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The Task Force Report: Comprehensible Forest or Unknown Beetles?

For about a week now, my first act when I reach my desk each morning is to read the Task Force report carefully, underlining, making notes. Perhaps no text composed by a committee can be expected to survive such scrutiny (and yet, there is the Declaration of Independence). With each new reading, I note yet some other peculiar phrasing, ask myself some new question about what certain words actually mean (exactly what are the salient differences among ethical approaches, methods, reasoning, and theories? ). By the end, I suspect that I have lost the forest for looking at not only trees but also mushrooms, grass blades, and beetles. However, some more general questions about the report did survive this perusal, and these four questions I address below. It may be worth saying, as a disclaimer, that my starting position is one of skepticism toward ethics consultation. This general suspicion lies, at least in part, in my sense of bioethics’ underlying hostility toward the power of physicians (such that consultation becomes an attempt to counter that power with an equal power, the sword of ethics) and, in part, in my belief that there is a trace of self-righteousness about this activity, a scent of unearned and destructive certainty. Indeed, if there is one single thing about the report that I find disappointing, it is that there is so little self-doubt within it. There is an acknowledgement that healthcare is changing and therefore that things might be different later on, but for the most part, the text reveals a confidence in its judgment that I do not and cannot share. I would have been much more encouraged by the report if the Task Force had somewhere suggested, “but, of course, we may be wrong about this.” Perhaps, however, ethics consultation simply does not permit the expression of such hesitancy (or levity?). In any case, my own view is that, to the extent that clinical bioethics is useful in healthcare, it should confine its efforts almost exclusively to promoting better structures for supporting ethical behavior and only rarely to engaging in consultant activity, with all its unresolvable language baggage of expertise, superior knowledge, and authority. That being said, the four questions and my thoughts on them are put forth below.