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Authority in Ethics Consultation

Published online by Cambridge University Press:  01 January 2021

George J. Agich
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Extract

Authority is an uneasy, political notion. Heard with modern ears, it calls forth images of oppression and power. In institutional settings, authority is everywhere present, and its use poses problems for the exercise both of individual autonomy and of responsibility. In medical ethics, the exercise of authority (along with power) has been located on the side of the physician or the health care institution, and it has usually been opposed by appeal to patient autonomy and rights. So, it is not surprising, though still ironic, that ethics consultation, which develops from this patient rights-dominated ethic, should itself bring forth questions of authority. Nonetheless, it does.

Insofar as authority has been discussed in ethics consultations, it has been understandably approached from the broad perspective of legitimation and power, which are common themes in social and political treatments of authority. These treatments have dominated twentieth-century discussions of authority, which primarily view authority as legitimate power.

Type
Article
Information
Journal of Law, Medicine & Ethics , Volume 23 , Issue 3 , Fall 1995 , pp. 273 - 283
Copyright
Copyright © American Society of Law, Medicine and Ethics 1995

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References

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I refer to the ethics consultant for convenience. My goal is to characterize an operative, but largely neglected, sense of authority in ethics consultation without regard to whether the consultations are provided by individual consultants, consultative teams, or HECs. Evident differences do exist between these three kinds of ethics consultations, and they will affect the application of my points. Although I allude to some of these differences in passing, my main concern is to outline a new way of understanding authority in the process of ethics consultation. The practical and ethical problems associated with this sense of authority will be different for individual consultants, consultative teams, and HECs, but systematically differentiating them is beyond the scope of this paper.Google Scholar
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Interestingly, when that question is raised about a specific in authority figure, the authority figure is usually well on his way to losing authority. A number of answers might be given to this question, none of which, however, gets at the distinctive phenomenon that reasoning accomplishes by augmenting and confirming the will. One might, for example, appeal to hierarchy and status, interest and advantage, personal attachments and loyalties, or some specific law. None of these considerations in itself really provides a satisfactory explanation of why an authority figure's advice should be followed in a specific context. Augmentation by reasons, however, does provide a basis that can justifiably motivate action.Google Scholar
Beyond that important practical question is one about the implications of this kind of power for the consultant's epistemic authority in clinical ethics. The issue is not whether the ethics consultant's epistemic and competence authority can be transformed into in authority or executive power by means of personal authorization, but whether a different kind of authority is infused that practically and politically complicates the situation. It is inevitable that the dynamics of certain cases will propel the ethics consultant into these uncharted waters. It is an open question to what extent this does occur in the course of ethics consultation.Google Scholar
In such instances, the ethics consultant needs to remember that the individual physician practices within the institution as a matter of privilege, not right. Appealing to the medical staff hierarchy without emotion and guided by clear-headed reasoning is a sure way to bring a recalcitrant physician in line with obvious patient rights. Also, administrative avenues of appeal are usually backed up by legal remedies. A reminder of the law can have a sobering effect on key members of both the medical staff and the administration. Going to such lengths, however, does not make the ethics consultant's authority executive or in authority power. Quite to the contrary, it simply confirms the epistemic authority of clinical ethics, which necessarily includes a detailed knowledge of the relevant common legal requirements, rules, and remedies. Willingness to deploy this knowledge in the service of a patient, however, can require courage and fortitude by the ethics consultant, a fact that underscores the importance of the ethics consultant's character or virtue. This point is important both practically and theoretically, because some contractual and work arrangements for ethics consultants might promote or enhance the expression of this character or virtue, while other arrangements might significantly thwart its expression and stymie its development.Google Scholar
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