Accreditation: Working towards a new clinical ethics framework

By Ruby Shanker

Ethics is part of everyone’s work. The values of our patients and healthcare professionals lie at the heart of many ethical issues: identifying these values and understanding how they influence decision-making is an important part of providing ethically defensible person-centered care in healthcare. However, the process can sometimes be overwhelming without direction of where to begin. Ethics frameworks can support organizing thoughts and offer structure to approaching ethics concerns, whether clinical, organizational, or research ethics related.

For clinical ethics issues and dilemmas, the IDEA Framework has been in use since 2013. The IDEA acronym stands for:

  • Identify the facts, preferences, and context
  • Determine relevant ethical principles
  • Explore the options
  • Act (recommend and implement)   

In recent years, there has been an evolving need to revise the framework more explicitly to highlight patient and care partner experiences.  Earlier this year, patients, care partners, and members of the community via the WCH Community Liaison Advisory Committee (CLAC) were engaged in revising the IDEA framework, particularly around adding two new components:

  • Story (whose story is it?)
  • Story sharers (who is affected by the decisions?)

CLAC members expressed that these new domains were important as cultural norms and values influence the lives of individuals, and thus can have a significant impact on the process towards meaningful resolution of ethical dilemmas. With these new elements identified and supported, the updated ethics framework is now known as IDEAS2.

For organizational ethics issues such as priority setting and the equitable distribution of scarce resources such as access to resource-limited-high-demand program services, WCH continues to use the Accountability for Reasonableness (A4R) Framework

Women’s College Hospital has a well-defined Ethics Program in place designed to guide staff as well as patients and their families with ethics-related concerns and questions, where values might be in conflict making it hard to reach a decision.

The WCH Ethics Program is overseen by our bioethicist, who is also a member of UHN’s bioethics team. Information about the program, including frequently asked questions, additional resources, and links to ethics related policies are available on the WCH intranet. Information regarding the program is also available for clients and their families on WCH’s public website.

For more information on Accreditation, visit our Accreditation Intranet Hub.