Questions of Method: One Ethics Consultant's Approach

James J. McCartney, OSA, Ph.D., is Associate Professor and former Chair of the Department of Philosophy at Villanova University and Adjunct Professor at the Villanova School of Law. He is Ethics Consultant for the Catholic Health East Health System and a Fellow of the Center for Bioethics at the University of Pennsylvania. He is the author of Unborn Persons: Pope John Paul II and the Abortion Debate (Peter Lang Publishing, 1987) and coeditor of Concepts of Health and Disease: Interdisciplinary Perspectives (Addison-Wesley, 1981).

In his very interesting article "The Question of Method in Ethics Consultation," George J. Agich (2001) focuses on three elements of the question of method: canon, discipline, and history.

The canon of ethics consultation includes the formal statement of rules that guide the action, cognition, and perception involved in ethics consultation as undertaken by a skilled or competent practitioner. The discipline of ethics consultation involves the practical actions, behaviors, cognitions, communications, deliberations, judgments and perceptions that normatively comprise ethics consultation.

(emphasis in original)

And the history of ethics consultation is that it "grew out of the engagement of philosophers and others identified as ethicists or bioethicists in the clinical practice of medicine at (primarily) academic medical centers."

In this peer commentary I would like to discuss how these elements have played out in my own lived-experi-ence as both a clinical and corporate ethics consultant in healthcare. However, I will reverse Agich's order, because I think it will be more helpful if I embody what I consider "my canon" within the context of my own professional history and its actual practice.

My career as a medical ethicist started at Georgetown University in the late 1970s. While finishing my Ph.D. in philosophy (biomedical ethics) at Georgetown, I worked at the School of Medicine as Assistant Director of the Health and Humanities Program. It was in this context that I was involved informally with physicians and medical students and formally by leading biweekly ethics grand rounds for Georgetown family practice residents at Providence Hospital in Washington, D.C.

Subsequently, I moved to Miami and started a bioethics institute at a community hospital (St. Francis in Miami Beach) where I provided many informal consultations as well as didactic sessions for healthcare professionals both within the facility and at other healthcare centers in South Florida. Additionally, I was on the ethics committees and also provided consultations for Mercy Hospital, Miami Children's Hospital, and Bon Secours Hospital/ Villa Maria Nursing Center (McCartney 1989).

In 1987 I was asked to be the ethics consultant for the health systemsponsored by the Franciscan Sisters of Allegany, a position I held until the Allegany Health Systembecame part of Catholic Health East. During that time I was also ethics consultant for the Franciscan Sisters of the Poor Health Systemand Holy Redeemer Health System. Currently, I am ethics consultant for Catholic Health East, one of the largest Catholic health systems in the United States.

As can be seen, my own personal history has led me from academic medicine to clinical ethical issues at the local level to clinical and corporate ethical issues on the regional level. Because I amalso a Catholic priest and have worked mostly within the context of Catholic healthcare, my legitimacy and hermeneutical perspective have rarely been questioned. And because my clinical consultations have, for the most part, been informal (often by telephone), the questions of narrative and development of case histories that Agich highlights have rarely been part of my experience.

What then has been my discipline, my practice? For the most part it has been didactic—I have given countless presentations to healthcare professionals on almost every clinical ethical issue in healthcare fromAIDS to the ontological status of the zygote. I have also provided pastoral interpretations of Catholic ethical teaching in concrete dilemmatic situations, and I believe have grown in wisdomand compassion in doing this over the years. I also have trained...