There are more than 27,000 healthcare ethics consultants in the United States.1 However, only a small percentage have obtained the American Society for Bioethics and Humanities (ASBH) Healthcare Ethics Consultant-Certified (HEC-C) designation. “We are looking to expand the number of people getting certified, and for more people to know about the availability of the credentialing process,” says Chris Feudtner, MD, PhD, MPH, HEC-C, chair of the HCEC Certification Commission.
The HEC-C program began accepting applications five years ago. As of June 2023, only 779 healthcare ethics consultants have earned the HEC-C. The ASBH recently convened a task force to grow the program. “We are interested in trying to understand why some long-standing consultants are declining the opportunity to become certified,” says Daniel Davis, PhD, HEC-C, chair of the task force and a founding member of the HCEC Certification Commission. The task force is conducting surveys and interviews to learn more about ethicists’ attitudes toward the credential.
Initially, ASBH targeted two groups: ASBH members, and people who expressed interest in certification. “We have broadened our outreach to potential audiences, including hospice and palliative care physicians, nurses, social workers, and chaplains,” reports Mary Beth Benner, CAE, executive director for ASBH and the HCEC Certification Commission.
Debate is ongoing as to exactly what experience and education demonstrates competency as a clinical ethics consultant. There also is no clear consensus in the field regarding how competency should be assessed. “I’m not suggesting that there’s no room for discussion about change. But the rationale for the current eligibility requirements, and the rigor and quality of the exam, are based on data and evidence,” Davis asserts.
The HEC-C program always was viewed as a work-in-progress, intended to be adjusted over time based on feedback from the ethics field.
“That’s been the case in most other healthcare professions. If we waited to get it just right, we’d never start,” Davis says.
The ASBH task force is actively promoting the HEC-C program among ethicists, organizations that employ ethicists, and through organizations like the American Hospital Association and the Association of American Medical Colleges’ Council of Teaching Hospitals and Health Systems.
“We have to find ways to convince them that competent ethics consultants are a worthy investment,” Davis reports.
Some hospitals are listing “HEC-C preferred” in job postings for clinical ethicists. Just the fact that there is a credential for ethicists could open the possibility of organizations adding paid positions.
“In some healthcare systems, there is a need to have a credentialed individual in order to post positions,” Feudtner explains. “Some healthcare systems are now posting positions for healthcare ethics consultants, where previously they did not.”
Hospitals and health systems are becoming more aware of the HEC-C credential. The task force surveyed 134 HEC-Cs in late 2022. About half reported their employer paid part or all of the HEC-C fees. One-fourth received time off to prepare and take the HEC-C exam; 10% received a salary increase, promotion, or both after achieving certification. Additionally, 23 respondents reported supervisors commended the ethicists for obtaining the HEC-C during performance reviews.
“We are hopeful that the credential will have a larger impact, of changing the position from ‘It’s good to have a healthcare ethics consultant as part of your team,’ to ‘You really ought to have a certified healthcare ethics consultant — and you need to staff them, the way you would any other service,’” Feudtner shares.
In this way, the HEC-C is advancing the overall professionalization of the field of ethics. “Pick any other area of practice in the hospital. People who are providing services — to patients, to families, even to the institution — are credentialed,” Feudtner observes.
Thus, the HEC-C designation puts ethicists on a level playing field with clinical counterparts. It also could advance quality improvement of ethics consultations.
“If ethics is being done as a side job or an afterthought, it’s hard to envision how you really get quality improvement done. To improve quality, a necessary step is a system change, where ethics is valued, and supported, and paid for — the way we do anything else in healthcare,” Feudtner says.
For individual ethicists, placing the HEC-C after their name signifies professionalism and credibility. “But it’s also about contributing a greater good. You are standing up for a movement, not just your own personal career,” Feudtner suggests.
Hospitals may perceive a competitive advantage to hiring credentialed ethicists. “If hospital leaders are looking at another healthcare organization that has four credentialed healthcare ethics consultants, and they have none, it puts that organizational role on the map,” Feudtner suggests. “The people making staffing decisions say, ‘Maybe we need to do this, too.’”
Just a decade ago, the field of palliative care was largely unknown, widely misunderstood, and difficult for patients to access. In recent years, palliative care has grown dramatically in terms of professionalism, training, and demand. The ASBH task force members foresee the same kind of trajectory for the ethics field.
“As a change agent, we do need to recognize that change does not happen overnight,” Feudtner admits. “But in 10 years, we will have noticeable change.”
REFERENCE
1. Fox E, Danis M, Tarzian AJ, Duke CC. Ethics consultation in U.S. hospitals: A national follow-up study. Am J Bioeth 2022;22:5-18.
The Healthcare Ethics Consultant-Certified (HEC-C) designation is advancing the overall professionalization of the field of ethics. The certification advances the quality of ethics consultations and puts ethicists on a level playing field with clinical counterparts.
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