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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.

There is an ethicist available seven days a week from 9:00 a.m. to 5:00 p.m.
Phone: (905) 848-7580, x3811
Email: ethics@thp.ca​​

What is the Regional Ethics Program at Trillium Health Partners?

The Regional Ethics Program based at Trillium Health Partners is comprised of a group of ethicists who provide ethics services to patients, families, physicians, 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; promoting the ethical conduct of research; and conducting ethics consultations. Requests for ethics consultation can be made by anyone including patients and family members.

Who are we?

The ethicists within the Regional Ethics Program come from a variety of backgrounds and have all completed graduate level education and/or post-graduate fellowships in health ethics. They work collaboratively across all 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 Regional Ethics program is supported by a part-time administrative assistant.

What is the 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.

What is an ethical issue?

Ethical issues generally fall into one of the following four categories:

  • Ethical Violation – when an action that appears to be unethical is being proposed or carried out
  • Ethical Dilemma – when there are competing courses of action both of which may be ethically defensible and there is a difference of opinion as to how to proceed
  • Ethical Uncertainty – when it is unclear what ethical principles are at play or whether or not the situation represents an ethical problem
  • Ethical Distress – when you are in a situation of discomfort because you are unable to carry out what you believe is the right course of action

If you are not sure how to determine what an ethical issue is, consider the following questions:

  • Am I trying to determine the right course of action?
  • Am I asking a “should” question?
  • Are values and beliefs involved?
  • Am I feeling uncomfortable?

If your answer is yes to one or more of these questions, you may be facing an ethical issue.

Here are a few examples of ethical issues that might arise 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. Should the patient receive dialysis?
  • 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 and informs the healthcare team that she does not want any “heroic treatment.” Should the patient’s opinions alter her care?
  • 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. Should the breathing machine be stopped?
  • A family member observes a staff member treating another patient in what appears to be a disrespectful manner. Should the family member report the staff?
  • A patient has been diagnosed with a terminal illness. The patient’s family does not want her informed of the diagnosis. Should the patient be informed of her diagnosis?

How might an Ethicist help me or my family?

At some point in time, you may be faced with making difficult treatment decisions for yourself or another person. 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 as the patient or the patient’s substitute decision-maker(s) to...

  • Identify the information needed to make a treatment decision
  • Understand the ethical and legal implications of making a treatment decision
  • Appreciate the ethical and legal principles for making decisions on behalf of another person
  • Explore the benefits and burdens of different treatment options
  • Link you with other persons and resources within and outside the organization

Before contacting an ethicist, you should first discuss treatment options with the healthcare team. After having discussed your treatment options with the healthcare team, you may wish to contact an 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

Ethics Resources:

IDEA: Ethical Decision-Making Framework

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. It is comprised of four steps and five conditions as illustrated and described below. (clicking image will open PDF document - IDEA: Ethical Decision-Making Framework)

clicking image will open PDF document - IDEA: Ethical Decision-Making Framework 

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

Brochures

The Regional Ethics Program Brochure provides more information about the Regional Ethics Program. The other brochures provide important details that you should know about a variety of ethics-related topics including advance care planning, cardio-pulmonary resuscitation, informed consent, medical assistance in dying and substitute decision-making.

Substitute Decision-making Videos

This series of short cartoon videos provides an overview of substitute decision-making. They include information about when a substitute decision-maker is needed, how to determine who a patient’s substitute decision maker(s) is, and the principles that guide the substitute decision-making process.


 

 

 

 


External Links

There are many ethics resources available on the internet. The following is a list of some that the Regional Ethics Program have found helpful.

Advance Care​​ Planning Speak-up Campaign
Powers of Attorney Booklet
Consent and Capacity Consent & Capacity Board
Health Care Consent Act and Substitute Decisions Act – 25 Misconceptions
Decision-Making Guides for Patients Ottawa Health Research Institute
End of Life Dalhousie End of Life Project
National Initiative – Care for the Elderly
General Info​ Canadian Bioethics Society
Joint Centre for Bioethics
Organ Transplantation Trillium Gift of Life Network
World Health Organization – Human Organ and Tissue Transplantation
Medical Assistance in Dying Information for Patients in Ontario
Dying with Dignity
Mental Health Centre for Addiction & Mental Health
Guide to Mental Health and the Law in Ontario
Psychiatric Patient Advocate Office (Info Guides)
Pandemic Planning Ethics Guidelines
Ontario Health Plan for an Influenza Pandemic
Privacy Information and Privacy Commissioner of Ontario
A Guide to the Personal Health Information Protection Act
Senior’s Health Advocacy Centre for the Elderly
Elder Abuse Network
Substitute Decision-Making Office of the Public Guardian and Trustee
A Guide to the Substitute Decisions Act

Contact Information

There is an ethicist available seven days a week from 9:00 a.m. to 5:00 p.m.
Phone: (905) 848-7580, x3811
Email: ethics@thp.ca​​