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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: Ethics allows us to take a step back from the ‘tyranny of the urgent’ and provides space for the big questions, such as - Why are we doing what we are doing? Is this the right approach to be taking? Are there other voices that need to be involved in this discussion? Identifying these values and understanding how they influence decision-making is an important part of providing ethically defensible person-centred care in healthcare. Ethical standards are also essential elements of professional codes of practice and are a vital component of the Accreditation Canada process.
Clinical Ethics, aka. 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.
Pembroke Regional 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:
- Conflicting goals of care, eg between patient and family, aggressive interventions vs comfort care, etc.
- Patients with unclear or fluctuating capacity, and perhaps no clear substitute decision maker.
- Moral distress in health care providers > feeling like one can’t do what is best for the patient because of circumstances outside your control.
- Clinical ethicists 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. Click here for the 'Q-Tip'
How do you know when you are facing an ethical dilemma?
Ethics frameworks can support organizing thoughts and offer structure to approaching concerns. For clinical ethics issues and dilemmas, the YODA principle-based ethics Framework is used– You, observe (problem, feelings & facts), deliberate ethical principles (alternatives, values) & options, and Act (implement plan).
When deliberating ethical principles, the core values that PRH follows should provide guidance to the decision:
1. The call to respect dignity
2. The call to foster trust
3. The call to promote justice
HELP! I think I’m facing a bioethical concern or dilemma - what should I do?
1. Speak to your manager2. Speak to one of the PRH clinical ethics leads3. Look at the YODA framework and ask for help to work through the process > manager, clinical ethics leads, clinical ethicist, etc as appropriate.
For more information, please access the 'Ethical Difficulties (YODA)', 'Supply Chain Code of Ethics Statement', 'Organizational Ethics Code', 'Ethics Review of Research Involving Human Participants' and 'Organizational Structure for Ethical Discernment' policies and documents in the Policy and Procedure manual.
The PRH Ethics Program is overseen by our Clinical ethicist, Dr. Hazel Markwell and our Clinical Ethics Leads; Garry Engler & Kirsten Johnson. Information regarding the program is also available for clients and their families on PRH’s public website.