Fine-Tuning the Future (Letters) (Letter to the Editor‪)‬

To the Editor: In "Charting the Future: Credentialing, Privileging, Quality, and Evaluation in Clinical Ethics Consultation" (Nov-Dec 2009), Nancy Dubler and colleagues aptly and accurately indict clinical ethics consultants, or CECs, for failing to develop standards of practice, standards for education, and standards for accrediting clinical ethics educational programs. Acting to fill this void, in eleven substance-packed pages they spell out standards for clinical ethics consultation, propose institutional and peer oversight of consultations, suggest criteria for ensuring CECs' qualifications and competency, detail standards for evaluating CEC education, and outline a plan for credentialing and privileging CECs. Their report--a product of the Clinical Ethics Credentialing Project--is good on many points and so likely to improve the level of clinical ethics consultation that it almost seems impolitic to criticize the details. As with most policy recommendations, however, there is always room for improvement. One item that appears to have been overlooked is the role that the clinical ethicists' professional society, the American Society for Bioethics and Humanities, might play in developing fieldwide standards. Dubler and colleagues cite the achievements of hospital chaplains and palliative care specialists in achieving training standards for their fields, yet these fields set standards by working with their professional societies. It seems odd and potentially self-defeating to offer a proposal for developing fieldwide standards and credentialing procedures without involving the field's professional society.