Clinical ethics consultation (CEC), as an activity that may be provided by clinical ethics committees and consultants, is nowadays a well-established practice in North America. Although it has been increasingly implemented in Europe and elsewhere, no agreement can be found among scholars and practitioners on the appropriate role or approach the consultant should play when ethically problematic cases involving conflicts and uncertainties come up. In particular, there is no consensus on the acceptability of consultants making recommendations, offering moral advice upon request, and expressing personal opinions. We translate these issues into the question of whether the consultant should be neutral when performing an ethics consultation. We argue that the notion of neutrality 1) functions as a hermeneutical key to review the history of CEC as a whole; 2) may be enlightened by a precise assessment of the nature and goals of CEC; 3) refers to the normative dimension of CEC. Here, we distinguish four different meanings of neutrality: a neutral stance toward the parties involved in clinical decision making, toward the arguments offered to frame the discussion, toward the values and norms involved in the case, and toward the outcome of decision making, that is to say the final decision and action that will be implemented. Lastly, we suggest a non-authoritarian way to intend the term "recommendation" in the context of clinical ethics consultation.

中文翻译：

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“临床伦理咨询中的中立概念”。

作为临床伦理委员会和顾问可能提供的一项活动，临床伦理咨询（CEC）如今在北美已成为一种惯例。尽管在欧洲和其他地方已经越来越多地实施该计划，但是当涉及冲突和不确定性的道德问题案件出现时，学者和实践者之间并未就顾问应扮演的适当角色或方法达成共识。尤其是，在提出建议，应要求提供道德建议以及发表个人意见方面，顾问们的可接受性尚无共识。我们将这些问题转化为咨询师在进行道德咨询时是否应该保持中立的问题。我们认为中立的概念是：1）作为解释整个CEC历史的解释学钥匙；2）通过对CEC的性质和目标的精确评估可能会有所启发；3）指CEC的规范维度。在这里，我们区分了中立的四种不同含义：对临床决策参与方的中立立场，对构成讨论的论点的中立立场，对案件所涉及的价值观和规范以及对决策结果的中立立场就是说将要执行的最终决定和行动。最后，我们建议在临床伦理咨询的背景下采用非专制的方式来指代“推荐”一词。对涉及临床决策的各方，对讨论框架提出的论点，对案件所涉及的价值观和规范以及对决策结果的态度持中立立场，也就是说，最终决定和将采取的行动被实施。最后，我们建议在临床伦理咨询的背景下采用非专制的方式来指代“推荐”一词。对涉及临床决策的各方，对讨论框架提出的论点，对案件所涉及的价值观和规范以及对决策结果的态度持中立立场，也就是说，最终决定和将采取的行动被实施。最后，我们建议在临床伦理咨询的背景下采用非专制的方式来指代“推荐”一词。