The bioethicist as advisor

Services dedicated to clinical ethics consultation (CEC) have rapidly proliferated through American hospital systems. One concern about this notable rate of growth is the possibility that practice has outstripped theory. In particular, it is controversial whether clinical ethicists should offer substantive recommendations as part of their practice. This article addresses the status, legitimacy, and authority of such recommendations, proceeding from the idea that they are to be treated as advisory. Taking this idea seriously and developing it through recent philosophical work on advising helps to defuse challenges to CEC as a profession and promotes a conception of CEC as a collaborative activity with a clear distribution of responsibility between ethicist and stakeholders. Moreover, moral norms for advising that exist in abstraction from particular knowledge domains can help to substantiate and clarify professional norms for CEC practice, including the loci of moral responsibility for patient outcomes, the relationship to patient advocacy, and the norm against functioning as the "ethics police."