Only a few months shy of completing my master’s degree in Bioethics, I was sure I had a firm understanding of what bioethics means. I knew I would need to learn more in the future, but I was confident that all I needed to navigate the field were the four core principles of bioethics: autonomy, benevolence, non-maleficence, and justice. While taking one of my final courses, Bioethics Consultation Skills Course (BCSC), I was surprised to find I made mistakes as a consultant during our role-playing exercise. I made mistakes even though I orchestrated a consensus among the parties involved, making sure to advocate for the patient’s family and doctor’s concerns and values. I had deemed myself a pro-bioethics consultant.
What did I do wrong? The role-play involved a patient who lacked decision making capacity, but had made clear in the past she did not want dialysis treatment. Her family and doctor saw her lack of capacity as an opportunity to overcome the patient’s wishes. My approach was to help guide the participants in the meeting to come to a mutual agreement, which I thought sufficed. It wasn’t until the debriefing session where I was informed by my instructors that I completely missed the major ethical issue: representing the patient’s values when she could not. I was upset with myself for improperly assessing the case and misunderstanding the point of the consultation. My idea of a successful bioethics consultation was missing an important piece: framing the ethical question. It wasn’t about an eloquent speech or getting a consensus; it was about addressing the ethical issue within the case. I not only had to question my understanding of ethical consulting but my understanding of bioethics. It was that moment that led me to revisit the meaning of bioethics.
So, what is bioethics?
According to the American Society for Bioethics and Humanities (ASBH), bioethics entails theories about what is morally right or wrong in the practice of medical ethics. When people in social situations ask me to define bioethics, I find it challenging to give an answer. I try to formulate a definition that is as academically sound as ASBH’s but more comprehensible. Helping others understand what bioethics is can be hard. They may have a misconception that bioethics is a futuristic study that deals with science-fiction and cyborgs. Bioethics does look to the future, but is broader than that. It is a multidisciplinary practice that encompasses complex theories and principles “of moral decisions within medicine.” (Albert Jonsen). It uses tools and methods like clinical consultation to resolve real world ethical problems.
The Bioethics Consultation Skills Course allowed me to take a step-back and understand that bioethics does not offer a one-size fits all solution. Consultation helps “resolve uncertainty or conflict regarding value-laden concerns that emerge in healthcare.”(1)[i] Essentially, it is a tool that allows the healthcare team and family members to systematically develop a solution by carefully dissecting the ethical question pertaining to the patient’s case. Most importantly bioethics consultation is a useful tool that applies the definition and principles of bioethics to tangible cases.
The purpose of the role-play was to help me frame an ethical question, one that respected the patient’s autonomy and integrity. The exercise helped me see how to put the core principles and theories into practice. I now have a greater appreciation for bioethics consultants. Their work requires them to weigh-in on the risks and benefits of a treatment or lack of a treatment while adhering to the patient’s values. Thus, the words of Justice Benjamin Cardozo ring true in the work of ethic consultations, “Every human being of adult years and sound mind has the right to determine what shall be done with his own body.”
There isn’t a perfect cookie-cutter answer for every bioethics dilemma, but there are steps in the practice of bioethics consultation to attain a solution that is morally sound. Perhaps the most important step is to honor the patient’s values. Albert Jonsen says the consultation process should involve “the ethicist, the patient, the family, the physicians, and the nurses [who] should come away from an ethical dilemma with a resolution of which they are not ashamed, if not with ‘a satisfactory total explanation of conduct.’ The BCSC component of my master’s degree education has not only taught me how to apply the core principles of bioethics in consultations, but to be confident in defining bioethics.
- Force, Core Competency Task. “Core competencies for healthcare ethics consultation.”Glenview: American Society for Bioethics and Humanities (2011).
- Jonsen, Albert R.The birth of bioethics. Oxford University Press, 2003.