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Proposed Guidelines Call for Formal Quality Attestation of Clinical Ethics Consultants

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Recommendations Co-Authored by Weill Cornell Bioethicist

Clinical ethicists should go through a standardized quality-attestation process in order to consult on patient care, according to proposed guidelines co-written by a Weill Cornell Medical College bioethicist.

Under the recommendations, prospective clinical ethics consultants (CECs) would submit a portfolio that demonstrates their education and experience, and then participate in an oral examination in which they demonstrate their knowledge of clinical ethics and ability to analyze ethical questions that arise in clinical practice.

Dr. Joseph J. Fins
The proposal written by a task force of the American Society for Bioethics and the Humanities (ASBH) was published in the September-October issue of the Hastings Center Report. ASBH is the largest U.S. professional organization for bioethicists.

"It's a breakthrough in clinical ethics in the fact that we're articulating standards and initiating a process" to attest to consultants' competency, said Dr. Joseph J. Fins, the E. William Davis Jr., MD Professor of Medical Ethics and chief of the Division of Medical Ethics at Weill Cornell. "People are doing this now without standards. There's a lot of variance. The idea is you should be treated the same - it shouldn't vary based on who the ethics guy is. This is a patient safety issue, this is a quality issue."

Though there is no official tally of clinical ethicists, a 2007 survey estimated that about 29,000 people consulted on dilemmas in patient care in a one-year period. Yet the field is not regulated and educational and professional expectations of consultants vary, the survey noted. The ASBH's proposed guidelines would require would-be CECs to apply to the society in order to consult on cases.

Once ASBH fully implements the process, health care facilities ultimately could be expected to use the protocol as part of their accreditation by medical regulatory bodies, Dr. Fins says.

"It's a landmark because people have been fighting over this topic for 25 years, not being able to reach consensus on it," Dr. Fins says. "But the board of ASBH voted to approve this process, so it's policy."

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