Clinical Ethics in Name Only? The Case for Moral Realism at the Bedside.

As Clinical Ethics Consultation (CEC) becomes more institutionalized, concerns about its legitimacy and efficacy have grown. We defend a realist orientation, according to which CEC has normative force only if its recommendations answer to stance-independent reasons, not to individual preferences and institutional policies. Public justification can and should proceed through familiar means (e.g., shared mid-level norms and transparent procedures) so that stakeholders can scrutinize the reasoning. We show how neutrality, admirable as a procedural virtue, hollows CEC when treated as a master ideal, leaving hard cases to defaults and institutional inertia. In its place, we develop moral expertise as sustained, transparent reasoning that integrates the clinical picture with the profession's content-full standards. We then construe warranted deference as rational trust in contrastive reason-tracking rather than deference to role. Our comparative thesis holds that shared norms successfully handle routine cases, but persistent disagreement and institutional pressure call for a realist grounding that secures determinate, action-guiding recommendations. On such realist understanding, CEC remains normatively accountable and oriented toward getting things right.