ASBH goes forward with CEC certification

Bioethics program accreditation also in plan

The American Society for Bioethics & Humanities is proceeding with plans to establish both a certification program for those who act as clinical ethics consultants and accreditation standards for bioethics programs at U.S. colleges,universities, and teaching hospitals.

Although there had been an effort to indicate that the certification of ethics consultants would result in a pilot certification program for 2010-2011, the ASBH board "did not choose to act on that statement," at its annual meeting in October in San Diego, says ASBH Board President Mark G. Kuczewski, PhD, director, Neiswanger Institute for Bioethics and Health Policy and professor of medical ethics at Loyola University Chicago Stritch School of Medicine.

"Basically, it came down to not wanting to commit to the specific date," Kuczewski tells Medical Ethics Advisor.

"At this point, there is a consensus in the field that certification of clinical ethicists is coming and, therefore . . . the question is whether the ASBH feels it should be the certifying agency ," Kuczewski explains. "Ultimately, much like other certifications in other fields, very often a professional society gets it started, but then you have to spin it out with some degree of independence, just so that we're not simply protecting self-interest; but we're creating a legitimate, independent, accrediting body."

Similar models, for example, would be accrediting medical schools in which there is the LCME that's supported by the American Association of Medical Colleges, as well as the American Medical Association and others.

Certifying bodies must be independent, "so that it's not politically controlled," he says.

Certification is going to happen for a couple of reasons, according to Kuczewski.

"One is simply, we work in the medical world and quality assurance is the coin of the realm; and so hospitals and other health care institutions ask that they have some kind of assurance that professionals who work there meet certain standards of quality and qualification," he explains.

Ethics consultation is a "relatively new field" going back 15 or 20 years, he says. Compared to the history of other fields in health care, certification efforts for clinical ethics consultants are "pretty much on the right time line."

"It takes about two decades to really get the certification up and running in that kind of way; and so, we're on that path, but it's clearly coming," Kuczewski says. "People are looking for that. And there are other bodies out there looking to do this — for–profit organizations and so on that are [also] on a path towards creating such programs, because they see profit in it [and] because they realize that health care institutions will want such credentials."

It is important that the ASBH offer certification programs, he says, since "we are the people where the expertise resides."

One organization, the Association of Bioethics Program Directors, has passed a motion "in support of the efforts of ASBH to develop a certification process for clinical ethics consultants," according to a letter sent by the president of that organization to Kuczewski.

Core competencies approved

As a first step on the path of offering certification of clinical ethics consultants, the ASBH board accepted the report from the Clinical Ethics Consultation Affairs (CECA) on the core competencies for such individuals.

One of the CECA recommendations to the board in that report was to issue a request for proposals from companies that could provide "test development and implementation, and seek start-up funding."

Another recommendation was to address "grandparenting of expert clinical ethics consultants if certification becomes a mandate."

The report also included a recommendation to "pursue certification of individuals at the advanced level, and create a self-learning program to teach and demonstrate basic CEC knowledge competencies."

Kuczewski notes that a "complication" that comes with its effort to certify CECs is that some hospitals and health care organizations have staff who "just do clinical ethics full time."

However, many also have staff, such as social workers, who participate in CECs on a part-time basis, "but they wear another hat in the institution as another profession," he says.

"Many of these institutions don't just do an individual model of consultation, but they do a team model; and so they have several people," he notes.

The effort to develop the core competencies for CECs took this into consideration, and in many cases, there is a suggested standard for the team model of CECs that at least one consultant have competence at the expert level.

"Our recommendation wouldn't be that you not be able to [participate in CECs] at all without certification, but that the hospitals amass a certain amount of expertise, so that . . . a certified team leader who would be leading the consultation, and that could be a person from any profession, such as a social worker. Other professionals who were not certified would still be able to participate," Kuczewski explains.

Accreditation also a goal

Much like residencies for physicians, where they go through an accredited residency program and ultimately must pass a test to become board-certified, the ASBH also wants to offer accreditation to the various types of bioethics programs, ranging from undergraduate degrees to masters, doctoral, and fellowship programs.

The ASBH is partnering with the Association of Bioethics Program Directors and currently conducting a curricular mapping exercise to determine how various bioethics educational programs prepared their students to participate in ethics consultations by asking these institutions to review the recently approved core competencies document and to explain how their programs teach the core competencies.

"We're doing an inventory of the field to see how people are trained to meet these core competencies," he says. "And then we'll try to develop a list and develop some kind of standards of what things are ideal for a person to come with in their portfolio for the performance evaluation piece," he says.

Kuczewski is careful to note that this is his personal opinion — and not the board's time line for meeting these goals of the organization — but "I think that this accreditation process is likely to come to fruition within the next two years or so; we'll pretty much have all the information that we need and have a model of how to proceed."


  • Mark G. Kuczewski, PhD, director, Neiswanger Institute for Bioethics and Health Policy and professor of medical ethics at Loyola University Chicago Stritch School of Medicine. For more information about the ASBH board's efforts toward certification and accreditation, send questions to