The ability to reason ethically is an extraordinarily important aspect of professionalism in any field. Indeed, the greatest challenge in ethical professional practice involves resolving the conflict that arises when the professional is required to choose between two competing ethical principles. Ethical Reasoning in the MentalHealth Professions explores how to develop the ability to reason ethically in difficult situations. Other books merely present ethical and legal issues one at a time, along with case examples involving (...) "right" and "wrong" answers. In dramatic contrast, Ethical Reasoning in the MentalHealth Professions provides you with the needed background in methods of ethical reasoning and introduces an innovative nine-step model of ethical decision-making for resolving ethical dilemmas. Ethical Reasoning in the MentalHealth Profession discusses the ethical codes of both psychology and counseling. This interdisciplinary approach promotes a better understanding of the similarities and differences in the points of emphasis in the two codes, which, in turn, enriches your understanding of the range of ethical considerations relevant to the practice of the mentalhealth professions. (shrink)
In spite of numerous studies of program outcomes finding little or no positive effect on violent behavior, the Duluth model remains the most common program type of interventions with perpetrators of domestic violence. In addition, Duluth model programs often ignore serious mentalhealth and substance abuse issues present in perpetrators. These and other issues of possible threat to mentalhealthprofessionalethics are reviewed in light of the court-mandated, compulsory nature of most Duluth model (...) programs and client and victim expectations for program efficacy. (shrink)
Patients who are subject to compulsory care constitute a substantial proportion of the work-load of mentalhealth professionals, particularly psychiatric nurses. This article examines the traditional ‘beneficence-autonomy’ approach to ethics in compulsory psychiatric care and evaluates it against the reality of daily practice. Risk to the public has always been an important but often unacknowledged consideration. Inequalities exist among ethnic and socio-economic groups and there is a lack of agreement on what constitutes mental disorder. Two major (...) changes in compulsory psychiatric care - community orders and care for patients with untreatable severe personality disorders - further challenge the traditional ethical approach. There are also important human rights implications. The simple patient-healthprofessional relationship no longer provides an adequate framework for mentalhealth professionals on which to base their ethical decisions. The public and organizations may have different perspectives and their interests are becoming increasingly important. Mentalhealth professionals, particularly psychiatric nurses, may face ethical dilemmas because of these different perspectives. (shrink)
As part of a project on professionals' lived experience of ethics, this article explores the guiding concepts and values concerning ethics of mentalhealth professionals in Cuba. The data, obtained through individual interviews and focus groups with 28 professionals, indicate that Cubans conceptualize applied ethics in terms of its central role in professional practice and its connection to the social context and subjective processes. Findings also show that Cuban professionals are guided not only by (...) a set of professional values but by a specific set of civic values as well. The former are subdivided into other-oriented values and self-oriented values. The study of ethics in another culture such as Cuba offers a unique point of view from which to critique the social construction of our own conceptions of applied ethics in North America. (shrink)
This article is the second one in a series dealing with mentalhealthethics in Cuba. It reports on ethical dilemmas, resources and limitations to their resolution, and recommendations for action. The data, obtained through individual interviews and focus groups with 28 professionals, indicate that Cubans experience dilemmas related to (a) the interests of clients, (b) their personal interests, and (c) the interest of the state. These conflicts are related to power differentials among (a) clients and professionals, (...) (b) professionals from various disciplines, and (c) professionals and organizational authorities. Resources to solve ethical dilemmas include government support, ethics committees, and collegial dialogue. Limitations include minimal training in ethics, lack of safe space to discuss professional disagreements, and little tolerance for criticism. Recommendations to address ethical dilemmas include better training, implementation of a code of ethics, and provision of safe space to discuss ethical dilemmas. The findings are discussed in light of the role of power in applied ethics. (shrink)
In recent years, the attention on the use of coercion in mentalhealth care has increased. The use of coercion is common and controversial, and involves many complex ethical challenges. The research question in this study was: What kind of ethical challenges related to the use of coercion do health care practitioners face in their daily clinical work?
Psychologists today must deal with a broad range of ethical issues--from charging fees to maintaining a client's confidentiality, and from conducting research to respecting clients, colleagues, and students. As the field of psychology has grown in size and scope, the role of ethics has become more important and complex whether the psychologist is involved in teaching, counseling, research, or practice. Now this most widely read and cited ethics text in psychology has been revised to reflect the ethics (...) questions and dilemmas that psychologists encounter in their everyday work. Ethics in Psychology has been completely updated in response to evolving trends in psychological research and practice, as well as extensive changes in the American Psychological Association's ethics code. Gerald P. Koocher and Patricia Keith-Spiegel take a practical, commonsense approach to ethics in modern-day psychological practice, and offer constructive suggestions for both preventing problems and resolving ethical predicaments. In this book, their main intent is to present the full range of contemporary ethical issues in psychology as not only relevant and intriguing, but also as integral and unavoidable aspects of the profession. The authors make extensive use of actual case studies in order to illustrate how the APA guidelines apply to specific situations, such as fee setting, advertising for clients, research ethics, sexual attraction, classroom ethics, managed care issues, confidentiality, and much more. The most recent ethics code of the American Psychological Association (1992) is used here only as a starting point. The authors go well beyond the APA code and incorporate the input of many experts. In addition to the analysis of a wide variety of general situations, new problematic areas are identified and explored. The book includes two appendixes - Ethical Principles of Psychologists and Code of Conduct, adopted by American Psychological Association, Rules and Procedures of the Ethics Committee of the American Psychological Association - both in an easy-to-use format. In addition, each chapter lists summary guidelines along with current and valuable references. Highly readable, the book unites a straightforward, lively writing style with humorous anecdotes that highlight the human side of ethics and make the book a pleasure to read. Ethics in Psychology will be an indispensable guide to ethical decision-making for all psychologists and students in psychology. (shrink)
Health care is provided in many contexts—not just hospitals, clinics, and community health settings. Different institutional settings may significantly influence the design and delivery of health care and the ethical obligations and practices of health care practitioners working within them. This is particularly true in institutions that are established to constrain freedom, ensure security and authority, and restrict movement and choice. We describe the results of a qualitative study of the experiences of doctors and nurses working (...) within two women’s prisons in the state of New South Wales (NSW), Australia. Their accounts make clear how the provision and ethics of health care may be compromised by the physical design of the prison, the institutional policies and practices restricting movement of prisoners and practitioners, the focus on maintaining control and security, and the very purpose of the prison and prison system itself. The results of this study make clear the impact that context has on professional practice and illustrate the importance of sociology and anthropology to bioethics and to the development of a more nuanced account of professionalethics. (shrink)
A barrier to the development and refinement of ethics education in and across healthprofessional schools is that there is not an agreed upon instrument or method for assessment in ethics education. The most widely used ethics education assessment instrument is the Defining Issues Test (DIT) I & II. This instrument is not specific to the health professions. But it has been modified for use in, and influenced the development of other instruments in, the (...)health professions. The DIT contains certain philosophical assumptions (“Kohlbergian” or “neo-Kohlbergian”) that have been criticized in recent years. It is also expensive for large institutions to use. The purpose of this article is to offer a rubric—which the authors have named the HealthProfessionalEthics Rubric—for the assessment of several learning outcomes related to ethics education in health science centers. This rubric is not open to the same philosophical critiques as the DIT and other such instruments. This rubric is also practical to use. This article includes the rubric being advocated, which was developed by faculty and administrators at a large academic health science center as a part of a campus-wide ethics education initiative. The process of developing the rubric is described, as well as certain limitations and plans for revision. (shrink)
Last year marks the first year of implementation for both the Patient Protection and Affordable Care Act and the MentalHealth Parity and Addiction Equity Act in the United States. As a result, healthcare reform is moving in the direction of integrating care for physical and mental illness, nudging clinicians to consider medical and psychiatric comorbidity as the expectation rather than the exception. Understanding the intersections of physical and mental illness with autonomy and self-determination in a (...) system realigning its values so fundamentally therefore becomes a top priority for clinicians. Yet Bioethics has missed opportunities to help guide clinicians through one of medicine's most ethically rich and challenging fields. Bioethics' distancing from mental illness is perhaps best explained by two overarching themes: 1) An intrinsic opposition between approaches to personhood rooted in Bioethics' early efforts to protect the competent individual from abuses in the research setting; and 2) Structural forces, such as deinstitutionalization, the Patient Rights Movement, and managed care. These two themes help explain Bioethics' relationship to mentalhealthethics and may also guide opportunities for rapprochement. The potential role for Bioethics may have the greatest implications for international human rights if bioethicists can re-energize an understanding of autonomy as not only free from abusive intrusions but also with rights to treatment and other fundamental necessities for restoring freedom of choice and self-determination. Bioethics thus has a great opportunity amid healthcare reform to strengthen the important role of the virtuous and humanistic care provider. (shrink)
This volume explores the focus of interest in community and the emerging theoretical opposition between communitarianism and liberalism, including the practical, theoretical and ethical issues that relate to community in the healthcare professions.
Written by a former corporate manager pursuing counseling as a 2nd career, this article offers pointed views on managed mentalhealth care. Values of practitioners that are a mismatch for managed care are noted, and more specific disadvantages and advantages are examined. Loss of client confidentiality is addressed and procedures and technologies for its reclamation are noted. Negative effects on therapy are acknowledged and potential for better accountability and research are pointed out. Economic disadvantages of a small provider's (...) practice as well as opportunities for creating new value and additional income are reviewed. The relatively sudden emergence of managed care is credited with a natural time lag preceding regulatory responses. Acknowledging that most new practitioners have little choice about the clients they serve, the article concludes that it would be shortsighted to rule managed care out of one's practice. (shrink)
This collection presents six case studies on the ethics of mentalhealth research, written by scientific researchers and ethicists from around the world. We publish them here as a resource for teachers of research ethics and as a contribution to several ongoing ethical debates. Each consists of a description of a research study that was proposed or carried out and an in-depth analysis of the ethics of the study.
Psychologists' courtroom involvement and testimony should not be dictated solely by what the judge or court allows but also require the application of personal or professional standards. This article explores various standards that might be used to determine whether psychological evidence is ready for courtroom application, whether or which evaluative procedures should be performed prior to courtroom use, and the potential tensions between personal validation or impression and formal scientific evidence. Although determining just how tough our professional standards (...) ought to be involves complex issues, the field should take a strong stance against testimony that is based largely on personal validation and that lacks scientific support or conflicts with research evidence. Much of current testimony violates this minimal standard. (shrink)
The complexities of professionalethics are best understood and interpreted within their sociohistorical context. This paper focuses on the experience of 20 rural psychologists from across Canada, a context rife with demographic and practice characteristics that may instigate ethical issues. Employing hermeneutic phenomenology, these qualitative research results are indicative of professional struggles that impacted the participants’ experience of professionalethics and raised key questions about policy and practise. Concerns regarding competition highlight potential professional vulnerability, (...) beget the idea of fostering general psychological practice, and question the role of professional bodies in addressing rural shortages. Dependency on government funding models and decisions highlights the benefits and medical cost-offset effect of psychological services’ role in funded medical care. The controversial prescriptive authority debate for psychologists raises myriad concerns that are particularly salient to rural practitioners. These include changes to training and practice, with risks of psychopharmacology gaining prominence over behavioural health interventions. National inconsistencies in level of registration add to the growing shortage of practitioners. Finally, the results illuminate the need for advocacy to move beyond the literature and into public policy to increase public awareness, decrease the stigma of mental illness, and develop rural Canadian psychology. Although limited to this study, these results allowed for a fuller and more robust understanding of rural practice in consideration of professionalethics, which may inform policy, science, or ethical clinical practice. (shrink)
The domain of professionalethics -- Virtue, ethics, and professional life -- Virtues, vices, and situations -- Professional wisdom -- Care -- Respectfulness -- Trustworthiness -- Justice -- Courage -- Integrity.
ln the Netherlands, as in other Western countries, there is a great time lag between the evidence of the carcinogenicity of asbestos (1949) and the launching of first legislation that reduces the occupational exposure (1971) and finally, the complete ban of the production and application of asbestos (1993). So, between 1949 and 1970 there was a serious health risk while effective protective regulations were lacking. This implied a serious ethical dilemma for occupational health professionals: according to their code (...) of ethics, they ought to contribute to a safe and healthy working environment while companies are not strictly obliged to do so. This study explores retrospectively the position of health and safety professionals with regard to asbestos between 1930 and 1990; specifically with respect to the prevention of harmful health effects for exposed workers, which is a central value in their professionalethics. It turns out that the associations of safety and health professionals did not promulgate any position on the prevention of harm due to asbestos. Nor did the uncertainty about the health impact of asbestos obviously cause an ethical dilemma for individual professionals. Professionals were usually involved in discussions on diagnostic methods of asbestos exposure in the human body (X-ray or detection in sputum), the existence of safe limits, the scientific basis of risk assessment and effective prevention strategies. Only a single professional was seeking attention to the severe health risks and advocated for preventive action. (shrink)
The authors describe the ethical considerations underlying the inclusion of mentalhealth services into a prioritizedhealth care system. The Oregon Health Plan is a process for defining and delivering basic health services to an entire state. As the plan was developed, the mentalhealth community needed to decide whether or not to participate in the process and, if so, how. Lengthy discussions among mentalhealth consumers, family members, and providers led to a (...) strategy that emphasized the integration of mentalhealth and chemical dependency services into a comprehensive and universal health care program. This approach appears to have achieved relative parity for mentalhealth. (shrink)
General health conditions are related to a great number of factors, including the socio-historical ones. As human beings are part of the social field, personality is also affected by them. Due to this, the main Ethics Codes of psychology, all around the world, remark in their preambles the importance of social responsibility in the practice and training in psychology. Argentina is confronted with several social problems that have severely influenced people’s mentalhealth. In countries like Argentina, (...) the ethical practice of psychology should respect what is explicitly stated in ethic codes about psychologists’ social responsibility, and psychologists should get more involved in promoting this issue in educational training and in national health policies. (shrink)
Background As a number of commentators have noted, SARS exposed the vulnerabilities of our health care systems and governance structures. Health care professionals (HCPs) and hospital systems that bore the brunt of the SARS outbreak continue to struggle with the aftermath of the crisis. Indeed, HCPs – both in clinical care and in public health – were severely tested by SARS. Unprecedented demands were placed on their skills and expertise, and their personal commitment to their profession was (...) severely tried. Many were exposed to serious risk of morbidity and mortality, as evidenced by the World Health Organization figures showing that approximately 30% of reported cases were among HCPs, some of whom died from the infection. Despite this challenge, professional codes of ethics are silent on the issue of duty to care during communicable disease outbreaks, thus providing no guidance on what is expected of HCPs or how they ought to approach their duty to care in the face of risk. Discussion In the aftermath of SARS and with the spectre of a pandemic avian influenza, it is imperative that we (re)consider the obligations of HCPs for patients with severe infectious diseases, particularly diseases that pose risks to those providing care. It is of pressing importance that organizations representing HCPs give clear indication of what standard of care is expected of their members in the event of a pandemic. In this paper, we address the issue of special obligations of HCPs during an infectious disease outbreak. We argue that there is a pressing need to clarify the rights and responsibilities of HCPs in the current context of pandemic flu preparedness, and that these rights and responsibilities ought to be codified in professional codes of ethics. Finally, we present a brief historical accounting of the treatment of the duty to care in professionalhealth care codes of ethics. Summary An honest and critical examination of the role of HCPs during communicable disease outbreaks is needed in order to provide guidelines regarding professional rights and responsibilities, as well as ethical duties and obligations. With this paper, we hope to open the social dialogue and advance the public debate on this increasingly urgent issue. (shrink)
In this paper, we put forward the view that emotions have a legitimate and important role in healthprofessionalethics education. This paper draws upon our experience of running a narrative ethics education programme for ethics educators from a range of healthcare disciplines. It describes the way in which emotions may be elicited in narrative ethics teaching and considers the appropriate role of emotions in ethics education for health professionals. We argue there (...) is a need for a pedagogical framework to productively incorporate the role of emotions in healthprofessionalethics teaching. We suggest a theoretical basis for an ethics pedagogy that integrates healthprofessional emotions in both the experience and the analysis of ethical practice, and identify a range of strategies to support the educator to incorporate emotion within their ethics teaching. (shrink)
This article examines the complex relationship between culture, values, and ethics in mentalhealth care. Cultural competence is a practical, concrete demonstration of the ethical principles of respect for persons, beneficence (doing good), nonmaleficence (not doing harm), and justice (treating people fairly)—the cornerstones of modern ethical codes for the health professions. Five clinical cases are presented to illustrate the range of ethical issues faced by mentalhealth clinicians working in a multicultural environment, including issues (...) of therapeutic boundaries, diagnosis, treatment choice, confidentiality and informed consent, and the just distribution of limited health care resources. (shrink)
The burgeoning field of medical ethics raises complicated questions for mentalhealth researchers. The critical issues of risk assessment, beneficence, and the moral duties researchers owe their patients are analyzed in James DuBois's well written Ethics in MentalHealth Research.
I am in the process of trying to organize an ethics committee at a large community mentalhealth center in Central Massachusetts and am seeking advice from anyone with experience in this or a similar milieu. The agency is a large (almost 700 employees), nonprofit, community-based program that operates under the auspices of a broad, academically affiliated, behavioral health system. An independent board of trustees, responsible to the parent organization governs the agency. The agency primarily provides (...) outpatient care and treatment to adults and children with mentalhealth, substance abuse, developmental disabilities, and homelessness issues. It does not provide any psychiatric emergency or acute in-patient mentalhealth services but does operate an inpatient detoxification unit for substance abuse treatment and DUI program. Additionally, the agency has a vast network of residential programs and transitional facilities for individuals with a history of chronic mental illness and substance abuse problems. Outpatient medical care is also provided to homeless clients who reside in area shelters (including a shelter for men and women) and a large number of clients who have HIV/AIDS and/or who have been dually diagnosed (substance abuse and mental illness), and are part of a scattered-site supportive housing program. (shrink)
I argue that Plato holds a medical model of virtue as health which does not have themorally unacceptable implications which have led some to describe it as authoritarian.This model, which draws on the educational virtues of the elenchos, lacks anyimplication that all criminals are mad or all mad people criminals – this implication beingat the source of many criticisms of Plato’s analogy of virtue and health. After setting upthe analogy and the model, I defend my argument against two (...) objections. The firstclaims that Plato's picture of virtue as health is unacceptable because it entails that vice isa defect and therefore that criminals are all mad. The second resists Kenny'sinterpretation but does so by attacking its first premise, i.e. that Plato believes virtue issome kind of health. I reply that both objections are misguided. (shrink)
Divided Staffs, Divided Selves offers a case-centered approach to the teaching of health care ethics to a wide range of students and clinicians. The book provides both clinical case material and a method for engaging in a dialogue regarding difficult decisions in the mentalhealth care field that have potentially tragic choices. The essays that introduce the volume place the ethical problems of treating mentally ill people in the context of the health care ethics (...) movement and traditions of ethical decision making. The individual cases are real, derived from actual clinical and consultative experiences. (shrink)
This case looks at the question of how to consider obligations of confidentiality by a mentalhealthprofessional who works for an institution and learns that a student has been using a drug intended for an animal research project. Dr. Paul Appelbaum, MD, a psychiatrist at Columbia University, examines the issue of the limits of confidentiality. Nicholas Steneck, PhD, a scholar in research misconduct at the University of Michigan, explores the obligations to report research misconduct. Walter Limehouse, (...) MD, an ethicist at the Medical University of South Carolina, considers the systems issues raised by this case and offers some suggestions that might change the institutional environment. (shrink)
Coercion in mentalhealth care gives rise to many ethical challenges. Many countries have recently implemented state policy programs or development projects aiming to reduce coercive practices and improve their quality. Few studies have explored the possible role of ethics in such initiatives. This study adds to this subject by exploring health professionals’ descriptions of their ethical challenges and strategies in everyday life to ensure morally justified coercion and best practices. Seven semi-structured telephone interviews were carried (...) out in 2012 with key informants in charge of central development projects and quality-assurance work in mentalhealth services in Norway. No facilities used formal clinical ethics support. However, the informants described five areas in which ethics was of importance: moral concerns as implicit parts of local quality improvement initiatives; moral uneasiness and idealism as a motivational source of change; creating a normative basis for development work; value-based leadership; and increased staff reflexivity on coercive practices. The study shows that coercion entails both individual and institutional ethical aspects. Thus, various kinds of moral deliberation and ethics support could contribute to addressing coercion challenges by offering more systematic ways of dealing with moral concerns. However, more strategic use of implicit and institutional ethics is also needed. (shrink)
Background: Patients today interact with physicians, physician groups, and health plans, each of which may follow distinct ethical guidelines.Method: We systematically compared physician codes of ethics with ethics policies at physician group practices and health plans, using the 1998–99 policies of 38 organisations—18 medical associations , nine physician group practices , and 12 health plans —selected using random and stratified purposive sampling. A clinician and a social scientist independently abstracted each document, using a 397-item (...) class='Hi'>health care ethics taxonomy; a reconciled abstraction form was used for analysis. This study focuses on ethics policies regarding professional obligation towards patients, resource allocation, and care for the vulnerable in society.Results: A majority in all three groups mention “fiduciary obligations” of one sort or another, but associations generally address physician/patient relations but not health plan obligations, while plans rarely endorse physicians’ obligations of advocacy, beneficence, and non-maleficence. Except for occasional mentions of cost effectiveness or efficiency, ethical considerations in resource allocation rarely arise in the ethics policies of all three organisational types. Very few associations, groups, or plans specifically endorse obligations to vulnerable populations.Conclusions: With some important exceptions, we found that the ethics policies of associations, groups, and plans are narrowly focused and often ignore important ethical concerns for society, such as resource allocation and care for vulnerable populations. More collaborative work is needed to build integrated sets of ethical standards that address the aims and responsibilities of the major stakeholders in health care delivery. (shrink)
In an exploratory context, a qualitative approach was used to document perceptions of psychiatric advance directives among legal professionals and mentalhealth professionals in Ontario and Quebec. A Web survey was administered and a qualitative analysis approach was used to explore attitudes towards PADs. It was found that legal and mentalhealth professionals hold dif erent values related to clinical, ethical and legal issues, which may be related to their professional training. Among the advantages associated (...) with PADs include their ability to document a mentally ill individual’s clear wishes, respect autonomous choices and foster collaborative treatment. Reported disadvantages of PADs include the possibility of new circumstances arising, mentally ill individuals may not comprehend completing a PAD, and whether a mentally ill individual should be permitted to refuse treatment on ethical grounds. (shrink)
Mentalhealth surveys are used extensively in epidemiological research worldwide. The ethical questions that arise regarding their risk of causing psychological distress or other potential harm have not been studied in the general population. We have investigated how study participants serving as controls in a population-based study perceived an anonymous postal questionnaire focusing on mentalhealth and wellbeing. Parents were contacted from the Swedish Census Bureau as part of a larger follow-up study on palliative care conducted (...) in 2001. Eligible parents had a child of the same gender, year of birth and were from the same counties in Sweden as parents who had lost a child to cancer. Five percent reported being negatively affected. The principle negative effect on participants was that self-reflection reminded them of their difficulties. Of the 418 respondents, 52% reported that they were positively affected by study participation and 95% perceived the inquiry as valuable. These findings support the use of population-based controls in future research. (shrink)
This trailblazing book provides a comprehensive view of the ethical issues that cut across the addiction field, from Employee Assistance Programs to treatment and aftercare. By addressing probing questions that illuminate today's complex ethical landscape, LeClair Bissell and James Royce explore how standard guidelines for professional conduct benefit counselors and clients alike.
The first words in the inaugural version of the American Psychological Association Ethical Standards of Psychologists (1953) declared, ?Psychology is a science? (p. v). Professionalethics for all of the mentalhealth disciplines support science (and objectivity) for knowledge and practice. Using school psychology as an example, consideration is given to the presence of science and research in the scientist-practitioner, professional practitioner, and psychoeducational training and practice models. Although none of the three models truly ignores (...) a commitment to science, the potential Achilles heel comes from the individual practitioner who fails to rely on science in planning, implementing, and evaluating interventions. Similarly, idiosyncratic preferences within training programs could lead to a diminution of science in the curriculum. (shrink)
Within an ethics framework, this article explores mentalhealth practitioners' use of credentials that lack acceptable accreditation or authority. Increased competition among mentalhealth care providers has elevated the importance of credentials for marketing professional services. Practitioners worried about economic survival, along with certain personality characteristics (e.g., sheer ego), are tempted to rely on credentials that lack proof of quality, thereby potentially jeopardizing professionalism. Specific assertions and recommendations are set forth in the interest of (...) safe-guarding consumers and promoting professionalism. (shrink)
The American Society for Bioethics and the Humanities (ASBH) issued its Core Competencies for Health Care Ethics Consultation just as it is becoming ever clearer that secular ethics is intractably plural and without foundations in any reality that is not a social–historical construction (ASBH Core Competencies for Health Care Ethics Consultation , 2nd edn. American Society for Bioethics and Humanities, Glenview, IL, 2011 ). Core Competencies fails to recognize that the ethics of health (...) care ethics consultants is not ethics in the usual sense of a morally canonical ethics. Its ethics is the ethics established at law and in enforceable health care public policy in a particular jurisdiction. Its normativity is a legal normativity, so that the wrongness of violating this ethics is simply the legal penalties involved and the likelihood of their being imposed. That the ethics of ethics consultation is that ethics legally established accounts for the circumstance that the major role of hospital ethics consultants is as quasi-lawyers giving legal advice, aiding in risk management, and engaging in mediation. It also indicates why this collage of roles has succeeded so well. This article shows how moral philosophy as it was reborn in the 13th century West led to the ethics of modernity and then finally to the ethics of hospital ethics consultation. It provides a brief history of the emergence of an ethics that is after morality. Against this background, the significance of Core Competencies must be critically reconsidered. (shrink)