Bioethics Forum Essay

Emerging from the Cacophony of Clinical Ethics Consultation

Seated in a conference room surrounded by a group of animated clinicians during a family meeting, I found myself a bit bewildered during the first weeks of my clinical ethics fellowship. I was uncertain of what was expected of me. What were they discussing? Why were they speaking so quickly and over one another?

I am confident in my abilities and pride myself in being a quick learner, yet this moment was disquieting. I had been transported into a different world. I remembered the simulation cases we did during my PhD program in bioethics. There, I effortlessly played the role of a clinical ethicist. However, this experience was starkly different.

As a new clinical ethics fellow, I was full-in with a team of seasoned clinicians. I grappled with the relentless buzz of medical jargon and information coming piecemeal from multiple directions simultaneously. The staccato of the conference room was a far cry from the academic calm training simulations back in grad school.

But I had underestimated the challenges I would face as an English-as-a-second-language (ESL) speaker when immersed in the dynamic space of the hospital. I take pride in my English proficiency. I came to the United States from Bangladesh for my advanced degrees, taught classes, presented talks, facilitated training sessions, and published papers—all in English. But this was different. This was like learning a third language.

I am not a clinician, but I am a curious observer grounded in theory and academia. Being an outsider has been a strength. As a nontraditional clinical ethicist, I have had a distinct perspective on the cultural nuances in the hospital. In that delicate space, language holds significant weight, with some meanings left unsaid and others only understood through the familiarity of experience. All this should have been a positive. But it was incredibly hard to piece together.

And it was a bit embarrassing. In the hospital’s go-go pace, I often sensed that people assumed that I was slow, missing the point, or not fully engaged. The nagging question was: How would I navigate these new waters and assume my new role as an ethics consultant? The challenge of grappling with all the intricacies and nuances of this truly foreign language made me doubt my ability to contribute in a high-paced, high-stakes clinical setting. Indeed, I questioned my suitability to become a clinical ethicist.

I did a bit of diagnostics and quickly realized that excellence in clinical ethics demanded mastery of another language of medical facts and linguistic shorthand that was often heavy-handed, jargon-laden, and incomprehensible to the nonclinician. This discourse was distinct to my ears as an ethics-educated entrant and a nonnative English speaker new to the clinic.

In addition, three formidable challenges stood in my way. First was the medical jargon spoken in the fast-paced and emotionally laden space of a consultation. Second was the stress of these situations. It was emotionally challenging for everyone, and the performative nature of the meeting compounded the difficulty in comprehending what people were really saying. Finally, there were the cultural values that I brought to the role. I had been acculturated, as a South Asian woman, to be submissive rather than assertive and not to speak up. The fear of others judging me as a brown non-Westerner added another layer of complexity.

With a bit of trepidation, I began to share my concerns with my very supportive team. Reflecting on my journey, I find solace in the warm embrace of my mentors and colleagues and their welcoming receptivity. Together, we embarked on a learning quest and tailored the expectations for my professional development to my unique background. Hours were spent in earnest conversation, seeking solutions to my challenges. I pushed, and we brainstormed, identifying three key strategies that could make a significant difference.

Firstly, my peers needed to appreciate that I was neither a native English speaker nor a clinician. Secondly, I proposed one-on-one communication with clinicians in a relatively quiet setting, helping me understand the case situation we were working on and allowing me to bring that knowledge with confidence into the team meetings. And, finally, I advocated for a structured pause and debrief after each encounter, providing a space for reflection and guidance with my mentors.

These steps proved invaluable for my educational needs. Through many late-night catch-up sessions, I began to learn how to decipher signals from noise during consult meetings and turn cacophony into intelligible conversation. I gained insight into the overarching and recurring themes of a case. I learned to detect and dissect each conversation segment, mastering the art of absorption and articulation. I wish I had reached out sooner for help.

What have I learned that can help other ESL ethics consultants? I’ve realized that despite our proficiency in English, we often require more time—even if it’s only a few seconds—to respond. Rather than this being viewed as a hindrance or deficiency, we need to reframe it as something positive. Slowing the pace and being more deliberate can yield valuable insights, uncovering perspectives and process improvements that can be hidden within the rapid, get-it-done flow of medical conversations. A slower pace can be calming and make possible a more nuanced analysis that might otherwise be overlooked.

To my knowledge, I am the first woman from Bangladesh undergoing training in clinical ethics in the U.S. I hope that I am not the last. My experience should be instructive to those who will train the next generation of clinical ethicists. If the call is for a more diverse workforce in clinical ethics to meet the needs of an increasingly diverse patient population, then fellowship programs must adapt to nontraditional fellows like me. As a group, if given the chance and the support, we will enrich the discourse in the clinic.

I look forward to being part of that conversation.

Fahmida Hossain, PhD, HEC-C, is a medical ethics fellow at Weill Cornell Medicine.

Acknowledgement:

I acknowledge and am indebted to Dr. Joesph J. Fins for encouraging me to share my insights and experiences as an emerging clinical ethicist. His support, guidance, suggestions, and deep conviction that open discussion of these matters benefits all in the field provided grounding, commitment, and courage to write this piece. I further acknowledge my colleagues in the Division of Medical Ethics and the clinicians of Weill Cornell for offering a hospitable clinical space.