Ethics by committee: the moral authority of consensus.

Consensus is commonly identified as the goal of ethics committee deliberation, but it is not clear what is morally authoritative about consensus. Various problems with the concept of an ethics committee in a health care institution are identified. The problem of consensus is placed in the context of the debate about realism in moral epistemology, and this is shown to be of interest for ethics committees. But further difficulties, such as the fact that consensus at one level of discourse need not imply consensus at another, oblige us to look more closely at the deliberative process itself. That yields two complementary methods of deliberation that have proven their worth. Finally, placing ethics committees in the context of Dewey's philosophy of social intelligence suggests that consensus should be regarded primarily as a condition rather than as the goal of inquiry.