Deference or critical engagement: how should healthcare practitioners use clinical ethics guidance?

Healthcare practitioners have access to a range of ethical guidance. However, the normative role of this guidance in ethical decision-making is underexplored. This paper considers two ways that healthcare practitioners could approach ethics guidance. We first outline the idea of deference to ethics guidance, showing how an attitude of deference raises three key problems: moral value; moral understanding; and moral error. Drawing on philosophical literature, we then advocate an alternative framing of ethics guidance as a form of moral testimony by colleagues and suggest that a more promising attitude to ethics guidance is to approach it in the spirit of 'critical engagement' rather than deference.

Policy-Development and Deference to Moral Experts.

The involvement of ethicists, philosophers or others who might qualify as 'moral experts' in policy-development, where they are sometimes, typically as members of a committee, given an advisory role, is often seen as problematic, for several reasons. First, there may be doubts as to the very existence of moral experts, and it may be hard to know who the moral experts are. Next, even if these problems are solved, giving experts a special role in policy-making might be problematic from a democratic point of view, if it involves politicians deferring to the moral judgements of experts. The paper considers possible replies to this problem of moral deference. One reply is that moral deference is unnecessary, because even moral non-experts are well equipped to assess the arguments offered by moral experts; I argue that this reply underestimates the complexity of moral arguments. Another reply is that if moral experts are simply given the 'technical' role of clarifying which concrete positions that follow from the values which decision-makers already accept, deference is not problematic. I will argue that this reply underestimates how a given set of moral values underdetermines which concrete positions follow from it. Finally, I will consider and defend the reply that since policy decisions are subject to a requirement that they be justified within the limits of public reason, and since these limits include a requirement that the justification be accessible, moral experts are barred from providing policy advice which rests on too complex moral arguments.