Transformative ethics consultation : a supplement to ethics facilitation for emotionally charged health care value conflicts

An emotionally difficult case of withdrawing artificial food and water from a patient in persistent vegetative state prompts consideration of the role of empathy and emotion in health care ethics consultation. Rather than viewing ethics consultation purely in terms of consultant-initiated ethical and largely cognitive analysis followed by interpersonal facilitation of consensus, this dissertation seeks a process to address emotion early and to cultivate empathy as-a collective responsibility among patients, surrogates, and clinicians. Moral decision-making and thus ethics consultation must integrate the emotional and cognitive processing of value perceptions and judgments. Promoting integration during ethics consultation encourages participants to adopt a moral orientation of respect and concern that facilitates consensus-building in emotionally charged value conflicts. Phenomenologists Jurgen Habermas and Arne Vetlesen describe this process as overcoming one's own perspective in order to understand the interests and perspective of one's fellows. By adapting this phenomenological sequence to ethics consultation, the dissertation culminates in the presentation of a two-step process, transformative ethics consultation (TEC). If consultants identify an emotional tension early, TEC can serve as a supplement to the identification and analysis of the value conflict or uncertainty. The first step of TEC allows consultation parties to explore, express, and have their emotions validated by the consultant as an initial empathy-building phase. The second step attempts to extend empathy to all parties in such a way that each party understands the other. Extending empathy thus encourages shared moral ownership of the problem and the process for its resolution. To illustrate the two steps of TEC in action, I analyze the case that sparked the dissertation and present another to supplement the argument. In the final chapter, I address two potential challenges to TEC—that it is equivalent to bioethics mediation and thus open to the pitfalls of bioethics mediation as a stand-alone consultation modality. I rebut both of these challenges. I overcome the first by arguing for a new understanding of impartiality in ethics consultation that comports with the spirit of ethics facilitation. I defend against the second by suggesting that TEC skills can be easily adapted for use outside of or after ethics consultation as a means to ameliorate the moral distress associated with emotionally charged value conflicts.