Should a hospital ethicist have clinical experience?

As the federal government, accrediting agencies, and board-certifying organizations pay closer attention to hospitals' handling of ethical issues, the need increases for trained medical ethicists. The role of such persons should be one of an inside aide, not an outside expert. Although persons from disciplines other than medicine may have differing ideas about life-and-death issues, their perspectives can be of great help to physicians. The more medicine grapples with complex ethical issues, the greater the need for interdisciplinary cooperation. The kind of strategy most appropriate for the institutional ethicist's work is not one of abstract philosophizing but rather one that focuses on concrete cases and the development of decision-making strategies. If ethicists help physicians develop the conceptual tools to think through practical cases, then physicians will be better equipped to make defensible ethical decisions. In addition to providing consultive services, staff ethicists could serve on policy-making committees. They also could help physicians and nurses explain to patients' families the reasons for certain decisions or policies.