Narrative Inquiry in Bioethics

Context

Like all stories, this one neither arises ex nihilo nor exists in a vacuum. In order to situate it in its proper context, one needs to know only three things. The first is that clinical is and for some time now has been, in its own words, ‘big business’. The second is that, accordingly to sociologists of the professions, one of the most means for securing professional ‘conformity’ consists of informal methods, such as peer pressure, the silent treatment, whisper campaigns, and the like. The last is that, to the extent I know anything about professions and professionalizing it is because, before I became known as a ‘right–to–die’ advocate I studied and wrote about health care professions and professionals in law school, and represented them for several years as a health care attorney.

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Once upon a time health care ethics consultation was born and named a nascent, fledgling profession. Having spent a good portion of my law school days studying the health care professions, and having represented both health care and legal professionals in the early days of my legal career, the moment I heard that health care ethics consultants were on the way to professionalizing, my curiosity was piqued and my professional liability/responsibility radar got turned on. Mind you, being a veteran of the culture war that attended legitimating a patient’s right to forgo life–sustaining treatment in the run–up to the Cruzan case, and having worked with hospitals and hospital ethics committees in post–Quinlan New Jersey, I knew that there was work to be done, and that this involved knowing something about ethics. But a new profession? Had this new profession really thought about what it means to be a profession? About what it would mean, for example, to obtain professional liability insurance coverage, which requires, among other things, a well–defined scope of practice?

Instead of trying to tackle these questions in all their complexities, I chose to focus first on an important, but all too often neglected issue: the problem of the impaired professional, of the professional that every profession needs to find some way to do something about, but that few professions ever take as seriously as they should. Partly because I thought it would shed light on a problem all professions face; partly to alert those who were interested in and dedicated to creating this new profession that there was considerably more to being a profession than having a scope of practice, a standard of care, and a code of ethics.

At the time, I was living and working in a city where I had access to a group of clinical bioethicists who regularly got together to discuss papers we were working on. When I thought that “the problem of the impaired ethicist” was ready to be looked at, I sent it along. As I recall, there wasn’t much discussion of the content of the paper. That is to say, others found it interesting and no one slammed it. Perhaps there was a discussion about whether ‘impairment’ was the right lens for viewing the problem I had identified, which also had something to do with an ethicist’s being compromised, but if there was any discussion of that point, it did not amount to much.

What I do recall is this. Some of those present wanted to know who I was talking about; others professed to know—or intuit—who it was that I must be talking about. In other words, I couldn’t just be writing about some theoretical problem concerning a hypothetical impaired ethicist. Rather, I must have—must have had—someone specific in mind, in their minds, at least. What a chatty, catty little clique, I thought to myself. What an interesting display of nascent, fledgling professional solidarity. Anyway. The problem of the impaired ethicist made its way into print, without very much notice or fanfare, which is not surprising, given the scant attention most professions and professionals pay to the problem of professional impairment.

Thereafter I turned my attention, among other things, to a more robust discussion of some...