Consensus, Clinical Decision Making, and Unsettled Cases

Journal of Clinical Ethics 22 (4):310-327 (2011)
  Copy   BIBTEX

Abstract

The model of clinical ethics consultation (CEC) defended in the ASBH Core Competencies report has gained significant traction among scholars and healthcare providers. On this model, the aim of CEC is to facilitate deliberative reflection and thereby resolve conflicts and clarify value uncertainty by invoking and pursuing a process of consensus building. It is central to the model that the facilitated consensus falls within a range of allowable options, defined by societal values: prevailing legal requirements, widely endorsed organizational policies, and professional standards of practice and codes of conduct. Moreover, the model stipulates that ethics consultants must refrain from giving substantive recommendations regarding how parties to a moral disagreement in the clinic should evaluate their options. We argue that this model of CEC is incomplete, because it wrongly assumes that what counts as the proper set of allowable options among which the parties are to deliberate will itself always be clearly discernible. We illustrate this problem with a recent case on which one of us consulted—a neonate born with trisomy 18 (T18). We try to show that law, policy, and standards of practice reveal no clear answer to the question posed by the case: namely, whether forgoing gastrostomy tube feedings for a baby with T18 is allowable. We suggest there may be other kinds of cases in which it may simply be unsettled whether a given choice falls within the set of allowable options within which consensus is to be facilitated. What should an ethicist do when confronting such unsettled cases? We agree with the facilitation model that an ethicist should remain neutral among the allowable options, when it is clear what the allowable options are. But, in unsettled cases, the role of a consultant should be expanded to include a process of moral inquiry into what the allowable options should be. We end by raising the issue of whether this means an ethicist should share his or her own conclusions or views about the allowability of a given clinical option.

Links

PhilArchive



    Upload a copy of this work     Papers currently archived: 92,261

External links

Setup an account with your affiliations in order to access resources via your University's proxy server

Through your library

Similar books and articles

Life and death decision making.Baruch A. Brody - 1988 - New York: Oxford University Press.
Data and Safety Monitoring Board and the Ratio Decidendi of the Trial.Roger Stanev - 2015 - Journal of Philosophy, Science and Law 15:1-26.
Medical decision making: a physician's guide.Alan Schwartz - 2008 - New York: Cambridge University Press. Edited by George Bergus.
Advancing a casuistic model of clinical decision making: a response to commentators.Mark R. Tonelli - 2007 - Journal of Evaluation in Clinical Practice 13 (4):504-507.
Shared decision-making, gender and new technologies.Kristin Zeiler - 2007 - Medicine, Health Care and Philosophy 10 (3):279-287.
The Ethical Action Principle in Decision-Making.Kumiko Yoshitake - 2008 - Proceedings of the Xxii World Congress of Philosophy 5:75-83.

Analytics

Added to PP
2013-12-15

Downloads
27 (#592,811)

6 months
14 (#184,493)

Historical graph of downloads
How can I increase my downloads?

Author's Profile

David M. Adams
California State Polytechnic University, Pomona

References found in this work

No references found.

Add more references