Let me address the “editorial” aspect of this editorial right away: I wholly agree with the principle that lies behind Mark Kuczewski’s admirable article. I take that principle to be that when clinical ethics issues affect undocumented patients, fostering efficient routine care in the setting of “new immigration-related stressors” is “to be resolved by finding creative means of instancing the values of care, efficiency, and public health.”
In Kuczewski’s article the clinical ethicist is a kind of mediator and moral conscience. His account of what he calls second-generation clinical ethics issues affecting undocumented patients caused me to think about a lively discussion in the late 1980s and 1990s: What is a clinical ethicist? Decades ago people wondered whether she was best defined as an applied philosopher, a moral witness, a “facilitator,” an educator, a secular priest or rabbi or imam, some combination of all of these, or something else entirely. Related questions were raised about the clinical ethicist’s moral authority, as well as problems like the ethicist’s role as potential whistle-blower, her possibly conflicted position as an employee of the institution, and the nature and source of the moral consensus upon which she might rely.