“We are not the ethics police”: The professionalization of clinical ethicists and the regulation of medical decision-making

Clinical ethicists represent a growing profession in U.S. healthcare. This profession's aspirations include serving as a supportive resource to hospital staff, but also as an ethics "watchdog," ensuring that medical decision-making adheres to ethical standards. Drawing on 31 in-depth interviews conducted in 2021 of clinical ethicists working across the U.S., I evaluate the extent to which these watchdog aspirations have been achieved. I investigate ethicists' success in leveraging three strategies aspiring professions have used to secure their jurisdictional claims: acquiring professional expertise, securing administrative authority, and cultivating trusting relationships. I show that ethicists face barriers to leveraging each, which has consequences for how ethical dilemmas are resolved. Findings point to challenges aspiring professions must overcome in order to claim jurisdictions posing a threat to incumbent professions; the tensions that exist between legal risk management and clinical ethics; and the organizational strategies marginal actors leverage to advance their interests and influence the delivery of healthcare.