Skip to main content
SpringerLink
Log in

Clinical Ethics and Professional Integrity: A Comment on the ASBH Code

  • Published:
HEC Forum Aims and scope Submit manuscript

Abstract

The Code of Ethics and Professional Responsibilities for Healthcare Ethics Consultants instructs clinical ethics consultants to preserve their professional integrity by “not engaging in activities that involve giving an ethical justification or stamp of approval to practices they believe are inconsistent with agreed-upon standards” (ASBH, 2014, p. 2). This instruction reflects a larger model of how to address value uncertainty and moral conflict in healthcare, and it brings up some intriguing and as yet unanswered questions—ones that the drafters of the Code, and the profession more broadly, should seek to address in upcoming revisions. The objective of this article is to raise these questions as a way of urging greater clarification of the Code’s overall approach to professional integrity, its meaning, and implications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Notes

  1. ASBH (2014)is reprinted in Tarzian and Wocial (2015).

  2. Tarzian and Wocial (2015) emphasizes this distinction.

  3. See for example McCullough (1995).

  4. See also Wicclair (2000).

  5. See, e.g., Ackerman (1987, pp. 313); Andre (2001, p. 17); ASBH (1998, p. 3); ASBH (2011, p. 2); Aulisio (2003, p. 9); Dubler (2009, p. 25); Dubler and Liebman (2011, p. 9); Fletcher and Siegler (1996, p. 125); Jonsen et al. (2002, p. 1); Kanoti and Younger (1995, p. 404); La Puma and Schiedermayer (1991, p. 141); Siegler et al. (1990, p. 5); Tarzian et al. (2015, p. 4).

  6. The second edition of Core Competencies charges the ethicist with determining “whether ethics consultation resulted in decisions or actions that are consistent with established ethical standards” (ASBH, 2011, p. 39).

  7. See also Kon (2021, p. 15): “The primary goals of a clinical ethics consultation are to (1) help patients and providers understand which options are ethically required, which are ethically permissible, and which are ethically unsupportable…”.

  8. See also Lowey (1990, p. 357): “Ethicists should support “reasonable” decisions falling “within the bounds of communal and institutional acceptability”.

  9. The Core Competencies Second Edition is more specific: Allowable options are to be ascertained by reviewing “the bioethics literature, medical literature, other relevant scholarly literature, current professional and practice standards in the field of [CEC], statutes, judicial opinions, and pertinent institutional policies” (ASBH, 2011, p. 6).

  10. I here set aside a question left unanswered by the Code: Can the ethicist violate the Code through negligent endorsement, that is, giving approval to conduct she fails (but ought) to know is inconsistent with prevailing norms?

  11. An issue of a major journal was recently devoted to this continuing debate. See American Journal of Bioethics (2014, vol 14, no. 8). See also Troug and Miller (2012); Nair-Collins (2015); Pope (2019). See also Shewmon (2021); Shewmon (2001).

  12. For illuminating discussions of these points, see Rhymes et al. (2000); Huddle and Bailey (2012); Jansen (2006); Gill (2015); Sulmasy (2007); Zelner et al. (2009).

  13. See, e.g., Sulmasy and Sugarman (1994); Gedge et al. (2007); Ursin (2019); Pilkington (2020).

  14. See also Dubler and Liebman (2011): “Bioethics mediators” have the responsibility to “transmit a body of knowledge about bioethics issues and enforce these norms” (2011, p. 24); “Ethicists “must be sure that any agreement…meets the state’s legal requirements”; “…[B]ioethics mediators almost always to some degree norm explainers and sometimes norm enforcers” (2011, p. 97).

  15. The Hastings Center Guidelines confidently asserts that “acknowledging” objections to neurological criteria for a determination of death “does not alter the physiological state of the deceased patient” (Berlinger et al., 2013, p. 107, italics added). A sincere objector will likely find this assurance question-begging.

References

  • Ackerman, T. (1987). The role of an ethicist in health care. In G. R. Anderson & V. A. Glesnes-Anderson (Eds.), Health care ethics: A guide for decision makers. Aspen Publishers.

    Google Scholar 

  • American Medical Association. (2021). Code of medical ethics. Retrieved February 5, 2021, from https://www.ama-assn.org/delivering-care/ama-code-medical-ethics.

  • Andre, J. (2001). Bioethics as practice. Chapel Hill, NC: University of North Carolina Press.

    Google Scholar 

  • ASBH (American Society for Bioethics and Humanities). (1998). Core competencies for health care ethics consultation. Retrieved February 5, 2021, from https://asbh.org/resources/books.

  • ASBH (American Society for Bioethics and Humanities). (2011). Core competencies for health care ethics consultation, 2nd ed. Retrieved February 5, 2021, from https://asbh.org/resources/books

  • ASBH (American Society for Bioethics and Humanities). (2014). Code of ethics and professional responsibilities for healthcare ethics consultants. Retrieved February 5, 2021, from https://asbh.org/resources/guidelines-standards

  • Aulisio, M. P. (2003). Meeting the need: Ethics consultation in health care today. In M. P. Aulisio, R. M. Arnold & S. J. B. Younger (Eds.), Ethics consultation: From theory to practice. Baltimore, MA: The Johns Hopkins University Press.

    Chapter  Google Scholar 

  • Berlinger, N., Jennings, B., & Wolf, S. M. (2013). The Hastings Center guidelines for decisions on life-sustaining treatment and care near the end of life. Oxford: Oxford University Press.

    Book  Google Scholar 

  • Dubler, N. N. (2011). A “Principled Resolution”: The fulcrum for bioethics mediation. Law and Contemporary Problems, 74(3), 177–200.

    Google Scholar 

  • Dubler, N. N., & Liebman, C. B. (2011). Bioethics meditation: A guide to shaping shared solutions (2nd ed.). Nashville, TN: Vanderbilt University Press.

    Book  Google Scholar 

  • Dubler, N. N., et al. (2009). Charting the future: Credentialing, privileging, quality, and evaluation in clinical ethics consultation. Hastings Center Report, 39(6), 23–33.

    Article  Google Scholar 

  • Fletcher, J. C., & Siegler, M. (1996). What are the goals of ethics consultation? A consensus statement. Journal of Clinical Ethics, 7(2), 122–126.

    Article  Google Scholar 

  • Gedge, E., Giacomini, M., & Cook, D. (2007). Withholding and withdrawing life support in critical care settings. Journal of Medical Ethics, 33(4), 215–218.

    Article  Google Scholar 

  • Gill, M. B. (2015). Implanted medical devices and end-of-life decisions. In M. Cholbi & J. Varelius (Eds.), New directions in the ethics of assisted suicide and euthanasia. New York: Springer.

    Google Scholar 

  • Gries, C. J., White, D. B., Truog, R. D., Dubois, J., Cosio, C. C., et al. (2013). An Official American Thoracic Society/International Society for Heart and Lung Transplantation/Society of Critical Care Medicine/Association of Organ and Procurement Organizations/United Network of Organ Sharing Statement: Ethical and policy considerations in organ donation after circulatory determination of death. American Journal of Critical Care Medicine, 188(1), 103–109.

    Article  Google Scholar 

  • Huddle, T. S., & Bailey, A. F. (2012). Pacemaker deactivation: Withdrawal of support of active ending of life? Theoretical Medicine and Bioethics, 33(6), 421–433.

    Article  Google Scholar 

  • Jansen, L. A. (2006). Hastening death and the boundaries of the self. Bioethics, 20(2), 105–111.

    Article  Google Scholar 

  • Jonsen, A., Siegler, M., & Winslade, W. (2002). Clinical ethics (5th ed.). New York: McGraw-Hill.

    Google Scholar 

  • Kanoti, G. A., & Younger, S. J. (1995). Clinical ethics consultation. In W. T. Reich (Ed.), Encyclopedia of bioethics. New York: Macmillan.

    Google Scholar 

  • Kon, A. A. (2021). Clinical ethics consultants: Advocates for both patients and clinicians. American Journal of Bioethics, 12(8), 15–17.

    Article  Google Scholar 

  • Lampert, R., et al. (2010). HRS Expert consensus statement on the management of Cardiovascular Implantable Electronic Devices (CIEDs) in patients nearing the end of life or requesting withdrawal of therapy. Heart Rhythm, 7(7), 1008–1026.

    Article  Google Scholar 

  • Lowey, E. H. (1990). Ethics consultation and ethics committees. HEC Forum, 2(6), 351–359.

    Article  Google Scholar 

  • McCullough, L. B. (1995). Preventative ethics, professional integrity, and boundary setting. Journal of Medicine and Philosophy, 20(1), 1–11.

    Article  Google Scholar 

  • Nair-Collins, M. (2015). Taking science seriously in the debate on death and organ transplantation. Hasting Center Report, 45(6), 38–48.

    Article  Google Scholar 

  • Pilkington, B. C. (2020). Treating of killing? The divergent moral implications of cardiac device deactivation. Journal of Medicine and Philosophy, 45(1), 28–41.

    Article  Google Scholar 

  • Pope, T. M. (2019). Brain death forsaken: Growing conflict and new legislative challenges. Journal of Legal Medicine, 37(3-4), 265–324.

    Article  Google Scholar 

  • President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. (1983). Deciding to forgo life-sustaining treatment. Retrieved December 10, 2023, from chrome-extension://bdfcnmeidppjeaggnmidamkiddifkdib/viewer.html?file=https://repository.library.georgetown.edu/bitstream/handle/10822/559344/deciding_to_forego_tx.pdf?sequence=1

  • Pritchard, M. S. (2006). Professional integrity. Lawrence, KS: University of Kansas Press.

    Google Scholar 

  • Puma, J. L., & David, L. (1991). The clinical ethicist at the bedside. Theoretical Medicine, 12(2), 141–149.

    Article  Google Scholar 

  • Rhymes, J. A., McCullough, L. B., Luchi, R. J., Teasdale, T. A., & Wilson, N. (2000). Withdrawing very low-burden interventions in chronically-Ill patients. Journal of the American Medical Association, 283(8), 1061–1063.

    Article  Google Scholar 

  • Shewmon, D. A. (2001). The Brain and somatic integration: Insights into the standard biological rationale for equating “Brain Death” with death. The Journal of Medicine and Philosophy, 26(5), 457–478.

    Article  Google Scholar 

  • Shewmon, D. A. (2021). Statement in support of revising the uniform determination of death act and in opposition to a proposed revision. The Journal of Medicine and Philosophy, 48(5), 453–477.

    Article  Google Scholar 

  • Siegler, M., Pellegrino, E. D., & Singer, P. A. (1990). Clinical medical ethics. The Journal of Clinical Ethics, 1(1), 5–9.

    Article  Google Scholar 

  • Sulmasy, D. P. (2007). Within you/without your: biotechnology, ontology, and ethics. Journal of General Internal Medicine, Suppl. 1(Suppl. 1), 69–72.

    Google Scholar 

  • Sulmasy, D. P., & Sugarman, J. (1994). Are withholding and withdrawing therapy always morally equivalent? Journal of Medical Ethics, 20(4), 218–222.

    Article  Google Scholar 

  • Tarzian, A. J., & ASBH Core Competencies Update Task Force. (2013). Health care ethics consultation: An update on core competencies and emerging standards from the American Society for Bioethics and Humanities’ core competencies update task force. American Journal of Bioethics, 13(2), 3–13.

    Article  Google Scholar 

  • Tarzian, A. J., Wocial, L. D., & ASBH Clinical Ethics Consultation Affairs Committee. (2015). A code of ethics for health care ethics consultants: Journey to the present and implications for the field. American Journal of Bioethics, 15(5), 38–51.

    Article  Google Scholar 

  • Troug, R., & Miller, F. (2012). Death, dying, and organ transplantation. Oxford: Oxford University Press.

    Google Scholar 

  • Truog, R., Campbell, M. L., Curtis, J. R., Haas, C. E., Luce, J. M., et al. (2008). Recommendations for end-of-life care in the intensive care unit: A consensus statement by the American College of Critical Care Medicine. Critical Care Medicine, 36(3), 953–963.

    Article  Google Scholar 

  • Ursin, L. (2019). Withholding and withdrawing life-sustaining treatment: Ethically equivalent? American Journal of Bioethics, 19(3), 10–20.

    Article  Google Scholar 

  • Veterans Health Administration. (2015). Ethics consultation: responding to ethics questions in health Care, Second Edition. Retrieved February 5, 2021, from http://www.ethics.va.gov/integratedethics/ecc.asp

  • Wicclair, M. R. (2000). Conscientious objection in medicine. Bioethics, 14(3), 205–227.

    Article  Google Scholar 

  • Zelner, R. A., Aulisio, M. P., & Lewis, W. R. (2009). Should implantable cardioverter-defibrillators and permanent pacemakers in patients with terminal illness be deactivated? Circulatory Arrhythmia Electrophysiology, 2(3), 340–344.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Philosophy, California State Polytechnic University, Pomona, CA, USA

    David M. Adams

  2. Pomona Valley Hospital Medical Center, Pomona, CA, USA

    David M. Adams

Authors
  1. David M. Adams
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David M. Adams.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Adams, D.M. Clinical Ethics and Professional Integrity: A Comment on the ASBH Code. HEC Forum (2023). https://doi.org/10.1007/s10730-023-09516-z

Download citation

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s10730-023-09516-z

Keywords

Search

Navigation