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”。


临床伦理咨询（CEC）作为一项由临床伦理委员会和顾问提供的活动，目前在北美已成为一种行之有效的做法。尽管它在欧洲和其他地方得到越来越多的实施，但学者和从业者之间对于顾问在涉及冲突和不确定性的道德问题案件出现时应发挥的适当作用或方法尚未达成一致。特别是，对于顾问提出建议、应要求提供道德建议以及表达个人意见的可接受性，尚未达成共识。我们将这些问题转化为顾问在进行道德咨询时是否应该保持中立的问题。我们认为，中立性的概念 1) 作为阐释学的关键，回顾 CEC 的整体历史； 2) 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，我们区分了中立性的四种不同含义：对参与临床决策的各方的中立立场，对框架讨论所提供的论点的中立立场，对案件中涉及的价值观和规范的中立立场，以及对决策结果的中立立场。就是说将要实施的最终决定和行动。最后，我们建议在临床伦理咨询的背景下以非独裁的方式来定义“推荐”一词。