Psychosomatics 39:391-392, August 1998
© 1998 The Academy of Psychosomatic Medine
Clinical Ethics Series
Kristi S. Williams, M.D., and
Joy D. Skeel, M.Div.,R.N.
Key Words: Letter
TO THE EDITOR: In the "Clinical Ethics Series," published in the July–August 1997 issue of Psychosomatics, there appears to be a strong emphasis on consultation-liaison (C-L) psychiatrists subsuming the role of clinical ethicists in their institutions. In the introduction, Donald Kornfeld, M.D., states, "It should be much simpler to train a C-L psychiatrist in this knowledge base (medical ethics and law) than to provide a lay ethicist with the knowledge and experience acquired in 4 years of medical school, 4 years of psychiatric residency, and a 1-year C-L fellowship."1 We believe assumptions underlying this statement are faulty because they imply that most ethicists are "laypersons" without clinical experience and knowledge and that training as a C-L psychiatrist encompasses the majority of the training required to be a clinical ethicist. Furthermore, we object to the omission of the value of collaboration between clinical ethicists and C-L psychiatrists.
In addition, it is unclear where/how the data were accrued by Tia Powell, M.D., for the table comparing skills and knowledge of C-L psychiatrists and ethicists,2 other than from Baylis' Canadian study. We take particular exception to the lack of acknowledgment of an ethicist's ability to be sensitive to cultural and religious differences, particularly in light of Dr. Powell's acknowledging that "if you examine the ranks nationally of excellent clinical ethicists,...you will also find lawyers, philosophers, internists, chaplains, and nurses."2 We believe it is dangerous to generalize that ethicists are less sensitive to cultural/religious differences as well as lack clinical experience and knowledge.
While some clinical ethicists do not have a strong clinical background, an increasing number have dual degrees and professional competency in theology, philosophy, or law, as well as nursing, medicine, or allied health. (See membership directory of the four major professional organizations related to clinical ethics.3,4)
Most glaring is the minimal discussion about collaboration between clinical ethicists and C-L psychiatrists. Collaboration between these specialties has great potential to enhance patient care without C-L psychiatrists resorting to assuming the dual roles of psychiatrist and ethicist. As Stuart Youngner, M.D., mentioned,5 there are similarities between clinical ethics and C-L psychiatry, for example, the false belief that both rely more on intuition than science and that they are not often called upon until crises arise.
Youngner's points reinforce the importance for us to collaborate rather than be territorial. Furthermore, each of these professional groups has opportunities to educate other health care providers about the importance of both ethics and psychiatry. This kind of collaboration has the potential to benefit the patient and generate collegiality.
We remain uncomfortable with the underlying theme of the "Clinical Ethics Series," namely that C-L psychiatry can readily subsume the role of clinical ethics, thereby obviating the need for nonpsychiatric clinical ethicists. We hope that institutions will examine positive examples of collaborative relationships between C-L psychiatry and clinical ethics, for example, the successful relationship during the past 20 years at the Medical College of Ohio. This collaboration has appeared to be highly productive for patients and for professionals in these specialties.
REFERENCES
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Kornfeld D: Clinical ethics: an important role for the consultation-liaison psychiatrist. Psychosomatics 1997; 38:307–308[Free Full Text]
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Powell T: Consultation-liaison psychiatry and clinical ethics. Psychosomatics 1997; 38:321–326[Abstract/Free Full Text]
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ASBH: American Society for Bioethics and Humanities (formerly the Society for Health and Human Values; Society for Bioethics Consultation and American Association of Bioethics), Glenview, IL. Directory available late 1998
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Society for Health and Human Values, Society for Bioethics Consultation, American Association of Bioethics, Boston, MA, American Society for Law, Medicine, and Ethics, 1994
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Youngner SJ: Consultation-liaison psychiatry and clinical ethics: historical parallels and diversions. Psychosomatics 1997; 38:309–312[Abstract/Free Full Text]
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