Christopher Meyers

Part memoir, part primer on doing ethics work, _Being an Ethicist_ is built upon the author’s four decades of work as a professor, center director, consultant, and public philosopher. Filled with realistic scenarios—mainly from clinical ethics, but also journalism and the academy—the book emphasizes how difficult ethics consulting can be: Intellectually, politically, and emotionally. It describes the tools needed to do it successfully, including a strong philosophical and theoretical grounding, qualitative empirical methods, and steps for complex ethics reasoning. Those tools, combined with the author’s direct experiences—with professionals, patients, clients, and students—have resulted in his provocative conclusions that, first, well-trained consultants are experts in ethics decision-making, and, second, that they should use that skill to be activist, that is, to advocate for better choices at case, institutional, and social levels.

This article’s thesis is that teachers of practical and professional ethics should adopt what Nick Fotion calls a “weak” approach to ethics theory and reasoning, one that is situated within a practice-driven attitude toward ethics engagement. This approach insists that ethics reasoning should strive to find real solutions to real world problems, while also embracing that such solutions are more often than not only tentative. That is, the approach does not demand that one’s reasoning model will always provide the complete and final answer to every ethics question, but instead strives for the best answer within acknowledged epistemological deficits. This humbler attitude recognizes that one’s proposed solutions could very well be upended by facts not currently available or by more skilled reasoning. Adopting such an approach can also do much to alleviate what I call the “roller-coaster” effect: namely, the all-too-common experience of reading the traditional theorists, quite rightly finding that they provide powerful and compelling—even convincing—arguments, only to then have that conviction undercut by the often devastating critique presented by the text or professor. On this model, one instead embraces key insights from those theorists and works to merge them into a practical method of ethics reasoning. I close with a proposal for one such method.

In this chapter I argue that ethics expertise unquestionably exists. We see it, in fact, in persons all around us, including in many clinical ethicists. Having such expertise, I suggest, means that it is more likely that one will be better than the average person at analyzing and providing solutions to tough ethical problems. In defending this position, I focus mainly on the practice of ethics, arguing that expertise resides in reasoning skills and discernment, just as it exists with reasoning in decision-making contexts other than ethics. I then switch to what it means to be an expert ethics consultant – the specialized skills and character traits needed to do that work in a manner that is more likely to successfully effectuate reasoned ethical judgments from within politically complex health care institutions. Throughout, I hold to the view that expertise, like wisdom, admits of degrees – some persons have more expertise than others and even the same persons have more, or less, throughout a lifetime and on different subjects. I also stress that expertise in ethics consulting is almost certainly enhanced by a team approach, in which each member brings their relevant skills.

To be a professional is to accept the obligation to sometimes participate in activities and to engage with people that one might otherwise choose to avoid. Lawyers, for example, must advocate on behalf of despicable clients, professors must teach and fairly evaluate lazy and insolent students, and physicians must minister to persons whose beliefs—and actions—run afoul of their core values. For example, at least three of the professionals who treated Robert Bower—the person who murdered 14 people in a Pittsburgh synagogue—were Jewish. As the hospital president, Jeffrey Cohen—also Jewish—put it, "We're here to take care of sick people. We're not here to judge you". Professionals must behave in this...

It is not unusual for patients or families to disagree with healthcare professionals (HCPs) over best treatment options. Conversation typically results and mutually agreeable choices are implemented. Rarely, but increasingly, patients or families will request, even demand, interventions the treating team believes will be ineffective (they will not achieve the intended goal) or inappropriate (the medical or moral harms clearly outweigh any potential benefits). One's duty as an HCP requires one to refuse such interventions, but resulting patient or family conflict makes such refusals challenging, even traumatic, and HCPs often acquiesce. Some states have legal options that protect HCPs and their respective institutions when they make such unilateral choices, but the process is complex, time‐consuming, and emotionally fraught. In this paper, We describe one especially difficult case, using it as a paradigmatic example of when, and why, a slow code is sometimes, if rarely, justified. We also discuss strategies HCPs can use to reduce the need for this, admittedly problematic, solution.

The Professional Ethics Toolkit is an engaging and accessible guide to the study of moral issues in professional life through the analysis of ethical dilemmas faced by people working in medicine, law, social work, business, and other industries where conflicting interests and ideas complicate professional practice and decision-making. Written by a seasoned ethicist and professional consultant, the volume uses philosophical ideas, theories, and principles to develop and articulate a definitive methodology for ethical decision-making in professional environments. Meyers offers the benefit of his expertise with clear and practical advice at every turn, guiding readers through numerous real-world examples and case studies to illustrate key concepts including role-engendered duties, conflicts of interest, competency, and the principles that underpin and define professionalism itself. Following the format of The Philosopher’s Toolkit, The Professional Ethics Toolkit is an essential companion to the study of professional ethics for use in both the classroom and the working world, encouraging students and general readers alike to think critically and engage intelligently with ethics in their professional lives.

Considerable debate prevails over how clinical ethics consultations should be managed: Should ethicists merely analyze problems and outline relevant value dimensions? Should they become patient advocates? Physician or hospital advocates? Should they give prescriptive recommendations as to best ethical choices? The dominant view has long been that the first, problem analysis, role is the only one appropriate, in largest part because, given the lack of agreement in moral theory, there are no established grounds upon which one could validly base prescriptive advice. That is, the seemingly unending and contentious debates in ethics theory have left many skeptical about the value of pursuing right answers in ethics and, even more, about whether philosophers have any particular ethics expertise. If philosophers cannot even agree on abstract theory, such skeptics maintain, why on earth should others turn to them for advice when faced with real world dilemmas? This skepticism has naturally found its way into the debates on the ethicist's role, resulting in the dominant, problem analysis, position. I wish here to challenge this dominant view and defend, instead, a role that combines good problem analysis with prescriptive recommendations.

In Abram Brummett and Erica K. Salter's excellent paper, “Mapping the Moral Terrain of Clinical Deception,” they rightly note that it is sometimes ethically appropriate for health care professionals to deceive patients and families. However, they also note that because doing so violates a prima facie duty of honesty, the ethical burden of proof falls upon the deceiver. Hence, they also provide a sophisticated framework for determining whether any given case is warranted. I applaud their overall approach but also critique some of their claims, in particular, their conclusion that lies of commission require greater justification than those of omission and their conflation of the principles of beneficence and nonmaleficence. I also urge them to give greater attention to how power asymmetries should be accounted for and to the impact such deceptive choices might have on the clinician's character.

Editor's Note: Among the core activities of many ethics centers has been helping organizations – businesses, healthcare institutions, professional bodies – evaluate and improve their ethical structures and practices. Much of that work has resulted in incisive and valued critiques that guide practitioners through tough ethics thickets. It has also produced reams of published material and considerable consulting income. All of which points to a telling irony: There is almost no such published analysis of how those same ethics centers should ethically organize their own work and activities. The one exception is the 2005 monograph, Ethics Centers and Conflict of Interest, but it just touches on core issues and is now difficult to obtain. It is now, thus, past time to give these topics sustained attention – hence this (Vol. 21, No. 2, Fall 2021) dedicated issue of Teaching Ethics.

Although clinical ethics scholarship and practice has largely avoided assuming an activist stance, the many health care crises of the last eighteen months motivated a distinct change: On listserves, in blog postings, and in published essays, activist language has permeated conversations over such issues as the impact of triage policies on persons with disabilities and of color, and how the health care system has historically failed African Americans. In this paper, I defend this turn, arguing that clinical ethicists should embrace activism—generally, and with particular emphasis on institutional, mesolevel concerns. Ethicists are often uniquely situated to understand the structural factors that regularly motivate clinical ethics cases, and they are often in a privileged position to be effective change agents. In making this case, I also stress the need not to overstep one's skills and to be acutely cognizant of the political risks associated with such work.

The Covid-19 pandemic has presented major challenges to society, exposing preexisting ethical weaknesses in the modern social fabric’s ability to respond. Distrust in government and a lessened authority of science to determine facts have both been exacerbated by the polarization and disinformation enhanced by social media. These have impaired society’s willingness to comply with and persevere with social distancing, which has been the most powerful initial response to mitigate the pandemic. These preexisting weaknesses also threaten the future acceptance of vaccination and contact tracing, two other tools needed to combat epidemics. Medical ethicists might best help in this situation by promoting truth-telling, encouraging the rational adjudication of facts, providing transparent decision-making and advocating the virtue of cooperation to maximize the common good. Those interventions should be aimed at the social level. The same elements of emphasizing cooperation and beneficence also apply to the design of triage protocols for when resources are overwhelmed. A life-stages approach increases beneficence and reduces harms. Triage should be kept as simple and straightforward as reasonably possible to avoid unwieldly application during a pandemic.

Late in 1990, the Center for the Study of Ethics in the Professions at Illinois Institute of Technology (lIT) received a grant of more than $200,000 from the National Science Foundation to try a campus-wide approach to integrating professional ethics into its technical curriculum.! Enough has now been accomplished to draw some tentative conclusions. I am the grant's principal investigator. In this paper, I shall describe what we at lIT did, what we learned, and what others, especially philosophers, can learn from us. We set out to develop an approach that others could profitably adopt. I believe that we succeeded.

In this article I argue, first, that genuinely effective ombudsmen could help restore news credibility-thereby staving off other, more intrusive external intervention-and that the position must have true sanctioning authority, much like that of the ethics officer in many corporations. I also argue that the effective ombudsman will be one who sufficiently understands the workings of journalism but who is not immersed in its ethos. This distancing is necessary for genuine critical appraisal to be possible.

The global turn in media ethics has presented a tough challenge for traditional models of moral theory: How do we assert common moral standards while also showing respect for the values of those from outside the Western tradition? The danger lies in advocating for either extreme: reason-dependent absolutism or cultural relativism. In this paper, I reject Cliff Christian’s attempts to solve the problem and propose instead a moral theory of universal standards that are discovered via a mix of rationally grounded methods. Such universality refutes relativism but, because it is grounded in evolutionary naturalism and life-world philosophy—as opposed to a Kantian or theological transcendentalism—it also avoids absolutism.

Much of the work in professional ethics sees ethical problems as resulting from ethical ignorance, ethical failure or evil intent. While this approach gets at real and valid concerns, it does not capture the whole story because it does not take into account the underlying professional or institutional culture in which moral decision making is imbedded. My argument in this paper is that this culture plays a powerful and sometimes determinant role in establishing the nature of the ethical debate; i.e., it helps to define what are viable action options, what is the organization’s genuine mission, and what behaviors will be rewarded or criticized. Given these conclusions, I also argue that consulting ethicists need more than an understanding of ethics theory, concepts and principles; they also need a sufficiently rich understanding of organizational culture and a willingness and an ability to critique that culture.

Does managed care represent the death knell for the ethical provision of medical care? Much of the current literature suggests as much. In this essay I argue that the types of ethical conflicts brought on by managed care are, in fact, similar to those long faced by physicians and by other professionals. Managed care presents new, but not fundamentally different, factors to be considered in medical decision making. I also suggest ways of better understanding and resolving these conflicts, in part by distinguishing among conflicts of interest, of bias and of obligation

Although autonomy is clearly still the paradigm in bioethics, there is increasing concern over its value and feasibility. In agreeing with those concerns, I argue that autonomy is not just a status, but a skill, one that must be developed and maintained. I also argue that nearly all healthcare interactions do anything but promote such decisional skills, since they rely upon assent, rather than upon genuinely autonomous consent. Thus, throughout most of their medical lives, patients are socialised to be heteronomous, rather than autonomous. Yet, at the worst possible time – critical care decision-making – when life and death consequences are attached to the choices, the paradigm shifts and real consent is sought, even demanded, thereby making an often traumatic situation even harder.I go on, though, to also reject paternalistic models of beneficence as an alternative. Rather, I conclude that the problem is so fundamental in healthcare that a genuine solution would require a radical restructuring. I recommend steps that can be taken in the interim to improve the situation and to move toward such a restructuring.

While it appears that respect for autonomy has become the fundamental principle in medical ethics, it is not clear what various authors have in mind when they use the term "autonomy." Accounts range from an equation of autonomy with negative freedom to a Kantian emphasis on self-governance. ;My goal here is to characterize that status in persons which we call autonomy and which demands our respect in such applied settings as medicine. What types of behavior must be present for us to honor persons' decisions as autonomous? And what kinds of factors can constrain that behavior? ;My answer is that being autonomous means being as much responsible for one's life as the situation allows and warrants. In explaining what these various claims entail, I note that autonomy is an exercise concept and that it admits of degrees. Being autonomous requires more than simply having the capacity to engage in certain kinds of behaviors; the autonomous person exercises those capacities. Furthermore, persons are more or less autonomous in different situations, and different types of decisions demand varying levels of autonomous behavior in order to warrant our respect. ;In addition to explaining what it means to be autonomous, I discuss the broad range of factors which can constrain autonomy. I extend the traditional analyses of constraints and show how such factors as illness, socio-economic and institutional realities, and interpersonal communication can constrain persons' ability to be autonomous. ;I conclude with an argument that persons have an obligation to be autonomous. This argument is based both on a position of self-respect and on avoidance of harms to others

Journalists are regularly criticized for causing harm to others, such as invading privacy, printing, or airing offensive material, and so forth. Although most sensitive journalists readily acknowledge these harms, they frequently argue that the pursuit and coverage of news is nonetheless justified because it fulfills a greater moral purpose - satisfaction of the public's right to know. This article argues that although "the public s right to know" does justify some harmful journalistic behavior, too often the phrase is used without the conceptual precision necessary to justify the competing harm. That is, journalists often confuse having a right to know with having an interest or curiosity in knowing and such conceptual confusion too often allows journalistic behavior to occur that would otherwise be seen as unethical