While looking into credentials in clinical ethics, I came across one I had never seen before: the “Certified Health Care Ethics Consultant,” with the initials HCEC-C. For a moment, I thought I was looking at a typo. The credential I know well, the one I hold, is the Healthcare Ethics Consultant-Certified, or HEC-C. This was something else.
The HEC-C credential dates to 2018 and is administered by the HCEC Certification Commission with the support of the American Society for Bioethics and Humanities. More recently, the American Institute of Health Care Professionals (AIHCP), a private continuing-education provider, began offering the HCEC-C credential. It is a real credential, offered by a real organization, in a growing market of professional credentials.
The problem is obvious: the titles are nearly identical, the initials are almost the same, and HCEC also names the HCEC Certification Commission. A hospital deciding who should perform ethics consultations, a clinician reading a consult note, or a patient viewing a consultant’s profile could easily mistake HCEC-C for HEC-C.
The ethical problem is not that two organizations offer different credentials for ethics consultants. It is that nearly identical names can mislead readers and obscure substantial differences in what the credentials require and demonstrate. Employers and prospective certificants, therefore, need to judge what stands behind a credential, not what its name and initials seem to imply.
Why this confusion matters
Credential confusion in clinical ethics is not just an academic annoyance. It affects how hospitals decide who should perform ethics consultations and how patients and families understand who is advising them on some of the most difficult decisions in their care.
Confusion of this kind is part of a broader problem. Across professions, the proliferation of certificates, badges, and other credentials has created what researchers describe as a “maze” that confuses consumers, employers, and even educators. Research on non-degree credentials shows that, in a crowded credential market, quality signals can be weak: names and initials may convey apparent legitimacy even when the underlying requirements differ sharply. Employers and prospective candidates may have little practical ability to distinguish rigorous professional certifications from credentials based principally on completion of educational courses.
The HCEC-C/HEC-C overlap illustrates that problem. The two credentials differ in eligibility, education and experience requirements, assessment, and renewal. Hospitals should not have to untangle those differences merely to determine what a credential signifies. A separate detailed side-by-side comparison is available for readers who want to see how different the two credentials actually are.
How a credential can be judged
The field cannot prevent every confusing credential from appearing, but several basic features of a certification program can be evaluated without specialized knowledge of clinical ethics. A central purpose of professional certification is to protect the public by distinguishing people who are competent to perform a defined role. Standards for how a certification program should be built exist for that reason, and they were developed outside the bioethics field. Widely recognized benchmarks include the NCCA accreditation standards and ANSI/ISO/IEC 17024. A decade ago, I identified these standards as a roadmap for developing a high-quality certification process for clinical ethics consultants in an American Journal of Bioethics article.
This table lists several core requirements from those standards:
| HEC-C | HCEC-C | |
| Certification program accredited by an independent body | Yes (NCCA) | No independent accreditation identified |
| Certification assessment is separate from the required education | Yes. No specific educational program is required; candidates must pass a separate standardized certification exam. | No. Eligibility is based on completing AIHCP’s curriculum, with possible waivers for prior coursework; the only identified assessments are open-book course exams. |
| Competencies based on a job analysis or role delineation study | Yes | None identified |
| Psychometrically developed exam with a formally set passing score | Yes | None identified |
| Documented practice experience required | Yes | No initial practice-hours requirement |
| Governing body publicly identified | Yes | Program-specific certification board and its members not publicly identified |
| Recertification requires continued practice or reassessment | Yes. Every renewal path requires practice hours, reexamination, or both. | No. Continuing education may substitute for practice hours, and no certification exam is required. |
Entries reflect public information on each organization’s website as of August 2, 2026. Sources: HEC-C Initial Examination Candidate Handbook; HEC-C Renewal Handbook; NCCA accreditation record; AIHCP Health Care Ethics Consultant Certification; AIHCP Health Care Ethics Consulting Certification Program Information; AIHCP Health Care Ethics Consultant Recertification; and AIHCP Advisory Boards.
Why there is no easy fix
When a problem like this appears, the instinct is to look for an enforcement mechanism: a cease-and-desist letter, a regulatory complaint, or a rule about who can use which initials. But clinical ethics consultants generally are not licensed as such, and no dedicated licensing board regulates who may use these credentials. Employers and patients, therefore, cannot turn to a profession-specific regulator to determine what a credential signifies or whether its use is misleading.
ASBH holds three live registered trademarks in this area: HEC-C, HCEC Certification Commission, and Healthcare Ethics Consultant-Certified. I am not a lawyer and will not comment on whether the similarities raise legal questions. Regardless, trademark law cannot prevent all credential confusion: many similar names will not infringe anything, and litigation is slow, costly, and uncertain.
Who decides in practice?
In practice, employers often determine which competing credentials carry weight. CPR certification provides a familiar example. Several reputable organizations offer programs, while a large online market in cheaper cards has also emerged. Hospitals commonly respond by specifying which organizations’ cards they will accept.
Candidates make choices, too, and they have apparently treated the two credentials quite differently. Although information about HCEC-C had been available online since at least 2024, the August 2, 2026 comparison identified only one person in AIHCP’s public opt-in directory, compared with 1,010 in HEC-C’s.
Government agencies also distinguish among training programs and credentials. For example, Florida publishes a Master Credentials List that applies a formal Framework of Quality. I am not aware of a comparable review of clinical ethics credentials, but employers, candidates, and regulators are all making choices that collectively determine which credentials are recognized and used in practice.
Credential confusion in clinical ethics will not disappear because new credentials will no doubt continue to appear. Standards for certification programs are public, however, and criteria such as those listed in the table above can be applied to any certification program in any field. Hospitals should therefore specify which certifications they recognize for particular consultation roles, verify credentials with issuing organizations, and examine what each credential requires. Prospective certificants should do the same before investing their time and money. In clinical ethics, one letter may be the only visible difference between two credentials, but it should not be the basis on which either is judged.
Ellen Fox, MD, HEC-C, is President of Fox Ethics Consulting, Arlington, Virginia.