Friday, October 30, 2009

Picking a Fight on Normative Ethics

Rosemary Flanigan
October 30, 2009

I have read the final article in the HEC Forum, the one by Tristram Engelhardt, Jr. who seriously questions whether or not one can define what a clinical ethicist is and does.

Maybe I’m just rarin’ to pick a fight, but I was disturbed by his paper.

He says, “The existence of clinical ethicists and ethics consultation is the result of a set of developments and commitments rooted in Enlightenment assumptions about the possibility of discovering through rational analysis and argument a canonical morality or at least a normative moral consensus. The difficulty is that these Enlightenment assumptions have proven false. Secular sound rational argument cannot resolve the important moral controversies we face, nor is there a non-controversial understanding of when consensus and by whom would be normative and for what. . .Ethics consultation is itself a matter for disagreement.”

I am not directly addressing CEC’s, but I am very concerned that his remarks be misread by ethics committee members, the education of whom has been a principal work of the Center during our 25 year history.

Is normative ethics possible for our committees to achieve? Yes, within parameters of the institution whether it be the mission and vision statement or the Ethical and Religious Directives for Catholic institutions or whatever states the purpose of the institution. Those, broadly speaking, express the presuppositions, assumptions, values on which the institution rests.

Argument (in a committee’s case consult) starts from there, and though the documents may express the aim and purpose broadly, there would be enough substance that we can craft our arguments to show the rationality of our responses within that institutional “ethic.”

I shall get off my high horse, but I don’t want the difficulties for credentialing clinical ethics consultants to erode the positive contributions made in clinical ethics by our committees.

Does this make sense?



Anonymous Mike Brannigan said...

Sr. Rosemary,

Your concern is well-founded. One of the problems in TE's assertion is that it all-too-easily paves a path to the genetic fallacy of associating origin, or sources - in this case certain Enlightenment assumptions - with outcome. As a start, though it seems partly true that certain Enlightenment presuppositions could inspire earlier approaches to ethics committees and consults, considering various tensions within so-called "enlightenment" thinking, let's not think of Enlightenment in a simplistic, reductionist fashion. More importantly, his assertion conveys a misleading, static view of clinical ethics committees, the dynamics of which have evolved over past decades, as attested to by those, like yourself, who have been earnestly engaged 'in the ethics trenches' in hospitals. Ethics committees and their deliberations are in sense a moving target, shifting according to leadership, membership, institutional needs, accreditation requirements, systemic traits, and certainly mission direction. From my experience, ruling out theological moral considerations within deliberations is wrongheaded. Moreover, we would hope that those who are trained in ethics and who are part of deliberations bring to this context developing understandings regarding the nature of moral theory and moral reasoning. To illustrate, particularly in view of cultural competency concerns, the four-principled sacred cow continue to be challenged or refashioned. I believe your misgivings are apropos. It would be most interesting to garner perspectives from your ethics committee members.

Friday, October 30, 2009  

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