The Ethics Program at Women’s College Hospital is available to assist patients, family members, staff and physicians to resolve complex ethical issues.  The program provides consultation, ethics education, policy review and contributes to research on bioethical issues.  There are four (4) components of the Ethics Program.

Clinical: Clinical Ethics addresses the ethical issues arising with individual patients, to help understand how we should (versus can) respond to issues and dilemmas facing patients, families and healthcare workers.

Organizational: Organizational Ethics is concerned with the ethical implications of organizational decisions and practices on patients, staff and the community.

Research: Bioethics programs may support the research activities of organizations by providing consultation to investigators, Research Ethics Boards and Research Institutes and research participants, to address issues.

Education: Bioethicists help build ethics capacity throughout the entire organization, from bedside to boardroom by providing education and resources.

Bioethics services are provided under an agreement with University Health Network (UHN). UHN is an active member of the University of Toronto Joint Centre for Bioethics and is committed to providing an integrated, accountable and sustainable ethics service.

What do Bioethicists do?

A bioethicist helps patients, families and health-care professionals deal with difficult ethical issues in patient care. He/she has special training in ethics, philosophy and conflict resolution, providing confidential consultation and mediation.

Our goal is not to impose values on others, but to assist individuals and groups in solving complex ethical problems so they can make informed decisions about treatment. In so doing, we may:

• Provide confidential consultation for patients, families and health-care providers on ethical issues in patient care
• Identify ethical issues in patient-care situations
• Ensure all relevant facts, values and options are explored
• Help facilitate discussion between patients, families and health-care teams about the risks and benefits of, and alternatives to available treatment options.
• Help people involved make decisions about ethical issues
• Mediate to assist groups or individuals when there is a difference of opinion or values about a particular patient care situation
• Address ethical issues in research
• Provide education to professionals on ethical issues in patient care
• Research ethical issues in patient care

What is Ethics?

Ethics is the attempt to give good reasons for what we want out of life, and what principles should guide how we go about getting it.  Ethical dilemmas arise when principles conflict or provide unclear direction.

For example, respecting individual choice is a principle compatible with many understandings of what we want out of life.  Yet respecting choices can conflict with the principles of trying to benefit patients or avoiding harm to others.  In such dilemmas, studying ethics helps us figure out good reasons for choosing one course of action over another.  Sometimes, people will disagree about how to solve an ethical dilemma; in these cases, ethics gives us the grounds for compromise.

What is Bioethics?

Bioethics (sometimes called ‘medical ethics') is the application of ethics to medicine and healthcare. Bioethics tries to understand how we should (versus can) respond to issues and dilemmas facing patients, families and healthcare workers. Bioethicists use principles to provide advice about how to define, clarify, and organize thinking around processes and outcomes in healthcare settings ranging from the patient's bedside to the boardroom.

To take a clinical example, a bioethicist might provide advice to clinicians about how to respond to a disagreement between a patient's substitute decision-makers over what end of life care is appropriate. Bioethics also addresses ethical issues on an organizational level that affect a whole hospital, including patient care. For example, bioethicists have participated in pandemic flu planning by helping to define the extent of a healthcare worker's duty-to-care in a flu pandemic.

Why is Bioethics important?

Ethical standards are essential elements of professional codes of practice

• Ethics is a major aspect of the CCHSA accreditation process.
• Individual self-determination lies at the heart of many ethical issues: resolving these is an important part of providing patient-centered care.
• Conserving Resources and Avoiding Costs: “Effective Ethics programs have been shown to improve quality of care and reduce length of stay and costs.”¹
• Increased Patient Satisfaction: Patients are more satisfied with the care they receive when they are actively involved in decisions about their health care.²
• Staff Satisfaction and Retention: Bioethics provides an important service in recognizing and addressing moral distress and its impact on staff.³
• Reduced Risk of Lawsuits: “Organizations that make strong commitments to ethical health care practices, such as being honest with patients, can reduce the risk of litigation and liability.”⁴

References:

1. Fox E et al. “Ethics Consultation: Responding to Ethics Questions in Health Care.” National Center for Ethics in Health Care, Veteran's Health Administration, 2006.
   
   Halloran S, Starkey G, Burke P et al. An educational intervention in the surgical intensive care unit to improve ethical decisions. Surgery 1995; 118: 294-5.
   
   Schneiderman LJ, Gilmer T, Teetzel HD et al. Effect of ethics consultations on nonbeneficial life-sustaining treatments in the intensive care setting. JAMA 2003: 290: 1166-72.
   
   Dowdy MD, Robertson C, Bander JA. A Study of proactive ethics consultation for critically and terminally ill patients with extended lengths of stay. Crit Care Med. 1998; 26: 252-59.
   
   Heilcser BJ, Meltzer D, Siegler M. The effect of clinical medical ethics consultation on healthcare costs. J Clin Ethics 2000; 11: 31-38.
2. Tierney WM, Dexter PR, Gramelspacher GP et al. The effect of discussions about advance directives on patients' satisfaction with primary care. J Gen Intern Med. 2001; 16: 32-40.
3. Bischoff SJ, DeTienne KB, Quick B. Effects of ethics stress on employee burnout and fatigue: An empirical investigation. J Health Hum Serv Admin. 1999; 21: 512-32.
   
   Francis RD. Evidence for the value of ethics. J Financial Crime 2001; 9(1): 26-30
4. Fox, E et al.“Ethics Consultation: Responding to Ethics Questions in Health Care.” National Center for Ethics in Health Care, Veteran's Health Administration, 2006.
   
   Vincern C, Young M, Phillips A. Why do people sue doctors? A study of patients and relatives taking legal action. The Lancet 1994; 343:1609-13.
   
   Kraman SS, Hamm G. Risk Management: Extreme honesty may be the best policy. Ann Intern Med. 1999; 131:963-7
   
   Levinson W et al. Physician-patient communication. The relationship with malpractice claims among primary care physicians and surgeons. JAMA 1997; 277: 553-59.

Acknowledgement: Content adapted from Bioethics Program, Corporate Intranet with permission from University Health Network.