By Ruby Shanker
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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-centred care in healthcare.
Bioethics is the application of ethics to healthcare and describes how we should (versus can) respond to ethical issues and dilemmas facing patients, families, healthcare providers, the healthcare system, and society whilst recognizing and addressing moral distress and its impact on staff. Ethical standards are also essential elements of professional codes of practice and are a vital component of the Accreditation Canada process.
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. This can be:
- At a clinical level with scenarios such as how to best to respond when there is a disagreement due to conflicting values, unclear interpretation of the patient’s wishes, or what constitutes appropriate care within chronic illness management.
- At an organizational level where bioethicists are frequently called upon to assist with decision-making related to priority setting and the equitable distribution of scarce resources such as access to resource-limited-high-demand program services.
- In the research context when a bioethicist might help investigators to determine how best to balance the participants’ interest in receiving timely information against the importance of protecting the study’s scientific integrity.
Ethics frameworks can support organizing thoughts and offer structure to approaching concerns. At WCH, for organizational ethics issues such as priority setting for the allocation of limited resources, WCH uses the Accountability for Reasonableness (A4R) Framework.
For clinical ethics issues and dilemmas, the IDEA Framework is used– Identify the facts, Determine relevant ethical principles, Explore the options, and Act (recommend and implement). For clients and their families, ethics-related issues are documented in the health record once they are aware about the involvement of the Ethics Program. Along with extensive broader engagement, we have also been working with patients, care partners, and members of the community via the WCH Community Liaison Advisory Committee (CLAC) to update the IDEA framework. Their feedback is being sought about adding two new components: Story (whose story is it?) and Story sharers (who is affected by the decisions?). CLAC members felt that these new domains were important as cultural norms and values direct the lives of individuals, and thus can have a significant impact on meaningful resolution of ethical dilemmas. With these new elements the updated framework will be known as IDEAS2.
The WCH Ethics Program is overseen by our bioethicist, Ruby Shanker who is also a member of UHN’s bioethics team. Ruby can be contacted through email (ruby.shanker@wchospital.ca) or by cell phone (647-929-7178). Information about the program, including frequently asked questions, additional resources, and links to ethics related policies are available on the WCH intranet (Access Here). Information regarding the program is also available for clients and their families on WCH’s public website (Access Here).
For more information on Accreditation, visit our Accreditation Intranet Hub.