Clinical ethics support services (CESS) are valuable tools in psychiatric practice. They have often been advocated as being useful by professionals in this field. More than 90% of German psychiatric hospitals have already implemented ethical support structures. However, despite this high implementation rate, the number of cases dealt with in these services is considerably low. Recent data suggests a mismatch between what is supplied and what is demanded. To develop their supportive capacities, structures and concepts of CESS must be reconsidered to fit psychiatry’s needs more accurately.
In this talk, the theoretical foundations of CESS are explored in regard to this challenge. One of their core elements is the claim of ethical expertise, that is, to be able to identify, analyze or solve ethical issues more accurate or better than others. Unfortunately, concepts of expertise within the context of CESS are manifold and often vague. In theoretic literature consistency – and even existence – of ethical expertise is often disputed. Claiming authority, it is said, is opposed by the idea of ethics itself. Others try to define expertise as kind of practical skill rather than authority over a certain branch of knowledge.
Empirical evidence, however, suggests that this discussion might be misleading. At least in psychiatry, the idea of authority is rejected by clinicians in practice. On the contrary, experts are appreciated for their non-directive behavior or their ability to provide normative insights and mutual understanding. It is recommended that experts should possess attributes like tolerance, prudence and integrity. Accordingly, the signifying property of expertise may not be its authority but rather its trustworthiness. Following this argument, trust-based concepts of expertise, their extent and their applicability in psychiatry are explored.