Gasparetto Alessandra, Jox Ralf J, Picozzi Mario
Center for Clinical Ethics, Biotechnology and Life Sciences Department, Insubria University, Varese, Italy.
Institute of Ethics, History and Theory of Medicine, Ludwig-Maximilian University (LMU), Munich, Germany.
Philos Ethics Humanit Med. 2018 Feb 27;13(1):3. doi: 10.1186/s13010-018-0056-1.
Clinical ethics consultation (CEC), as an activity that may be provided by clinical ethics committees and consultants, is nowadays a well-established practice in North America. Although it has been increasingly implemented in Europe and elsewhere, no agreement can be found among scholars and practitioners on the appropriate role or approach the consultant should play when ethically problematic cases involving conflicts and uncertainties come up. In particular, there is no consensus on the acceptability of consultants making recommendations, offering moral advice upon request, and expressing personal opinions. We translate these issues into the question of whether the consultant should be neutral when performing an ethics consultation. We argue that the notion of neutrality 1) functions as a hermeneutical key to review the history of CEC as a whole; 2) may be enlightened by a precise assessment of the nature and goals of CEC; 3) refers to the normative dimension of CEC. Here, we distinguish four different meanings of neutrality: a neutral stance toward the parties involved in clinical decision making, toward the arguments offered to frame the discussion, toward the values and norms involved in the case, and toward the outcome of decision making, that is to say the final decision and action that will be implemented. Lastly, we suggest a non-authoritarian way to intend the term "recommendation" in the context of clinical ethics consultation.
临床伦理咨询（CEC）作为一项可由临床伦理委员会及咨询人员提供的活动，如今在北美已是一种成熟的做法。尽管它在欧洲及其他地区的应用越来越广泛，但在涉及冲突和不确定性的伦理问题案例出现时，学者和从业者对于咨询人员应扮演的适当角色或采用的方法并未达成共识。特别是，对于咨询人员提出建议、应要求提供道德建议以及表达个人观点的可接受性，尚无一致意见。我们将这些问题转化为咨询人员在进行伦理咨询时是否应保持中立的问题。我们认为，中立概念1）作为一个诠释学关键，用于审视CEC的整体历史；2）可通过对CEC的性质和目标进行精确评估而得到启发；3）涉及CEC的规范层面。在此，我们区分中立的四种不同含义：对临床决策所涉及各方的中立立场、对用于构建讨论的论据的中立立场、对案例中所涉及的价值观和规范的中立立场，以及对决策结果的中立立场，也就是说对将要实施的最终决策和行动的中立立场。最后，我们建议在临床伦理咨询的背景下，以一种非专制的方式来理解“建议”一词。
