Telling about engagement is not enough: Seeking the “ethics” of ethics consultation in clinical ethics case reports

Abstract

Introduction “The Zadeh Scenario,” a wondrously rich narrative generously shared by Finder, walks the reader through the interactions of an ethics consultant during a case. In this telling, Finder appears deeply cognizant of how memories can be affected by subsequent decisions and experiences. Hence, it is important to note that many key parts of the narrative – if not all of it – were captured concurrently or in close proximity to the actual events, thereby revealing the factual and normative obscurity that unfolds over the course of an ethics consultation. Finder’s polished skills of careful attention and mindful appreciation in recounting the “doing” of an ethics consult thus provide something of an anthropological account – telling us who went where and the content of several weighty conversations – rather than what might traditionally be expected from an ethical analysis of a case presentation. Importantly, though, this accounting exposes the difficulty of abstracting moral understanding from a description of the actions of the involved parties. At the same time, the narrative also reveals an important limitation of case presentations, namely that they are generally presented as a concrete case in time with a firm beginning and end. For all its richness, much of the information that is needed to assess what is ethically important or problematic in the consult falls outside of the scope of the narrative we have before us. This deficiency may partly lie in the fact that like many ethics consults, the ethics consult in which Finder finds himself has an unclear beginning – did it begin 3 years ago when an ethics consult was called by the neurologist; did it begin during subsequent hospitalizations when Dr. Moore was approached by concerned individuals involved in Mrs. Hamadani’s care; did it begin.