Suzanne Metselaar

Genetic testing of children: the need for a family perspective.

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Beyond recommendation and mediation: moral case deliberation as moral learning in dialogue.

In “Neglected Ends: Clinical Ethics Consultation and the Prospects for Closure,” Autumn Fiester (2015) rightly criticizes the “Recommendation-Focused Model” (RFM) in clinical ethics consultations (...

Dealing With the Nocebo Effect: Taking Physician–Patient Interaction Seriously

In “When Respecting Autonomy Is Harmful: A Clinically Useful Approach to the Nocebo Effect,” Fortunato, Wasserman, and Menkes (2017) argue that, seeking to respect patient autonomy, physicians ofte...

Reconsidering Bias: A Hermeneutic Perspective

In “Biases and Heuristics in Decision Making and their Impact on Autonomy,” Blumenthal-Barby (2016) rightfully draws attention to the relevance of cognitive science findings for ethical concepts such as consent, agency, and autonomy. Her central claim is that biases and heuristics “pose a serious threat to autonomous decision making and human agency” (13). Blumenthal-Barby’s concept of autonomy refers to personal self-governance: “personal rule of the self by adequate understanding while remaining free from controlling interferences by others and from personal limitations that prevent choice” (7). Understanding, one of the dimensions of autonomy Blumenthal-Barby identifies, is described as correctly understanding both the action that is considered and its consequences. She maintains that autonomous agency may be significantly compromised when a person’s understanding of the nature of this action or decision and its foreseeable consequences is distorted by biases and heuristics, and that “efforts should be made to remove, mitigate them, or counter them” (5). Although we do not deny the importance of challenging biases and heuristics in patients in order to promote understanding and therefore autonomy, we provide a different perspective on biases, derived from hermeneutics (Widdershoven and Abma 2007). Hermeneutics clearly recognizes the effects of biases, or “prejudices,” but emphasizes that they are both limiting and productive in human understanding. Furthermore, hermeneutics suggests that although biases cannot be overcome, they can be investigated and changed into more encompassing views through dialogue. Hermeneutics is a philosophical theory that deals with the fundamental characteristics of human understanding and interpretation. Against a “view from nowhere” (Nagel 1986), hermeneutics argues that man is fundamentally bound to a “horizon of understanding,” which influences his outlook on the world. Hans-Georg Gadamer, one of the founders of hermeneutics, argues that this horizon entails “prejudices,” that is, “prejudgments,” dispositions or tacit beliefs that determine the way we see the world and how we experience things. We cannot even exist without them. Thus, for Blumenthal-Barby, a nonbiased, full understanding seems to be the norm in autonomous action and decision making—although she does recognize that it is not reasonable to maintain that full understanding is always necessary to be autonomous—whereas hermeneutics rejects that norm. Furthermore, although our understanding is always, to some extent, biased, this initial, prejudiced understanding is also the foundation of further understanding. As a

Peer Review and Beyond: Towards a Dialogical Approach of Quality in Ethics Support

In this chapter we reflect on the relevance of peer review for assessing the quality of clinical ethics consultation. We contend that peer review in the narrative form as presented in this book provides an alternative to the formal clinical ethics consultation review procedures typically found in the clinical ethics literature. We elaborate on peer review as a reflection on clinical ethics consultation practice, the elements which a story should contain in order to provide a basis for peer review, and the differences between the assessments of the peer reviewers. We argue that a narrative approach to assessing the quality of ethics consultation can be further developed by allowing all stakeholders who are involved in the clinical ethics practice to actively take part in the evaluation process, following a “responsive evaluation” approach. An example of this is creating a Community of Practice, the aim of which is to foster a joint learning process of all parties involved. At the end of this chapter, we draw conclusions on peer review as a dialogical tool for evaluating quality of clinical ethics consultation.

Ethical Issues in Fecal Microbiota Transplantion: Taking Into Account Identity and Family Relations

Ethical Issues in Fecal Microbiota Transplantion: Taking Into Account Identity and Family Relations Suzanne Metselaar & Guy Widdershoven To cite this article: Suzanne Metselaar & Guy Widdershoven (2017) Ethical Issues in Fecal Microbiota Transplantion: Taking Into Account Identity and Family Relations, The American Journal of Bioethics, 17:5, 53-55, DOI: 10.1080/15265161.2017.1299245 To link to this article: http://dx.doi.org/10.1080/15265161.2017.1299245

Reclaiming Narrative Identity and Recovery in Psychiatry

Jecker and Ko (2017) rightfully argue that the acknowledgment of narrative identity is crucial in care for patients after neurosurgical interventions, and that it is vital for patients that their i...

Moral Case Deliberation: Its Value for Neuroethics

In “Ethics, Ethicists, and Professional Organizations in the Neurological Sciences,” Moses and Illes (2017) plead for a coordinated effort to organize ethicists with specialized expertise in the neurological sciences, which is lagging behind in a discipline that needs ethics as a “cornerstone.” They hold that “all professional organizations that focus on the neurological sciences [should] have a resident ethics committee or an identified pathway to an authoritative consulting body with neuroethics expertise” (10). Furthermore, they plead for harmonization, standardization, and transparancy of ethics structures within neuroscience organizations. To this purpose, they recommend committee mandates (such as an organizational code of ethics), selection procedures for members (in which their degree or background is considered), and a standardized training curriculum. Drawing a parallel with medicine, Moses and Illes argue that committee members of neuroscience organizations should possess sufficient specialized expertise “just as a hospital would not hire an ethicist without expertise in the field of medical ethics” (3). Consequently, they argue that ethics committee members should provide ethics consultations within the organization in their capacity as specialized neuroethics experts. We agree that councils and task forces should work on the standardization of medical ethics, on the implementation of these standards, and on tools to ensure the quality, transparency, and comparability of medical ethics activities (Pearlman et al. 2016). Also, the focus on codes of professional accountability and the formal accreditation of ethicists working in the medical domain has increased (Tarzian and Wocial 2015). Meanwhile, we argue that delegating neuroethical expertise to an ethics committee within an organization is neither sufficient nor efficient. First, neuroscience professionals themselves (researchers, practitioners, etc.) should be able to integrate ethical reflection into their daily practice, rather than merely rely on the expert judgment of committee members who provide ethics consultations. As McClimans and Slowther argue in a recent article, scientists ought to make the values on which they base their judgments more transparent, so as to maintain the integrity of science, to render these values subject to discussion and evaluation by the public, and to remain accountable (McClimans and Slowther 2016; Douglas 2009, 155). This is also recognized in the growing attention for research integrity. Drawing a parallel with medical ethics once more, the importance of making one’s values explicit has since long been emphasized in the context of the physician–patient relationship, as McClimans and Slowther point out, especially by Emanuel and Emanuel, who argue that physicians should articulate the values that underpin their clinical recommendations and discuss why they feel some of these values are more worthy than others, if only to provide patients with a better position to evaluate whether they are a good match with their doctor (Emanuel and Emanuel 1992; McClimans and Slowther 2016). This would require, however, that neuroscientists working in brain-based organizations possess the skills to render their values explicit and to engage in a dialogue with other stakeholders about them. This set of skills is identified by Michael Parker as “moral craftsmanship”: the commitment to do the moral part of a job well by reflecting upon, understanding, and deliberating on moral aspects, including one’s own values and those of others, especially in the case of conflict, and in situations that are experienced as morally troublesome (Parker 2012). Hence, if neuroscientists would merely “follow” the neuroethics expert judgment of an ethics committee member, it is unlikely that this would result in further development of their own knowledge of ethics, their capacity to articulate and reflect on their own values, and their ability to deal with a morally complex situation and its ambivalences. In our view, this makes it desirable that, in addition to promoting ethicists with neuroethics expertise in the neurosciences in ethics committees, an