Clinical Ethics Consulting and Conflict of Interest: Structurally Intertwined: Clinical Ethical Consultants are Subject to an Unavoidable Conflict of Interest. Their Work Requires That They be Independent, But Incentives Attached to Their Role Chip Relentlessly at Independence. This is a Problem Without Any Solution, But It can at Least be Ameliorated Through Careful Management‪.‬

The thesis of this paper is both straightforward and challenging: clinical ethics consulting embroils the clinical ethicist in a structural conflict of interest. One cannot properly fulfill the function and activities of a clinical ethicist without having one's judgment damaged by conflicting interests. This conclusion has unsettling implications, but it follows from a careful analysis of the nature of conflict of interest and the correct role of clinical ethics consultants. Both of these topics have been thoroughly studied over the years; in what follows I aim to show how this work intersects. What consultants should be doing--the kinds of judgments they should be formulating, expressing, and acting upon--is structurally in conflict with the incentives typically attached to this role, chief among which is that ethics consultants are paid for their judgment. As I will argue, however, other, more intangible benefits may be an even greater threat.