Ethics

Welcome to the Centre for Clinical Ethics

We provide consultative services to patients, families, hospital staff, volunteers and students on a wide range of ethical issues across the life-span. Frequently encountered issues include value conflicts around decisions, such as withholding or withdrawing treatment; consent and capacity; resource allocation; and organizational ethics.

What is Ethics?

Ethics is the study of right and wrong, the ‘grey’ areas in between, and the reasons and justifications for our actions. Clinical ethics is the application of ethics to healthcare contexts. The role of a clinical ethics service is to help facilitate sound ethical decision-making, by bringing stakeholders’ voices to the table, and identifying and respecting the needs of patients, families, and healthcare staff. In some cases, we are faced with a choice between a few different options, each with their own benefits and challenges. In these cases, clinical ethics promotes reflective practice and can help stakeholders reach justifiable decisions with which they are comfortable.

Ethics Consultation Services:

Case consultations: one-on-one w/ any stakeholder; attendance at team & family meetings
Support: one-on-one confidential
Preventive ethics: education (e.g. in-services, lunch & learns, Ethics Grand Rounds), attendance at clinical rounds/huddles
Retrospective case/issues analysis: confidential debriefs on cases or issue clusters, case reviews, publications and case studies
Organizational issues support: some tools used are the Accountability for Reasonableness Framework or A4R (in tandem with YODA); and a weighted decision-making matrix for guiding deliberations and measuring potential options
Behaviour agreement development and implementation: relationship plans between healthcare teams and patients and/or family, and guidance on how to enact them well
Committees and Working Groups: development and/or participation
Policy/guideline/document review and development
Debriefs: confidential group sessions to facilitate team decompression, promote solidarity, problem-solve, and analyze tough cases
Education
Research
Research protocol reviews: sitting on Research Ethics Boards
Documentation of process, outcome & trends: consult numbers, sites, roles requesting, recurrent issues, follow-up activities

Ethical Decision-making:

Principle Based Framework for Ethical Decision Making

Principles

Autonomy, beneficence, non-maleficence, justice etc.

Lakeridge Health Values

Inclusion, Compassion, Innovation, Teamwork, Joy

Ethical Dilemmas occur when these and/or other principles/values come into conflict.

G.R.E.A.T: Principle-based Ethical Decision-making Framework

Gather

Refine

Evaluate

Act with Transparency

Some Common issues:

Substitute decision-making
Decision-making capacity
Communication difficulties
Informed consent & informed refusal
Level of care

Ethicists are not:

Arbiters of right and wrong
Legal or Risk
Watchdogs

When to call the Centre?

If you are facing a difficult situation and are unsure of the best course of action, we may be able to assist. Not sure what we “should” be doing? Not certain what the “right” course of action is? Feel like we are not doing the “right” thing? Are you or a staff/patient/family member struggling with a decision? Anyone can trigger an ethics consult…feel free, no need to hesitate!

How to Reach Us (24/7 support):

Locating “0” or #33200
Epic secure chat (follow-up by phone if no same-day response)
On-site Ethicist ext. 32528 or cell: 647.200.9772 during regular business hours, also by email v.shillman@lh.ca
CCE office (business hours if not on-site or not reachable in office) 416.530.6750
On-call pager (for after-hours or urgent requests - leave FULL number including extension!) 416.864.5070 - ID #4211

More Information

The Centre for Clinical Ethics has developed a series of brochures for health care consumers and providers on the following topics:

Additionally, here are some useful decisional tools: