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 Ethics at Trillium Health Partners

​At Trillium Health Partners, everyone has a role to play in ensuring the ethical delivery of care, from the point of care to the boardroom. Ethical principles and values are incorporated into the way that decisions are made and care is delivered every day.

The Regional Ethics Program based at Trillium Health Partners provides ethics services to patients, families, staff, students, and volunteers across all sites, as well as to a number of external organizations. Ethics services include: delivering education; reviewing, developing, implementing, and evaluating ethics-related policies; participating on relevant hospital committees and working groups; and conducting ethics consultations. Requests for ethics consultation can be made by anyone including patients and family members.

The Ethicists with the Regional Ethics Program work collaboratively across sites. Their overarching role is to facilitate and support ethical decision-making throughout the organization through the identification, analysis, and resolution of ethical issues.

The IDEA: Ethical Decision-Making Framework has been adopted by the Board of Trillium Health Partners as a guide to help healthcare providers and administrators work through challenging ethical issues.

What is ethics?

  • Ethics is about right and wrong and the reasons that we give for our choices and actions.
  • In ethics, we address the question, “What ought we to do and why?”
  • Ethics promotes reflective practice and the making of “right” or “good” choices and decisions in the delivery of health care.
  • Ethical issues are often framed as “should” questions—e.g., Should we withdraw treatment? Should we fund more beds for the maternal child program? Should we disclose a medical error?

What are some examples of ethical situations in the hospital?

  • A patient has kidneys that are failing and needs dialysis (a medical treatment to remove waste products from blood) to survive. The patient is refusing dialysis. His wife is concerned that her husband does not realize the consequences of his decision.
  • A patient is in hospital for routine surgery. There is a history of strokes in her family. She has strong opinions about the kind of care she would want to receive if she suffered a serious stroke.
  • A patient recently experienced a cardiac arrest (heart stopped beating). Although his heart was restarted, he suffered brain damage that is likely permanent. He is in the intensive care unit attached to a breathing machine. The patient has previously stated that he would not want to live connected to machines.
  • A family member observes a staff member treating another patient in what appears to be a disrespectful manner.
  • A patient has been diagnosed with a terminal illness. Her family does not want her informed of the diagnosis.

How can an Ethicist help me or my family?

While in hospital you may be faced with making difficult treatment decisions for yourself or a family member. The Ethicist’s role is to facilitate good decision-making processes and support individuals through those processes.

The ethicist may be able to help you...

  • Identify the information you need to make a treatment decision
  • Understand the ethical and legal implications of your treatment decision
  • Explore the benefits and burdens of different treatment options
  • Link you with other persons and resources within and outside the organization

When might I consider contacting an Ethicist?

First, you should discuss any treatment decisions with your health care team. After having discussed your treatment decisions with your health care team, you may wish to contact the Ethicist for any of the following reasons:

  • If you are uncertain about what decision should be made
  • If there are differences of opinion about what decision should be made
  • If you would like to explore further the ethical and legal aspects of a decision

THP Ethics Resources

Ethics Resources on the Internet

Advance Care Planning

Who will speak for you? Learn about making a plan.
http://www.advancecareplanning.ca/

Consent and Capacity

Consent & Capacity Board http://www.ccboard.on.ca/scripts/english/index.asp
Health Care Consent Act
http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_96h02_e.htm

Decision-Making Guides

Ottawa Health Research Institute https://decisionaid.ohri.ca/index.html

End of Life

Dalhousie End of Life Project http://eol.law.dal.ca/?page_id=221
National Initiative – Care for the Elderly http://www.nicenet.ca/

General Info

Canadian Bioethics Society https://www.bioethics.ca/  
Joint Centre for Bioethics http://www.jcb.utoronto.ca/  

Organ Transplantation

Trillium Gift of Life Network http://www.giftoflife.on.ca/en/
World Health Organization – Human Organ and Tissue Transplantation http://www.who.int/ethics/topics/human_transplant/en/

Mental Health

Centre for Addiction & Mental Health - Resources for Professionals http://www.camh.ca/en/hospital/Pages/home.aspx
Mental Health Act
http://www.ontario.ca/laws/statute/90m07
Psychiatric Patient Advocate Office (Info Guides) http://www.sse.gov.on.ca/mohltc/ppao/default.aspx

Pandemic Planning

Ethics Guidelines http://www.cdc.gov/od/science/integrity/phethics/ESdocuments.htm
Ontario Health Plan for an Influenza Pandemic http://www.health.gov.on.ca/en/pro/programs/emb/pan_flu/pan_flu_plan.aspx
World Health Organization http://www.who.int/en/

Privacy

Information and Privacy Commissioner of Ontario
https://www.ipc.on.ca/english/Home-Page/   
Personal Health Information Protection Act

http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_04p03_e.htm

Substitute Decision-Making

Office of the Public Guardian and Trustee http://www.attorneygeneral.jus.gov.on.ca/english/family/pgt/
Substitute Decisions Act http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_92s30_e.htm


IDEA: Ethical Decision Making Framework

Idea Framework - image representation of steps and conditions listed below 

 

The IDEA Framework is comprised of 4 steps and 5 conditions as described below:

Steps:

  1. Identify the facts (medical indications, patient preferences, evidence, contextual features)
    Ask: What is the ethical issue(s)?
  2. Determine the relevant ethical principles (nature and scope, relative weights)
    Ask: Have perspectives of relevant individuals been sought?
  3. Explore the options (harms and benefits/strengths and limitations, laws and policies, mission, vision, values)
    Ask: What is the most ethically justifiable option?
  4. Act (recommend, implement, evaluate)
    Ask: Are we (am I) comfortable with this decision?

Conditions:

  1. Empowerment – those with less power/ knowledge have a voice
  2. Publicity – process is made transparent
  3. Relevance – key stakeholders agree on relevant ethical principles/decision-making criteria
  4. Revisions and Appeals – process in place
  5. Compliance – all of above conditions met


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