Doing Well or Doing Good in Ethics Consultation

Excerpt

“The Zadeh Scenario,” when taken together with the subsequent layers of peer review and commentary on that peer review, highlights two crucial insights regarding peer review for clinical ethics. The first is one that most (but not all) of Finder’s peer reviewers miss: peer-reviewers who would give attestation to quality need to be critically attentive to, and reflective about, the evidence supplied to them by candidates. The second is a more significant point: the kind of doing that is clinical ethics consultation is a local form of moral enquiry, seeking not just to achieve medical – or clinical ethical – goals, but to enact human goods. Good peer review thus turns on being clear regarding the goods of ethics consultation. Buried inside “The Zadeh Scenario” one can find several goods of clinical ethics. These goods are subjective, idiosyncratically named and defined by patients, and embedded in an institution of healthcare that purports to be of service to the goods of health. The clinical ethics consultant, at her best, acts as a careful mid-wife, attempting to bring forth the goods desired, the goods possible, and perhaps even the goods that, while desired, are not possible. After all, some goods pursued by patients are not possible due to the limits of medicine. On the other hand, some goods pursued by medicine are not desired by patients. And equally, some goods pursued by clinical ethicists might be limited, provisional, and local. “The Zadeh Scenario” thus acts to problematize the goals of clinical ethics consultation, asking it to focus on the goods that the practice might bring forth.