Lisa Marie Rasmussen

The question of whether clinical ethics consultants may engage in patient advocacy in the course of consultation has not been addressed, but it highlights for the field that consultants? allegiances, and the boundaries of appropriate professional practice, must be better understood. I consider arguments for and against patient advocacy in clinical ethics consultation, which demonstrate that patient advocacy is permissible, but not central to the practice of consultation. I then offer four recommendations for consultants who engage in patient advocacy, and consider the implications of this issue for the field.1

The legitimacy of clinical ethics consultation is often implied to rest on the legitimacy of moral expertise. In turn, moral expertise seems subject to many serious critiques, the success of which implies that clinical ethics consultation is illegitimate. I explore a number of these critiques, and forward “ethics expertise,” as distinct from “moral expertise,” as a way of avoiding these critiques. I argue that “ethics expertise” succeeds in avoiding most of the critiques, captures what clinical ethics consultants might justifiably do, and expresses a subject matter which can be taught and assessed

The attempt to critique the profession of clinical ethics consultation by establishing the impossibility of ethics expertise has been a red herring. Decisions made in clinical ethics cases are almost never based purely on moral judgments. Instead, they are all-things-considered judgments that involve determining how to balance other values as well. A standard of justified decision-making in this context would enable us to identify experts who could achieve these standards more often than others, and thus provide a basis for expertise in clinical ethics consultation. This expertise relies in part on what Richard Zaner calls the “expert knowledge of ethical phenomena”.

The Office of Research Integrity found in 2011 that Vipul Bhrigu, a postdoctoral researcher who sabotaged a colleague’s research materials, was guilty of misconduct. However, I argue that this judgment is ill-considered and sets a problematic precedent for future cases. I first discuss the current federal definition of research misconduct and representative cases of research misconduct. Then, because this case recalls a debate from the 1990s over what the definition of “research misconduct” ought to be, I briefly recapitulate that history and reconsider the Bhrigu case in light of that history and in comparison to other cases involving tampering. Finally, I consider what the aim of a definition of research misconduct ought to be, and argue that the precedent set by the reasoning in this case is problematic

The nature, possibility, and implications of ethics expertise in general and of bioethics expertise in particular has been the focus of extensive debate for over thirty years. What is ethics expertise and what does it enable experts to do? Knowing what ethics expertise is can help answer another important question: What, if anything, makes a claim of expertise legitimate? In other words, how does someone earn the appellation “ethics expert?” There remains deep disagreement on whether ethics expertise is possible, and if so, what constitutes such expertise and what it entails and legitimates. Discussion of bioethics expertise has become particularly important given the growing presence of bioethicists in the clinical setting as well as efforts to professionalize bioethics through codes of ethics and certification efforts. Unlike in the law or in engineering, where there may be a body of knowledge that professional organizations or others have articulated as important for education and training of experts, ethics expertise admits of no such body of knowledge or required experience. Nor is there an entity seen as having the authority to articulate the necessary scope of knowledge. Questions about whether there is such a body of knowledge for particular areas within bioethics have emerged and played a central role in professionalization efforts in recent years, especially in the area of clinical ethics.

“Chiaroscuro” is a art technique that makes use of light and shade to suggest depth and solidity on a flat surface. I argue that the standards regarding accountability in the second edition of the Core Competencies for Healthcare Ethics Consultation , are chiaroscuro, because, despite the offered lists of competencies, it is very difficult to imagine how consultants might be held accountable to such standards. It is not clear to which of the many suggested standards a consultant should be held accountable, and even if one stipulates that only the tabulated competencies are meant as standards, the vague wording makes it hard to know how a consultant might fail to meet the standards or perform excellently. In addition, because terms such as “ethics” and “ethical” are not defined in the document, we are left with no way to determine whether consultants have made appropriate recommendations. The document is useful as a point of discussion, but not yet ready to serve as a tool for holding practitioners accountable

Is there only one bioethics? Is a global bioethics possible? Or, instead, does one encounter a plurality of bioethical approaches shaped by local cultural and national traditions? Some thirty years ago a field of applied ethics emerged under the rubric `bioethics'. Little thought was given at the time to the possibility that this field bore the imprint of a particular American set of moral commitments. This volume explores the plurality of moral perspectives shaping bioethics. It is inspired by Kazumasa Hoshino's critical reflections on the differences in moral perspectives separating Japanese and American bioethics. The essays include contributions from Hong Kong, China, Japan, Texas, the United States, Germany, Switzerland, and Italy. The volume offers a rich perspective of the range of approaches to bioethics. It brings into question whether there is unambiguously one ethics for bioethics to apply.

A subcommittee of the American Association of University Professors has published a report, “Research on Human Subjects: Academic Freedom and the Institutional Review Board” , which argues that institutional review board oversight may pose a threat to academic freedom, and that a different oversight model based on departmental review would both maintain subject protection and eliminate the threat. But the report does not demonstrate that IRBs pose a threat to academic freedom, and using departmental oversight may not sufficiently protect human subjects of research, could introduce other problems, and would itself pose threats to academic freedom. Instead, some alternative methods of streamlining IRB oversight for certain types of research would better address the practical problems currently encountered

Intellectual contribution in the form of authorship is a fundamental component of the academic career. While research has addressed questionable and harmful authorship practices, there has largely been no discussion of how U.S. academic institutions interpret and potentially mitigate such practices through the use of institution-level authorship policies. To gain a better understanding of the role of U.S. academic institutions in authorship practices, we conducted a systematic review of publicly available authorship policies for U.S. doctoral institutions, focusing on components such as specification of authorship criteria, recommendations for discussing authorship, dispute resolution processes, and guidance for faculty-student collaborations. We found that only 24% of the 266 Carnegie R1 and R2 Universities had publicly available authorship policies. Within these policies, the majority specified criteria for authorship, but provided less guidance about actual processes for applying such criteria, handling authorship disputes, and managing faculty-student author teams. Further, we found that any discussion of dispute resolution practices typically lacked specificity. Recommendations grounded in these findings are offered for institutions to leverage their ability to guide the authorship process by adopting an authorship policy that acknowledges disciplinary diversity while still offering substantive guidance.

A major obstacle to broad support of clinical ethics consultation is suspicion regarding the nature of the moral expertise it claims to offer. The suspicion seems to be confirmed when the field fails to make its moral expertise explicit. In this vacuum, critics suggest the following:Clinical ethics consultation's legitimacy depends on its ability to offer an expertise in moral matters.Expertise in moral matters is knowledge of a singular moral truth which applies to everyone.The claim that a clinical ethics consultant can offer knowledge of a singular moral truth in virtue of her professional training is absurd, false, or gravely immoral.Therefore,The field is illegitimate.