This is an accepted manuscript of an article published by Taylor & Francis in American Journal of Bioethics, 12(8), 2012. Available online: http://dx.doi.org/10.1080/15265161.2012.692434 Patient Advocacy in Clinical Ethics Consultation Lisa M. Rasmussen, University of North Carolina, Charlotte Abstract: The question of whether clinical ethics consultants may engage in patient advocacy in the course of consultation has not been addressed, but it highlights for the field that consultants’ allegiances, and the boundaries of appropriate professional practice, must be better understood. I consider arguments for and against patient advocacy in clinical ethics consultation, which demonstrate that patient advocacy is permissible, but not central to the practice of consultation. I then offer four recommendations for consultants who engage in patient advocacy, and consider the implications of this issue for the field. 1 Keywords: advocacy in clinical ethics consultation, patient advocacy Practicing clinical ethics consultation is—or ought to be—unsettling for reflective individuals. It has an ambiguous professional status, and occurs in emotionally fraught situations involving contested moral values, suffering, and death. Consultants must neither be too prescriptive with their recommendations nor fail to offer any at all. They must acknowledge, respect, and support diverse moral values, yet not fall prey to egregious relativism, paternalism, or ethical imperialism. They must justify the value of consultation services without relying merely on regulatory mandates for their existence or on the language of marketplace value. They must not be watchdogs or moral policemen, yet must also reject being used as mere window dressing for other purposes. Balancing on the intersection point between these various axes of obligation seems difficult, if not impossible. The usual recourse for a professional would be to hold oneself bound by professional guidelines regarding appropriate conduct, but what guidelines exist in clinical ethics consultation are often too vague to help with these kinds of questions. One area in which these tensions must be navigated is the role of the clinical ethics consultant (CEC) in supporting a patient’s interests and wishes, and the lengths to which 1 Ideas in this article were initially explored in a panel discussion with Maureen Kelley, Dien Ho, Susan Miller, and Boris Yudin at the 6th International Conference on Clinical Ethics Consultation in 2011 in Amsterdam, the Netherlands, and subsequently developed for formal presentation at the Wake Forest University Junior Scholars in Bioethics Workshop in September 2011. I thank the sponsor of the Workshop, the Center for Bioethics, Health and Society, which made possible a rich environment for the extended exchange of ideas. My gratitude also goes to the workshop participants whose insights helped to shape my work on this article, particularly my formal commentators Heather Gert, Hannah Hargrave, Michael Hyde, Ana Iltis, John Moskop, and Rebecca Walker.