We are not the ethics police: The professionalization of clinical ethicists and the regulation of medical decision-making

Clinical ethicists represent a growing profession in U.S. healthcare. This profession's aspirations include serving as a supportive resource to hospital staff, but also as an ethics watchdog, ensuring that medical decision -making adheres to ethical standards. Drawing on 31 in-depth interviews conducted in 2021 of clinical ethi-cists working across the U.S., I evaluate the extent to which these watchdog aspirations have been achieved. I investigate ethicists' success in leveraging three strategies aspiring professions have used to secure their juris-dictional claims: acquiring professional expertise, securing administrative authority, and cultivating trusting relationships. I show that ethicists face barriers to leveraging each, which has consequences for how ethical dilemmas are resolved. Findings point to challenges aspiring professions must overcome in order to claim ju-risdictions posing a threat to incumbent professions; the tensions that exist between legal risk management and clinical ethics; and the organizational strategies marginal actors leverage to advance their interests and influence the delivery of healthcare.

Automated summary

Clinical ethicists in the U.S. healthcare system aim to serve as a supportive resource to hospital staff and ensure adherence to ethical standards in medical decision-making. This study evaluates the extent to which clinical ethicists have achieved their aspirations of being ethics watchdogs through in-depth interviews and identifies barriers they face in leveraging professional expertise, administrative authority, and trusting relationships. The findings highlight the challenges new professions must overcome to establish their jurisdiction, the tensions between legal risk management and clinical ethics, and the strategies marginalized actors use to advance their interests in healthcare delivery.