Center for Bioethics Papers

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Journal Article

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Hastings Center Report





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The Quality Attestation Presidential Task Force’s recent proposal for “quality attestation” (QA) of clinical ethics consultants was advanced on the premise that, “[g]iven the importance of clinical ethics consultation, the people doing it should be asked to show that they do it well.” To this end, the task force attempted to develop “a standardized system for proactively assessing the knowledge, skills, and practice of clinical ethicists.” But can this proposed method deliver? If the proposed QA process is flawed, it will label clinical ethicists as qualified to do clinical ethics consultations (CECs) when they are not. The result will be the creation of a new, likely intractable, problem of CEC “false positives:” consultants who have passed QA without actually possessing the requisite knowledge and skills to perform CECs.

To avoid the risk of false positives, the QAPTF needs to conduct a rigorous analysis of the skills that the QA process will be positioned to judge and those that are simply beyond the scope of its current metrics. Rather than “attesting” to overall CEC “quality,” QA needs to be precise about the skill inventory it can confirm yet honest about the skills it has no basis to assess. I will argue here that QA has strong prospects for accurately assessing consultants’ competence in ethical analysis but very weak prospects for determining competence in two other skills listed as essential by the QAPTF: value-neutrality and conflict resolution.


This is a pre-print version of an article in the Hastings Center Report.

Fiester, A. "'Quality Attestation' and the Risk of the False Positive," Hastings Center Report, 2014, Vol. 44, No. 3, 19-22.


bioethics, clinical ethics, medical ethics



Date Posted: 02 December 2016

This document has been peer reviewed.