On What Grounds? Squaring Clinical Ethics Recommendations With Inclusive Public Discourse

This panel will explore different views about ethical justification in healthcare ethics consultation (HEC), and participants will argue that debates about ‘whether ethicists should make recommendations’ may hinge on disagreements about ethical justification. At the core of the ‘ethics facilitation approach’ to HEC is a distinction between (1) cases when more than one course of action is ethically justified and (2) cases when there is only one ethically justified option, or an unethical option is being requested. According to Core Competencies for Healthcare Ethics Consultation, the ethicist may make recommendations in the latter case, but should be very careful about doing so in the former case, lest they unduly influence decision makers. Core Competencies does not explain what ethical justification in HEC involves.

Speaker One will argue for a comparatively expansive account of ethical justification. On their account, a stakeholder’s view can be ethically justified if it can be supported by moral reasons we recognize as belonging to the set of American bioethical values in the context of a broad national ethical pluralism. Speaker Two will argue for a comparatively restrictive account of ethical justification, according to which an ethically justified option is one that is consistent with bioethical consensus that has been refined using wide reflective equilibrium. Speaker Three will argue for a novel ‘public reason’ account of clinical ethical justification that is intermediate between the ones endorsed by the other speakers. Two of the speakers have published extensively on topics related to this panel presentation.