Ethical expertise revisited

The status of knowledge, skills and virtues in morality has been discussed since the days of Socrates. However, in the last few decades, ethicists have become involved in healthcare, business, industry, journalism as never before. This development has triggered a modern debate about whether bestowing a specific authority in morals upon specialists is a good idea. The discussion focuses on the possibility, content, and desirability of ethical expertise and ethics experts. Some authors are very skeptical about the status of ethicists as professionals. They challenge the very concept of expertise in ethics because of the dissimilarity of moral knowledge and expert knowledge in other professions, such as medicine and engineering. Others are in favor of the concept of ethical expertise but argue that the ethics expert should exclusively focus on procedural and formal matters such as analysis and clarification of concepts and arguments. According to the strongest view the ethicist is considered an expert in substantively pointing out what is morally right or wrong. Jukka Varelius contributes to this debate in his paper ‘‘Is ethical expertise possible?’’ He carefully assesses and rejects the criticism raised against ethical expertise. With her paper ‘‘Be careful what you wish for? Theoretical and ethical aspects of wish-fulfilling medicine’’ Alena Buyx won the second prize in the ESPMH essay contest for young scholars in 2007. She analyses theoretical aspects and ethical implications of the growing tendency towards wish-fulfilling medicine and concludes that it is hard to provide strong ethical arguments why wishfulfilling medicine should be banned or discouraged altogether. However, the numerous questions that surround wish-fulfilling medical procedures clearly mark them out as having a special status amongst other medical activities. Thus, more reflection about the subject, goal and ends of modern medicine is needed in order to reach any definite conclusion about the ethical assessment of the matter. Carl-Åke Elmersjö and Gert Helgesson present and analyze the results of an empirical study concerning the notion of ‘‘just health care’’ amongst health care personnel on all organizational levels in three Swedish hospitals. They first lay bare what concept of justice is pivotal to the understanding of the personnel. Secondly, they try to find out how this understanding informs the way in which priorities are made in daily clinical practice. The next two papers are cross-cultural or cross country comparative studies. Ralf Jox et al. compare legal approaches and ethico-legal discourse concerning substitute decision making in medicine in England and Germany. In their comparison, they highlight the following issue: (1) order of relatives who serve as health care proxies, (2) respective roles and decisional powers of patient-appointed versus court-appointed substitute decision-makers, and (3) legal criteria to guide substitute decision-makers. Next, Subrata Chattopadhyay and Alfred Simon demonstrate that culture significantly influences individuals’ experience of life as well as their understanding of the moral meaning of illness, suffering and death. In their paper ‘‘East meets West: Cross-cultural perspective in end-of-life decision making from Indian and German viewpoints’’ the authors analyze differences in the roles of patient, family and physicians in dealing with endof-life decisions in India and Germany. Bernward Gesang concentrates on end-of-life issues as well in his paper ‘‘Passive and active euthanasia: What is B. Gordijn W. Dekkers (&) Department of Ethics, Philosophy and History of Medicine, Radboud University Nijmegen Medical Centre, 137 EFG, PO Box 9101, 6500 HB Nijmegen, The Netherlands e-mail: [email protected]