Strange, but not stranger: The peculiar visage of philosophy in clinical ethics consultation

Baylis, Tomlinson, and Hoffmaster each raise a number of critiques in respo nse to Bliton's manuscript. In response, we focus on three themes we believ e run through each of their critiques. The first is the ambiguity between t he role of ethics consultation within an institution and the role of the ac tual ethics consultant in a particular situation, as well as the resulting confusion when these roles are conflated. We explore this theme by revisiti ng the question of "'What's going on?" in clinical ethics consultations. Mo ving from those issues associated with the role of the ethics consultant to those associated with the role of inquiry within the practice of ethics co nsultation, we then take up the serious challenge that Bliton seems shackle d by the assumptions and institutional dispositions embedded in the medical culture in which he is working. This reveals the second theme, namely that there is a risk of co-optation when acting in a role that derives its legi timacy from institutional sources. Finally, we focus on an even more proble matic implication stemming from the first two, namely that the focus on ins titutional power as the crucial factor for determining ethical significance has the effect of distorting, and perhaps obscuring, other forms of relati onal, interpersonal, and moral meaning.