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09/10/2020

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Michel

FWIW, there are dedicated bioethics/medical ethics programs out there, many of which operate in conjunction with the university's philosophy department (McGill Bioethics comes to mind). Such programs will give you the hands-on experience required. I've known many people who got these kinds of jobs, usually in a hospital setting, with a bioethics Master's degree.

Beyond that, I don't have a clue, really. One way to get some hands-on applied ethics experience is to join your university's IRB (/REB/ERB/whatever acronym yours uses). I imagine that could help--surely it would be useful!--even though it's not a direct path to an alt-ac job. (FWIW, I've been told it's an asset for transitioning to admin, at least.)

ethicist

These are great questions. But I think this post conflates business ethics consultants in the corporate world (or general ethicist-for-hire independent contractors) with clinical ethics consultants in medicine. I can't speak to the former but I have some experience as a philosopher involved in the hiring process for the latter at an academic hospital. Clinical ethics consultation in health care is an interdisciplinary field in which philosophers have no special status. The relevant professional organization is not the APA but the ASBH. There is even now a certification process to take a test and become a certified clinical ethics consultant. These folks do bedside consults in hospitals and many have a clinical field (medicine, nursing, social work, clinical psychology, medical chaplaincy) as part of their workload, especially if there aren't enough ethics consultations to support a full time position. People with PhDs in Philosophy interested in breaking into this field would do well to connect with people on a hospital ethics committee (ideally an academic hospital) early in their training, and/or to seek a fellowship after graduation. Some fellowships require no prior clinical background. E.g. the NIH Bioethics post-doc and also this one: https://careercenter.asbh.org/jobs/13821123/clinical-ethics-fellow

Students primarily interested in bioethics should also consider getting an MA, MS, or PhD in bioethics or health care ethics, instead of in Philosophy. A list of programs can be found here: https://asbh.org/professional-development/academic-programs

Clinical Ethicist

I agree with Ethicist above who notes that business or corporate ethics consulting and clinical ethics consultation are two distinct pathways. I don't know about the former (though assume it is a potentially fruitful and less structured field). I am, however, a philosopher who trained in a clinical ethics fellowship and currently work as a clinical ethicist/faculty at an academic medical center.

To pursue this pathway, Marcus's original post is correct that the main entry point for non-clinicians (i.e. PhD or JD clinical ethicists) is to complete a recognized fellowship program (UCLA, Baylor, Cleveland Clinic, Albany all have 2 year fellowship programs that rigorously train in clinical ethics). The Philosophers in the Industry page has some great folks on it who do clinical ethics work and who have agreed by being on that list to be resources to others.

While professionals in the field disagree on this point, despite the proliferation of PhDs programs in bioethics or health care ethics, these kinds of interdisciplinary PhDs remain controversial, and would not be the route I would recommend currently to a job in an academic medical center. Perhaps non-academic health care settings though would be more warm to these bioethics specific PhD programs. That said, specializing in bioethics within a philosophy PhD program would be important and useful to earning a spot in a clinical ethics fellowship, though not necessarily essential - but you do need to show a genuine interest other than "there are no jobs in philosophy" or "medical centers pay better" (and an MA or certificate in bioethics concurrent to a PhD could also support one's candidacy for and performance in a fellowship).

MA/MS/Certificates as stand-alone bioethics degrees are generally only useful in conjunction with a terminal degree (MD, JD, PhD).

All to say this transition will require some thoughtful planning and time, but this is the season to submit those clinical ethics fellowship applications!

L

Like Clinical Ethicist, I’m a philosophy PhD who completed a clinical ethics fellowship. I’m now a faculty member at a medical school. A few points that haven’t been made already:

1. In addition to having a genuine interest in a fellowship, I also think it’s important that you 1) do your homework regarding what clinical ethics consultation entails and 2) demonstrate that you have the interpersonal skills necessary to effectively do the job. You’ll be interacting with patients, which is very different than interacting with peers and professors in grad school. Some of the people you’ll talk to did not graduate from high school; some are really scared; some are really angry. While my background in ethics helped, I think being able to show that I could work effectively with a diverse (in every sense the word) patient population in addition to teaching effectively and producing quality scholarship is what ultimately made me competitive.

2. In my experience, completing the clinical ethics fellowship definitely opened doors. While I ended up accepting a faculty job, it is a job I would have been competitive for if not for the fellowship. In addition, I had a number of interviews for clinical ethicist positions that I would not have otherwise been qualified for.

3. Not all clinical ethics jobs and fellowships get posted to PhilJobs. I recommend checking bioethics.net.

m

The clinical bioethics field sounds very structured, which isn't surprising. For lack of a better contrast, to what extent does someone in this position do flexible/original/independent analysis, vs merely applying a rigid set of clinical norms or laws to particular cases?

For those with experience on the business ethics side, to what extent do people doing this work ("chief ethics officers", independent consultants, etc) do what philosophers would think of as ethical analysis, vs merely serving either as a fancy PR agent, or merely in a quasi-legal role, advising not on ethics, but legality?

L

m, I found that I did a mixture of both of those types of thinking. It really just depended on the case. Sometimes we would get relatively straightforward questions, e.g. "Who is the appropriate surrogate decision-maker for this patient?," for which there are pretty straightforward legal guidelines. In other cases, the question might be something like "which of these possible interventions will cause less harm to the patient?," in which case I would be doing much more, as you put it, flexible/independent/original analysis.

I should note that, even in seemingly straightforward cases, things would often become murky upon further investigation (and you, as the clinical ethicist, are often the one doing that further investigation). Perhaps you learn that the patient's spouse has filed for divorce or has a conflict of interest that might compromise their decision-making about the patient. So even seemingly straightforward cases can wind up requiring more creativity and analysis than initially expected.

Clinical Ethicist

To follow up on L's comments, and m's question: I agree with the nuance L added to the discussion, and definitely look at bioethics.net for the clinical ethics jobs (and consider a membership to ASBH - which is not cheap though they do have sliding scale and student rates).

m's question: "to what extent does someone in this position do flexible/original/independent analysis, vs merely applying a rigid set of clinical norms or laws to particular cases"

In addition to what L already said, I would add that medicine itself is a normative practice, emerging out of both clinical "facts" and "evidence" and the values particular to medicine and its social and political role (I write this to a bunch of philosophers - we might disagree about this and that is okay, it is the approach I tend to take). So while there are all sorts of layers of norms, I don't think "rigid" is the right way to describe them.

Like L said: many ethics consults are not straightforward, and defy and sort of easy analysis; if they were, there would be no need for a consult. So even if you are balancing ethical principles with medical practice with social and political norms, we tend to accept reasonable pluralism in each of these areas, and then need to accommodate for the specifics of individual experiences and details. I find it takes a lot of creativity, reflection, and analysis to do well. Clinical ethics might be in conversation with established law, but there are offices of legal affairs who handle the legal side of things. I have definitely made recommendations from an ethics perspective that suggest follow up with the office of legal affairs in so far as the ethically permissible options might be more expansive than what is legally permissible.

Of course some ethics questions are straightforward - these are usually more information sharing consults, coaching, or simple clarification issues. In this way I don't think it is dissimilar from how you will get basic questions from some students in a philosophy class, and then more complicated ones from advanced students thinking in nuanced ways about hard topics.

The difference from philosophy teaching, of course, is that ethics cases are not in a book or hypothetical, but are real people. I think L put it well that people considering clinical ethics should reflect on their own skills for and interest in the interpersonal aspects of the job. The great part is you are involved in helping people work through some of the hardest moments of their lives - sometimes the end of their lives - and this is both what makes the job challenging and rewarding.

m

L and Clinical Ethicist, thanks!

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