The Quality Attestation Presidential Task Force has made a thoughtful and thorough contribution to the establishment of clinical ethics consultation as a professional field. As Eric Kodish, Joseph J. Fins, and colleagues indicate, quality attestation is another step in bringing greater accountability and transparency to CEC. To complete this process, however, the work of the QAPTF must be situated within a larger project. As the field further develops, there will be a move toward restricting CEC to those who have demonstrated, (...) by means of this version of the quality attestation or an eventual iteration of it, that they are capable of conducting an ethics consultation with the skill, knowledge, and rigor necessary. This raises the question of how potential consultants will gain the experience required to produce a portfolio of cases when only those who are qualified are permitted to perform CECs, either by their institution or by some external evaluator, such as The Joint Commission. Now may be the time to begin thinking about further developments in the field that will complement both current academic training programs and the quality attestation process. For this, we might look to the Association for Clinical Pastoral Education for its model for certifying educators of chaplains who wish to become professionals. (shrink)

Social epidemiology has made a powerful case that health determined not just by individual-level factors such as our genetic make-up, access to medical services, or lifestyle choices, but also by social conditions, including the economy, law, and culture. Indeed, at the level of populations, evidence suggests that these “structural” factors are thepredominantinfluences on health. Legal scholars in public health, including those in the health and human rights movement, have contended that human rights, laws, and legal practices are powerfully linked to (...) health. Social epidemiology and health-oriented legal scholarship are complementary in their focus and their research needs. Legal scholarship has identified plausible ways in which legal and human rights factors could be influencing health, but empirical evidence has been limited. (shrink)