Changing "Hats": Benefits, Challenges, and Best Practice Proposals for Dual-Role Clinical Ethicists.

Abstract

Clinical ethics consultation has become increasingly professionalized, yet many ethics consultants continue to maintain active clinical practice as physicians, nurses, or social workers. Despite the prevalence of these dual-role clinical ethicists, the benefits, challenges, and best practices associated with this model remain underexplored. Drawing on the experiences of physician-, nurse-, and social worker-ethicists, we examine how dual-role ethicists approach the intersection of clinical care and ethics consultation. We highlight key strengths of the dual-role model, including enhanced clinical insight, pragmatic ethical analysis, professional credibility, and the ability to translate between clinical and ethical domains. We also explore challenges, including role conflict, boundary ambiguity, conflicts of interest, rollover of professional norms from the clinical role into the ethics role, hierarchical barriers, and concerns regarding accountability and liability. These tensions require dual-role ethicists to continuously negotiate competing professional identities and responsibilities. Lastly, we propose best practices for both individual clinicians and healthcare organizations, emphasizing role clarification, conflict-of-interest management, role-conscious communication skills, and the benefits of multidisciplinary ethics practice, mentorship, protected time, and institutional support.