Patient Expertise and Medical Authority: Epistemic Implications for the Provider-Patient Relationship.

The provider-patient relationship is typically regarded as an expert-to-novice relationship, and with good reason. Providers have extensive education and experience that have developed in them the competence to treat conditions better and with fewer harms than anyone else. However, some researchers argue that many patients with long-term conditions (LTCs), such as arthritis and chronic pain, have become "experts" at managing their LTC. Unfortunately, there is no generally agreed-upon conception of "patient expertise" or what it implies for the provider-patient relationship. I review three prominent accounts of patient expertise and argue that all face serious objections. I contend, however, that a plausible account of patient expertise is available and that it provides a framework both for further empirical studies and for enhancing the provider-patient relationship.

Epistemic neighbors: trespassing and the range of expert authority.

The world is abuzz with experts who can help us in domains where we understand too little to help ourselves. But sometimes experts in one domain carry their privileged status into domains outside their specialization, where they give advice or otherwise presume to speak authoritatively. Ballantyne (in: Knowing our limits. Oxford University Press, New York, 2019) calls these boundary crossings "epistemic trespassing" and argues that they often violate epistemic norms. In the few cases where traveling in other domains is permissible, Ballantyne suggests there should be regulative checks ("easements") for the experts who are crossing domain boundaries. I argue that boundary crossing is warranted more often than Ballantyne allows. And while Ballantyne argues that boundary crossing is prima facie epistemically problematic, I contend that many cases of boundary crossing are not properly instances of "trespassing," and, therefore, raise no prima facie epistemic concerns. I further argue that identifying cases of what I call "epistemic neighborliness" bolsters Ballantyne's project, making it easier for novices and other experts to identify epistemic trespassing along with its epistemic problems.

The Advent of the Professional Ethicist: Moral Expertise and Health-Care Ethics Certification.

With the Healthcare Ethics Consultant Certification (HEC-C) offered through the American Society for Bioethics and Humanities (ASBH), the practice of clinical ethics has taken a decisive step into professionalization. But without an unambiguous sense of what clinical ethicists can contribute to the clinical environment, it is unclear what the HEC-C ensures clinical ethicists can do. Though the ASBH enumerates a set of core competencies, many disagree over what role those competencies empower ethicists to serve. Two recent publications are notable for advocating conflicting positions on the question of ethicists' competence: "Ethics Expertise: What It Is, How to Get It, and What to Do with It" by Christopher Meyers (2018) and Rethinking Health Care Ethics by Stephen Scher and Kasia Kozlowska (2018). In response to Scher and Kozlowska's argument that the primary role of ethicists is to create space to engage clinician's moral intuitions, this analysis follows Meyers in contending that ethicists can also contribute a kind of moral expertise. However, acquiring moral expertise is no easy task, and it is unlikely to be substantiated by a certification exam. This analysis draws on research from the psychology of expertise to outline the sort of training needed to cultivate and enhance moral expertise.

Talking the Talk: Enhancing Clinical Ethics with Health Literacy Best Practices.

A significant proportion of the U.S. population exhibits low health literacy. Evidence suggests that low health literacy is correlated with higher medical costs and poorer health outcomes. Even more concerning, evidence suggests that low health literacy threatens patients' and families' autonomy and exacerbates injustices in patients who are already vulnerable to difficulties navigating the health care system. There is also, however, increasing evidence that health literacy interventions-including initiatives such as plain language practices and teach-back-improve comprehension and usefulness of health care information. I show how health literacy best practices can enhance the work of clinical ethicists in their primary roles of policy, consultation, and education. In the final section, I suggest ways health literacy initiatives may be enhanced with insights from clinical ethicists.

Checks and balances: the welcomed tension between philosophy and science.

There is a tension between science and philosophy, but this tension need not engender enmity or derision. Scientists and philosophers can work together, and we argue that working together is beneficial to both, even if it is sometimes uncomfortable. We offer examples of how philosophy can autonomously and effectively inform scientific practice. Science and philosophy share certain methodological concerns and practices; therefore, scientists who disregard philosophy are vulnerable to critical conceptual mistakes. If our arguments are correct, and if it can also be shown that science informs philosophy, then, while it is possible for both disciplines to operate autonomously, each should welcome the checks and balances that each provides for one another in the investigation and explanation of reality.