Ethicists View HEC-C as One Step Toward Professionalization
A small but growing number of ethicists are obtaining the American Society for Bioethics and Humanities (ASBH) Healthcare Ethics Consultant-Certified (HEC-C) designation. Joan Henriksen, PhD, RN, HEC-C, was part of the original cohort of ethicists to take the HEC-C exam, earning the credential in 2018.
“I had already been doing consultation professionally for a long time, and wanted to support efforts to define the work,” says Henriksen, a clinical ethicist in the Program for Clinical Ethics and Values at Abbott Northwestern Hospital, part of Allina Health, in Minneapolis.
The HEC-C process ensures a minimal standard of competency for those conducting ethics consultations. The certification alone is not necessarily an indication of excellence in consultation. “Rather, it’s a sort of assurance that the person has a basic set of knowledge that should lead to safe practice,” Henriksen explains.
With considerable study and practical experience, a person who is not a professional ethicist can earn the certification.
“That allows for organizations that are not inclined to invest in an ethicist to still have some attestation of quality and safety for those providing consultation,” Henriksen says.
In Henriksen’s experience, most clinicians, patients, and hospital leaders are unaware of the HEC-C. Few appreciate its significance. “I have found myself explaining it to organizational leaders and others, drawing parallels to other forms of certification and processes that they are already familiar with,” Henriksen says.
For example, most people understand that some chaplains obtain board certification, and that some nurses obtain critical care certification. Although Henriksen is the only full-time ethicist at Allina Health, another ethicist will be added soon. Hospital leaders supported requiring HEC-C. “Broader appreciation of the certification will come with growing understanding of the work that clinical ethicists do,” Henriksen predicts.
Across the country, most of the individuals who conduct ethics consults are clinicians who work as volunteers.1 Henriksen expects the HEC-C might help change that model. “It will demonstrate value to leaders, in terms they understand,” she suggests.
Three of Allina Health’s ethicists recently obtained the HEC-C. “The preparation required to pass the HEC-C exam has made the clinicians better able to perform consults and participate in quality review processes,” Henriksen reports.
Despite debate among ethicists about the value of certification, Henriksen expects the process of professionalization of clinical ethics to continue. More demand for ethics work is the primary reason. “The complexity of healthcare brings more ethical tensions, not fewer,” Henriksen says.
Hospitals must identify and address all kinds of ethical issues. That requires people with specific knowledge and skills. “The HEC-C process is part of the scaffolding that can help organizations ensure they have those people among them,” Henriksen asserts.
Aimee Milliken, PhD, RN, HEC-C, obtained the certification during postdoctoral fellowship training. Although ethicists were not required to earn the credential, program leaders strongly encouraged it. “This is a trend we are seeing in many large ethics programs,” reports Milliken, an associate professor of the practice at the Boston College Connell School of Nursing.
Milliken notes the field of clinical ethics is “professionally diverse.” The HEC-C credential sets a baseline standard that can be applied across ethicists of varying backgrounds. “It is important to begin establishing what criteria are required for someone to call themselves a clinical ethicist,” Milliken says. “Credentialing is one step in that direction.”
Andrew G. Shuman, MD, FACS, HEC-C, actively encourages clinical ethicists to obtain the credential. “The professionalization of clinical ethics consultation is important to our field, to recognize the importance of rigorous training and experience for the work that we do,” says Shuman, co-chief of the clinical ethics service at the University of Michigan Center for Bioethics and Social Sciences in Medicine.
The HEC-C, adds Shuman, also provides external validation of the value of ethics services, and the need to financially support the work of ethics. “As with all professional certifications, I expect the criteria, requirements, and process will evolve to recognize the importance of practical experience, as well as the diversity of professionals doing this critical work,” Shuman says.
1. Danis M, Fox E, Tarzian A, Duke CC. Health care ethics programs in U.S. hospitals: Results from a national survey. BMC Med Ethics 2021;22:107.
The demand for ethics work is rising, but most individuals who conduct consults are clinicians who work as volunteers. Leaders must identify and address all kinds of ethical issues, which requires employing the right people with relevant and specific knowledge and skills.
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