3 The Issue of Expertise in Clinical Ethics

The proliferation of ethics committees and ethics consultation services has engendered a discussion of the issue of the expertise of those who provide clinical ethics consultation services. In this paper, I discuss two aspects of this issue: the cognitive dimension or content knowledge that the clinical ethics consultant should possess and the practical dimension or set of dispositions, skills, and traits that are necessary for effective ethics consultation. I argue that the failure to differ-entiate and fully explicate these dimensions contributes to the confusion over the issue of expertise and fuels, at least partly, the controversies about expertise (or authority) in ethics and the legitimacy of the use of ethical knowledge in clinical ethics consultation. The proliferation of hospital ethics committees and ethics consultation ser-vices in health care organizations has been influenced by two interrelated devel-opments: first, the growing recognition that a mechanism to resolve conflicts and issues arising in medical care without recourse to courts of law was needed,1 and, second, the Joint Commission for the Accreditation of Healthcare Organizations requirement for an “ethics mechanism,”2 which was built on recommendations by other influential groups such as the President’s Commission for the Study of Ethi-cal Problems in Medicine and Biomedical Research3 and the American Medical Association.4 These recommendations reflect the recognition that the basic need for some authoritative voice to address ethical conflicts and issues arising within patient care contexts. As Aulisio and Arnold recently expressed it, Much more significant, in our view, are the features of contemporary clinical care settings that give rise to the need for ethics committees (or something like them). These features include the complex value-laden nature of clinical decision making, the pluralistic context of contemporary society that is reflected to various degree