capacities for selecting the best possible resolution of a particular problem vis-à-vis particular expectations regarding the resolution of a problem. At its core, expertise thus comes to exist in reference not to epistemic but to dialogical, deliberative, democratic practice.

The role of normative reflection and the possibilities of ethical inquiry in technology assessment have been under discussion in the TA community for several years. As an outcome of this discussion the necessity of explicitly dealing with normativity in TA has widely been acknowledged. However, it is still quite unclear in which way this should be done. This paper is dedicated to the role (and limitations) of ethical expertise in this field, especially in HTA. By methodological analysis an approach is developed to show how entry points for ethical expertise could be identified. The result is that ethical expertise can inform moral debates by uncovering underlying assumptions, by making the normative structure of argumentation transparent, and by weighing the strength of the arguments. In this way moral debates in HTA can become more transparent and opened to argumentative reasoning instead of consisting of bargaining processes determined by power distributions. Ethical reflection, however, does not replace decision-making.

This reply to Giles Scofield's critique of the authors' article in the June 2008 issue of the Kennedy Institute of Ethics Journal highlights two main topics. First, contrary to what Scofield suggests, using the terms "ethics" and "morality" interchangeably constitutes an oversimplification that blurs important distinctions. Second, in a representative democracy, ethical expertise and consultation need not generate a "tragic choice" of the kind Scofield has in mind.

The legitimacy of clinical ethics consultation is often implied to rest on the legitimacy of moral expertise. In turn, moral expertise seems subject to many serious critiques, the success of which implies that clinical ethics consultation is illegitimate. I explore a number of these critiques, and forward “ethics expertise,” as distinct from “moral expertise,” as a way of avoiding these critiques. I argue that “ethics expertise” succeeds in avoiding most of the critiques, captures what clinical ethics consultants might justifiably do, and expresses a subject matter which can be taught and assessed.

Can we legitimately speak of ethicsexperts? Recent literature in philosophy and medical ethics addresses this important question but does not offer a satisfactory answer. Part of the problem is the absence of an examination of what it means to be an expert in general. I therefore begin by reviewing my analysis of expertise which appeared earlier in this journal. We speak of two kinds of experts: persons whose expertise is in virtue of what theyknow (epistemic expertise), or what theydo (performative expertise). Applying this analysis to the domain of ethics, I argue that we may speak of ethical expertise in three epistemic senses: a) expertise indescriptive ethics, b) expertise inmetaethics, c) expertise innormative ethics, and in a performative sense: d) expertise inliving a good life. I conclude with a brief description of some social roles of ethics experts.

The proliferation of ethics committees and ethics consultation services has engendered a discussion of the issue of the expertise of those who provide clinical ethics consultation services. In this paper, I discuss two aspects of this issue: the cognitive dimension or content knowledge that the clinical ethics consultant should possess and the practical dimension or set of dispositions, skills, and traits that are necessary for effective ethics consultation. I argue that the failure to differentiate and fully explicate these dimensions contributes to the confusion over the issue of expertise and fuels, at least partly, the controversies about expertise (or authority) in ethics and the legitimacy of the use of ethical knowledge in clinical ethics consultation.

In a recent article, Steinkamp, Gordijn, and ten Have discussed a new way of thinking about the ethics consultant's ethical expertise. After critiquing their model of ethical expertise, along with the notion that discourse can and will enable ethicists to consult without over-reaching, this essay suggests that the debate about ethical expertise is intractable because it constitutes a 'tragic choice'.