Should Bioethicists be Credentialed, Licensed?

I am often called a bioethicist—although I don’t call myself one.  Why?  I write a lot about bioethical issues and some people pay attention to my opinions—some in support and others in opposition.  Voila—I’m a bioethicist!

The bioethics movement sees this as a problem.  Those with strong ambitions for the field are acutely aware that while barbers are licensed by the state and required to pass certain competency tests, bioethicists are not.  So too, lawyers, nurses, physicians, psychotherapists, teachers, etc.  And some want to change that by establishing accrediting documents from the primary professional organization, if not state licensing.  From the story:

For years bioethicists have debated how far to go in professionalizing the field — particularly clinical ethics. Currently, there is nocertification process, but Magnus and others think the field is moving toward some kind of credentialing for those who practice clinical ethics. The debate over credentialing has come up repeatedly, says Magnus, and the lack of resolution has prompted a few outside, for-profit groups to express interest in setting up a clinical ethics certification process.

That outside interest, in part, has spurred the American Society for Bioethics and Humanities to update the core competencies for clinical bioethics that were established in 1998, setting forth the skill set required for hospitals that offer clinical ethics consultations. For instance, the skills would include the ability to distinguish the ethical dimension of a particular problem from the legal and medical dimensions, as well as being able to research peer-reviewed ethics publications for precedents. “In some hospitals, there may not be an individual who possesses the full skill set, but there should be a committee or group that collectively has all of the skills,” Magnus says.

The revised core competencies will be published in the coming months, he says, although the requirements would not initially be binding. But he holds out hope that hospitals and other health-care organizations will play a stronger role in requiring that their clinical ethicists meet the core-competency requirements. “It’s embarrassing, in some ways, how poor the quality of clinical ethics is at many institutions,” Magnus says.

I am certainly not against bioethics as a general field—although I wish it had more humility—nor do I oppose the higher education of practitioners  to have certain skill sets and areas of knowledge.  And I believe bioethics committees and members are very well intentioned, and often serve as splendid sources of mediation and counseling with patients/families and medical professionals about tough clinical  issues.  Heck, I have been on a hospital bioethics committee myself, and I once represented a client (pro bono) in front of a bioethics committee futile care hearing (a daunting experience) that turned out well.

That being said, bioethicists should not be allowed to become, to use George Bush’s phrase, the deciders. And credentialing, whether intended or not, would move the field in that direction.

But keep in mind, bioethics is an entirely subjective enterprise.  Just because someone has read Kant, Ramsey, and Fletcher, or understands the science of cloning, that doesn’t mean their opinions about whether to permit, say, embryonic stem cell research, assisted suicide, organ harvesting from people in a persistent unconscious condition—all of which are on the public policy table—should be given special deference.

Moreover, I suspect that bioethics credentialing could increase the existing ossification of the majority-held views in bioethics beyond what what I see as the current general homogeneity (oft denied by those in the field).  As I put it in Culture of Death: The Assault on Medical Ethics in America (citations omitted):

Put more simply, bioethics seeks to create the morality of medicine, define the meaning of health, establish the mores of society, and forge the public policies that will promote these all-encompassing ends.  Undoubtedly, some bioethicists will angrily reject these assertions as provocative and hyperbolic.  They act in good faith, they will contend.  They only intend the creation of a better world.  Besides, they will assert forcefully, bioethics is not monolithic.  Practitioners have widely divergent opinions about the issues and controversies — ranging from assisted suicide, to cloning, to the definition of “health” — with which bioethics discourse grapples.  Moreover, many would undoubtedly claim, bioethics doesn’t have an end goal.  It is more akin to a conversation among professional colleagues, a process that merely seeks consensus about the most pressing moral and medical issues of our time.

If that was ever true, I contend that it is true no longer.  While there are certainly dissenters within the bioethics ranks, I have come to the unhappy conclusion that the predominate and most influential strain of bioethics has a distinct philosophical outlook and planned policy agenda which dehumanizes the weakest and most vulnerable among us and is antithetical to virtuous public policies, medical protocols, and professional attitudes that have guided health care for millennia.  Indeed, after immersing myself in the field’s literature, text books, and opinion articles, after tracing the public impact of bioethics advocacy in our medical policies, court decisions and laws, it is clear to me that predominate bioethics has long ceased to be a dispassionate dialogue, if it ever was one.  Its leading voices have forged it into what I believe is described fairly as orthodoxy, perhaps even an ideology.

My opinion is undoubtedly uncontroversial.  Most bioethicists would recoil at a depiction of themselves as “true believers” subject to orthodox precepts and the emotional zeal generated by intensely-felt ideology.  Their self-view is that of the ultimate rational analyzer of moral problems, who, were pipe smoking still fashionable, would sit back, pipe firmly in mouth, acting as dispassionate “mediators” between the extremes of medical technology and the perceived need for limits.  But that is self-deception.  Once bioethics moved away from ivory tower rumination and to actively influence public policy and medical protocols, by definition the field became goal oriented.

I wrote those words in 2000.  I am more convinced in 2011 than ever that they are true.

Credentialing, it seems to me, would be primarily about narrowing the backgrounds of those who go into the field and raising the power of bioethicists in society to better enable them to impose orthodoxies and the bioethical consenses upon the rest of us.  I have seen no reason in my nearly two decades contending about these matters to think that would be good for society.

HT:Bioedge.