Hastings Cent Rep. 2013 Sep;43(5):39-40. doi: 10.1002/hast.210.

Does Quality Attestation Come in Only One Size?

Postema DC.

Abstract

The American Society for Bioethics and Humanities is now proposing a process whereby the role and authority of clinical ethics consultants can be legitimated. Without regulation and oversight, the field lacks validity and accountability. ASBH has sought to remedy the lack of uniform standards and accreditation by publishing Core Competencies in Health Care Ethics Consultation and an education guide, and now by proposing a "quality attestation process," situated between national certification processes and local credentialing practices, to "attest to the skills and ability of properly trained and competent clinical ethicists." If the process is successful, a cadre of certified clinical ethics consultants will emerge. Before the dawn of this new era, it is worth pausing to consider the adequacy of the quality attestation process itself and how it will affect the current world of clinicalethics consultants. Ethics consultations are often done by a multidisciplinary team, and the consult note is a compilation or synthesis of the work of the team. If the evidence required to attest to one's quality as an ethics consultant is to bear on one's ability to work with a team and present an integrated consult note, then these notes are relevant. If, however, the evidence is to bear on the quality of one's own work, then the evidence is inconclusive at best, fraudulent at worst. The quality attestation process seems to be predicated on the individual ethics consultant model, which may not jibe with the realities of ethics consultation. There may be more than one way to demonstrate one's competence, and there may be more than one competency to demonstrate.