The Healthcare Ethics Consultation Certification is the first program to identify and assess a national standard for healthcare ethics consultants. The certification assesses consultants’ ability to:
• lead healthcare ethics policy at the institutional level;
• effectively and accurately provide service to patients, families, and colleagues;
• contribute to institutional policies and procedures related to ethical decision-making.
Are individuals who perform clinical ethics consultations qualified to do so? For the first time, it’s possible to demonstrate this with a credential. The American Society for Bioethics and Humanities (ASBH) Healthcare Ethics Consultant—Certified (HEC-C) program is “the first of its kind to identify and assess a national standard for healthcare ethics consultants,” says Felicia Cohn, PhD, chair of the Health Care Ethics Consultation Certification Commission.
The certification recognizes the consultant’s proficiency in identifying, counseling, and resolving ethical issues and leading healthcare ethics policy at the institutional level.
“Ultimately, becoming certified validates the healthcare ethics consultant’s role in ensuring ethical decision-making and care practices within the healthcare setting,” says Cohn.
ASBH president Alexander A. Kon, MD, FAAP, FCCM, says the organization has “worked toward improved quality and consistency in healthcare ethics consultation for nearly two decades. Certification of healthcare ethics consultants is the natural next step.”
Over time, the certification program will improve the overall quality of healthcare ethics consultation, thereby improving patient care and decreasing moral distress, says Kon.
“We believe that certification is one very important step in the professionalization of the field,” adds Kon.
Healthcare ethics consultants come from a variety of qualifying backgrounds. Often, they serve in multiple roles at multiple organizations. These include serving on ethics committees; performing ethics consultations with patients, families, and healthcare providers; writing policies and guidelines; and identifying organizationwide ethics opportunities.
In addition to demonstrating their clinical expertise and commitment to high-quality patient care, says Cohn, consultants who obtain the HEC-C credential “will serve as an agent of change within the healthcare ethics field.”
Leaders in healthcare ethics often oversee their facility’s ethics consultation service or ethics committee. They may be responsible for, or a resource for, executive decision-making. “Although this group may feel like their many years of hands-on experience negate their need for certification that tests fundamental knowledge, certification will provide evidence of their expertise,” says Cohn.
Cohn would like to see ethics leaders encourage novice or mid-level healthcare ethicists, and perhaps even medical staff with ethics expertise, to obtain certification. The HEC-C program assesses the core knowledge and competencies healthcare ethics consultants need to:
• effectively and accurately provide service to patients, families, and patient care colleagues;
• contribute to institutional policies and procedures related to ethical decision-making at all levels of patient care.
“Any new program of importance is likely to be met with some controversy,” notes Cohn.
Recognizing this, ASBH followed a comprehensive and carefully designed process to research the need for healthcare ethics consultant certification. “This was done through broad environmental scanning and needs assessment, following National Commission for Certifying Agencies criteria,” says Cohn.
The Healthcare Ethics Consultation Certification Commission “brings crucial content expertise to the table, and reflects the diversity of healthcare ethics consultant roles across the healthcare spectrum,” says Cohn. A knowledge-based process was used to develop candidate criteria and the examination.
Questions and concerns are expected due to the newness of the program and the diversity of professionals involved in healthcare ethics consults. “These will be addressed as the program moves forward,” says Cohn.
The impact of the new certification will depend in part on how valued the practice of ethics already is at a given institution. This varies widely. “I think at the very least, the inherent good of having some sort of certification is that it will establish some sort of baseline as to what’s required,” says Paula Goodman-Crews, MSW, LCSW, co-director for Kaiser Permanente’s Southern California bioethics program.
At Kaiser Permanente, there’s already a general consensus that ethicists are very well-qualified. “Our leadership is very supportive and values our work,” says Goodman-Crews.
Certification would be most useful at hospitals and health systems that are building up their ethics programs. “It serves as a safeguard to help us be more confident that the person is skilled and has the competency to do ethics,” Goodman-Crews says.
Healthcare institutions that do not have dedicated ethicists would benefit from encouraging members of the bioethics commission to seek certification, she says: “It’s always a good idea to augment the collective competencies of bioethics committee members.”
Widely varying practices for ethics consultations are well-established. Only 41% of consultants had formal supervised training in ethics consultation, found one study — and while most (65%) always made recommendations, some (6%) never did.1 “That really opened all of our eyes on the variability in how we practice,” says Goodman-Crews.
When hiring ethicists for Kaiser Permanente’s Southern California region, Goodman-Crews saw that finding the right skill set was a challenge. Many applicants had authored papers or were teaching at medical or law schools, but lacked clinical experience. “There’s been a proliferation of people with master’s degrees in bioethics, but most of the programs don’t have any clinical fellowship attached to them,” says Goodman-Crews. “Over the years, we’ve started hiring people with clinical training.”
The value of certification is lost on hospital leaders who don’t realize that ethicists need a specific skill set. “There is a belief that if you are a good doctor or nurse, you are ‘ethical.’ But that has no bearing on being able to actually handle the dynamics of an ethical conflict,” says Goodman-Crews.
Absence of regulatory requirements means that at some organizations, ethics just doesn’t register as a priority. The Joint Commission has required hospitals to employ a mechanism for resolving ethical dilemmas in patient care for more than two decades — yet the accrediting body has never specified how to do this.
Goodman-Crews has been involved in dozens of Joint Commission surveys at various organizations. Occasionally, a surveyor brings up something related to ethics, such as a patient’s advance directive that cannot be found in the chart. “But I can’t remember any time when they’ve ever asked about the qualifications of people doing ethics consultation,” she says.
If the organization passes the survey “and no one is calling the institution out on ethics practice, many will probably see no reason to require certification,” says Goodman-Crews.
The ability to communicate, build rapport, and demonstrate tolerance, trust, empathy, and compassion also are important parts of being an ethicist. “A written test probably can’t account for those kinds of skills,” says Goodman-Crews. “But it’s one tool in the toolbox that’s going to enable us to make sure we have people who are skilled.”
1. Fox E, Myers S, Pearlman RA. Ethics consultation in United States hospitals: A national survey. Amer Journ Bioethics 2007: 2(7):13-25.
• Alexander A. Kon, MD, FAAP, FCCM, Clinical Professor of Pediatrics, University of California, San Diego School of Medicine. Email: firstname.lastname@example.org.