Deferential Diagnoses: Are Clinical Ethics Consults Fundamentally Problematic?

Abstract: Deference to moral testimony is under fire from some ethicists. These so-called “pessimists” problematize testimony, deference, and expertise. But from ethics boards to institutional codes of ethics to ethics consults, deference to moral testimony is common throughout the biomedical field. One might be tempted to vindicate the biomedical field’s ethical practices by rebutting pessimistic arguments. I suggest another tactic. It is common in theoretical fields to account for the praxis of its applied practitioners. Thus, philosophers of math must account for what mathematicians do; successful mathematical praxis is evidence for philosophy of mathematics. Similarly, philosophers of science must account for what scientists do; the successful practices of scientists is a fixed point in our theorizing about, and philosophy of, science. Similarly, then, I propose that the successful practices of actual biomedical ethicists play a similar role for theorizing about ethics as the practices of mathematicians and scientists play for their respective theoretical fields—that is, evidence to be explained by theoretical ethicists and philosophers. On this view, at least some deference to moral testimony (and, concomitantly, some form of moral expertise) is presumptively valid, and the pessimism of moral theory is a failure of moral theory rather than a reason to revisit ethical practices in the biomedical field.

Keywords: clinical ethics, moral expertise, moral deference