Last month I attended and presented at a recent conference entitled “ICCEC 2015 – Improving Quality and Professionalism of Clinical Ethics Education & Consulting.” Being in the clinical ethics field for only five years and having come from a career of organizational ethics and technology, I was looking forward to the discussions and to gauging the readiness for change within the discipline.

Not a new discipline, clinical ethics has benefitted from several decades of dedication. It is said that it is much easier to see clearly when standing on the shoulders of a giant, and for bioethics there are many giants who began the field fifty years ago: Beauchamp, Childress, Pellegrino, and so many more. They were the first generation and typically physicians. The next generation and current leaders are primarily academics. At least it appears thus if judging by conference speakers and by the name of the largest bioethics association, American Society for Bioethics and Humanities, who encourage interdisciplinary integration of ethics into various practices. With the academics at the helm, there has been an increased emphasis on education and training, yet still no official practice standards or certifications for clinical ethicists or training and skills standards exist. Furthermore, the newly revised standards for clinical ethics competency are not formally required or enforced.

At the conference, I realized that there is a 3rd generation developing: practical, business-oriented ethicists who want to establish processes and see quantifiable results using standardization and technology as tools to improve outcomes. These individuals are looking to make a tactical and concrete difference in their facilities, sharing the belief that healthcare facilities today must maximize the value for the patient and minimize the cost to consistently make a meaningful and measurable difference. They see three areas of responsibility: education, policy review, and ethics consultation.

Overall, healthcare is transforming and embracing a new way of doing business: maximizing the value for patients, i.e., striving to achieve the best outcomes at the lowest cost. And, likewise, the ethics department must follow suit, making this an overarching strategy. To stay abreast with the transformation of healthcare, these 3rd generation ethicists will view the discipline as an integral component of a larger structure, the organization. To effect the changes they seek, they will assess various features of their environment for efficiency and efficacy: (1) ethical work climate – the aspect of an organization’s culture that guides employees in identifying ethics issues and provides their frame of reference in handling those issues effectively; (2) education/training – the mechanisms that empower clinicians to make decisions and ensure that patient and employee rights are protected; (3) policies – whether written or implicitly understood, these express organizational values and beliefs; and (4) organizational implementation mechanisms – the frameworks that support the organization enabling full integration of all policies, training programs, and enforcement mechanisms.

I am looking forward to seeing these new dynamic and business-savvy ethicists make great, quantitative strides in influencing the focus and application of this discipline. They can effectively shape the culture at their institutions in a measurable and memorable way!