Radioactive Recommendations: Where Ethics Advice Lands Dangerously

Abstract: In the course of a clinical ethics consultation, a professional clinical ethicist may find herself making a recommendation to the requestor, the patient’s attending physician, or the treating team as a whole. Some guidance to the field in this regard includes the 2nd edition of the ASBH Core Competencies for Healthcare Ethics Consultation which states that “consultants should be careful about recommending a single course of action if more than one course of action is ethically acceptable,” and the ASBH Code of Ethics and Professional Responsibilities for Health Care Ethics Consultants which articulates, under Preserve Integrity, that “[Healthcare ethics consultants] should strive to be worthy of the trust placed in them by patients, family members and caregivers, healthcare staff members, and the institutional leaders who seek their help in addressing ethical questions and problems.” In some situations, the advice an ethicist renders is categorically of a more benign nature such as recommendations to solicit a patient’s preferences at a time of capacity when a serious illness is diagnosed in order to provide goal-concordance care later. However, we suggest there may be a category of “radioactive recommendations” where a singularly-appropriate course of action that is recommended in a given case may be indiscriminately applied elsewhere. After reviewing some potentially radioactive recommendations, we will discuss inter alia whether this is a unique challenge for clinical ethicists, how to manage dual roles of consultant and educator in an institution, and what strategies could mitigate dangerous applications of ethics advice to ensure professional trustworthiness.

Keywords: clinical ethics consultation, clinical ethicist, ethics education