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St. Joseph’s Health System (SJHS) is pleased to announce Sean Sergi as Vice President, Nunavut Partnership, a role dedicated to strengthening relationships and advancing health care collaboration in Nunavut.

“Our Nunavut Partnership is deeply linked to our mission and values at St. Joe’s,” said Liz Buller, President and CEO of SJHS. “Sean’s experience, expertise, and dedication to the mission will allow him to support the delivery of compassionate, high-quality care that meets the unique needs and strengths of Nunavut communities.”

Sean brings nearly 30 years of experience spanning both public and private sectors. Since 2019, Sean has served as a key leader at St. Joseph’s Healthcare Hamilton as Director of HR Services. His collaborative leadership style and expertise in project management, HR technologies, and process improvement have been instrumental in supporting St. Joe’s teams.

Sean’s connection to Nunavut began early in his career when he worked with the Nunavut Secretariat at the Department of Indigenous and Northern Affairs Canada. This formative experience deepened his appreciation for the people of Nunavut and their communities.

In his role as VP, Nunavut Partnership, Sean will continue to build meaningful collaborations that reflect the unique strengths and needs of Nunavut communities. In partnership with the Government of Nunavut, he will help advance strategic initiatives to ensure compassionate, high-quality care while fostering innovation in health care delivery. Support for governance, quality improvement, pharmacy services, point of care testing, mental health services are a few of the areas that this role will oversee. This work will be done in addition to Sean’s current position as Director, HR Services.

Advancing our Mission

The VP, Nunavut Partnership role reflects SJHS’ unwavering commitment to our mission: Living the Legacy. Compassionate Care. Faith. Discovery. Through meaningful partnerships, SJHS is enhancing health equity, serving the community and driving innovation in health care.

St. Joseph’s Health System is one of the largest corporations in Canada devoted to health care. We are a large network of hospitals, long-term care facilities, hospices, home care, research institutes and foundations located in four cities in the Ontario-West region, connected by the legacy of our founders, the Sisters of St. Joseph. Together, we are continuing their legacy by reimagining how we provide care, conduct research, and educate our healthcare professionals.

As a system of care, SJHS supports patients, residents and clients across the lifespan: from acute care, post-acute care, long-term care, home and community care to rehabilitation and hospice. St. Joseph’s Health System’s presence across the care continuum — combined with government, academic, research and innovation partnerships — creates unique, rewarding and distinctive experiences for staff, physicians, researchers and learners.

For more information, please contact:

Nicole Vaillancourt
Senior Communications and Engagement Officer
St. Joseph’s Health System
nvaillan@stjoes.ca

 

Following the announcement of Mark Fam’s appointment of President and CEO of Oak Valley Health, Gary Higgs, Vice President & Chief Information Officer at St. Mary’s, has accepted the role of Interim President of St. Mary’s General Hospital effective December 16, 2024.

Gary will work closely with Mark and the hospital’s leadership team on a seamless handover of responsibilities, ensuring St. Mary’s continues to provide exceptional care while advancing the integration and redevelopment work.

Gary is a compassionate senior executive committed to supporting St. Mary’s team members through the transition and ensuring continuity as a partner in the planned merger with Grand River Hospital and beyond.

Since joining St. Mary’s senior leadership team in 2008, Gary has held many roles, including Integrated Chief Information Officer of St. Mary’s and Grand River Hospitals, VP and Chief Information Officer of St. Mary’s, and VP, Digital and Chief Information Officer of St. Mary’s and Grand River. He supported the senior team through the pandemic and implemented Cerner — the new hospital information system — in partnership with Grand River. He also co-led early-stage planning and redevelopment for the Building the Future of Care Together Project.

Join us in welcoming Gary to the Interim President role.

St. Joseph’s Health System is making bold changes to create more connected care experiences across three campuses of care.

This fall, St. Joseph’s Health System (SJHS) announced new integrated leadership across its three campuses of care. This signals a new era of innovation at SJHS aimed at transforming health services beyond traditional boundaries, creating more connected care experiences, and ensuring a sustainable, thriving health system for future generations.

“We are making bold changes to advance health beyond boundaries and reimagine connected care to support individuals to live and thrive in our communities,” said Elizabeth Buller, President and CEO of St. Joseph’s Health System. “Not only does this advance our mission of compassionate care, faith, and discovery, it’s a necessary change for Ontario’s health system.”

St. Joseph’s Health System is one of Ontario’s largest not-for-profit long-term care providers with more than 1,000 beds across three campuses of care in Brantford, Guelph and Dundas. As a campus of care, each site is home to local and regional programs and services that support holistic care for patients, clients, residents, and families. Services include long-term care, complex care, rehabilitation, hospice and palliative care, community support and outreach services, respite and day programs, seniors housing, and behavioral support programs. There’s also more than 500 seniors’ housing units across SJHS, including low income, affordable, and market rate seniors’ housing — with room to expand.

As leader in seniors’ care, SJHS recognizes that the needs of aging populations are evolving. By 2028, the Canadian Medical Association projects that 21 per cent of all Canadians will be seniors, approximately 3.3 million people in Ontario. Designing solutions that allow individuals to age in place supported by an integrated system of care is key. The SJHS campus of care model supports this by designing connected communities, without the need for individuals to transition from one facility to another as their needs change. This vision not only supports SJHS’ mission, it’s also critical to addressing the broader societal challenges of aging populations.

“By having an integrated approach for the three organizations, we have a stronger chance to grow and generate new opportunities for everyone we serve – our residents, patients, care partners and our staff,” said John Woods, who was named Integrated President of St. Joseph’s Health Centre Guelph, St. Joseph’s Villa Dundas and St. Joseph’s Lifecare Centre Brantford on October 3.

Woods has worked in the SJHS community for more than 30 years. Most recently, he served as President of St. Joseph’s Health Centre Guelph, Interim President of St. Joseph’s Villa Dundas and Vice President of the SJHS Nunavut Partnership. He has also served as Interim President for St. Joseph’s Home Care and St. Mary’s General Hospital. John is a Governing Council member of the Catholic Health Alliance of Canada and past chair of the Catholic Health Association of Ontario. Through this rich experience, Woods has a broad perspective on Ontario’s health and long-term care sectors.

“I always wanted to understand the whole of healthcare — community, acute and long-term care — and these experiences provided me with a window into Ontario healthcare that will help drive change in this integrated role,” said Woods.

Woods is an advocate for integrated care designed at the point of care and measured from the perspective of clients. He’s passionate about removing barriers or boundaries, allowing healthcare professionals to build different models of care that are tailored to each individual.

“Programs designed at the point-of-care are more powerful. I’ve watched front-line teams go from “that’s impossible” to making it work – all by keeping their patient, resident, or client at the centre of the model.”

Building on this integrated leadership transformation at SJHS, Woods named an Integrated Chief Operating Officer, Mieke Ewen, who will work collaboratively to provide leadership support at St. Joseph’s Villa Dundas and St. Joseph’s Lifecare Centre Brantford. Mieke joins Sandra Ramelli, who is the Integrated VP of People and Strategy at St. Joseph’s Health Centre Guelph and St. Joseph’s Lifecare Centre Brantford as well as Natalie Hovey who is Integrated VP Finance, Information Services & CFO at St. Joseph’s Lifecare Centre Brantford and St. Joseph’s Health Centre Guelph, as part of an evolving campus of care leadership team.

Creating an integrated leadership approach across three campuses of care is one way that SJHS is boldly transforming care. There’s also integration happening at the leadership and front-line levels at St. Joseph’s Healthcare Hamilton and St. Joseph’s Home Care through their hospital to home program. There’s also growing connections between St. Joe’s Hamilton and St. Joe’s Villa, such as the Reactivation Care Centre. All these connections help leaders and staff to amplify innovative seniors care solutions and advance health across the continuum of care — from acute, to home care, to long-term care ­— and beyond boundaries.

“Integrated leadership maximizes our resources and expertise to improve models of care. For example, we have a critical mass that will enable us to strengthen quality, align our strategy and finances, ultimately improving care experiences for those we serve.”

For Woods, taking on this unique integrated role advances SJHS’ mission by continuing to grow all campuses as integrated care hubs where teams of healthcare professionals help people navigate the healthcare system.

“Our campuses of care are vibrant health and social hubs where people can access not only healthcare, but things like transport options, seniors’ gyms, social supports, respite care to allow caregivers a break, personal care support with showering or getting their nails done,” said Woods. “We are already deeply embedded in and passionate about serving our communities. Now our structure better reflects that.”

Recognizing Health Ethics Week from November 11 to 15, 2024

From the bedside to the boardroom, ethics shape every dimension of healthcare delivery. We are all involved in ethics, which is the study of what we value and how we put values into action. Ethics includes thinking critically about what’s right and what’s wrong; about how we live and act; about our ways of being in relationship with each other; and, about the ways our values influence our decision-making and behaviour. 

“Ethics at St. Joe’s includes a growing group of ethics champions, who are creatively envisioning and working together to build a coordinated approach to ethics across the system that meaningfully integrates ethical reflection at all levels,” said Dr. Lee de Bie, Clinical Ethicist and Lead of the St. Joseph’s Health System Ethics Program. “During Ethics Week, we invite you to get informed, involved, and to share with us the ethical questions and issues you’d like to see discussed in the year ahead.”   

The Ethics Program at St. Joseph’s Health System (SJHS) is an integrated community of practice, serving all member organizations. As a member of the Catholic Health Alliance of Canada (CHAC), SJHS follows the CHAC Health Ethics Guide. The guide provides clear direction to support health and social services professionals in responding to key questions within a consistent ethical framework.

The Ethics Program at SJHS provides approximately 200 ethics consults every year, supporting all healthcare workers with ethics questions such as: 

• What should we do? Deciding what actions or ways of being are morally good, right, just, equitable, fair, or acceptable. 
• Why should we do it? Using ethical principles and values to explain and justify which plans or approaches are most ethical in a given situation. 
• How should we do it? Describing how we should go about enacting a decision in the best way possible. 

At SJHS, our ethics work is rooted in a rich history. The Sisters of St. Joseph first established an ethics service at St. Joseph’s Hospital in Toronto in 1982, which has evolved into the Centre for Clinical Ethics (CCE). St. Joseph’s Healthcare Hamilton created an Ethics Consultant role in 1986, over time expanding to become the St. Joseph’s Health System-wide Ethics Program. Today, SJHS continues as a member of the CCE, collaboratively delivering monthly Ethics Grand Rounds and sharing responsibilities for a 24/7 afterhours and urgent on-call ethics paging service available to all SJHS member organizations. 

“As we recognize Health Ethics Week, we are reminded that the heart of healthcare is not just in the science of healing but in the ethics that guide our every decision,” said Liz Buller, President and CEO of St. Joseph’s Health System. “Our commitment to our values —dignity, enquiry, justice, respect, responsibility and service — is what ensures that we truly serve the well-being of our communities. The value of working with an ethicist cannot be overstated, and I encourage all of our healthcare workers to reach out to the Ethics Program whenever faced with challenging situations where there’s uncertainty about what to do.”  

As St. Joe’s recognizes Health Ethics Week from November 11 to 15, all SJHS staff, leaders, physicians, learners and volunteers are encouraged to: 

 1.     Think deeply about what ethics looks like in your professional practice 

• Keep reading to learn more about how your St. Joe’s colleagues practice ethics everyday. 
• Complete our Health Ethics Week crossword or word search, discuss themes with your team, check out our on-site tables, and submit your ethics questions.  

2.    Seek out information to help you feel more confident, comfortable and supported in making ethical decisions 

•  Check out our new Ethics webpage to learn more about the Ethics Program and how, when, and why to contact an ethicist for support.  
• Attend CCE’s Discussion Series on The Ethics of Withholding CPR and No-CPR Orders on November 13, 20, and 27. Topics include: the legal status of No-CPR orders in Ontario, cultural and religious perspectives, and withholding CPR in the community and post-acute settings. 

3.   Get involved in ethics at St. Joseph’s Health System

• Apply to join our St. Joe’s Health System Ethics Committee or Ethics Education Subcommittee. 
• Sign up for a focus group to inform the review and revision of our Ethics Framework. 
• Complete a 15-minute survey to give feedback on how the Ethics Program can improve the curation of ethics brochures/materials for patients/families. 

The SJHS Ethics Program is here to support you. Any staff, physician, learner, leader, volunteer, or patient/family member affiliated with St. Joe’s can contact the program directly for confidential support. Please email ethics@stjoes.ca or call 437-248-3684 (Lee). For after hours and urgent support, you can reach the 24/7 on-call ethicist by calling 416-864-5070, inputting pager ID: 4211, and leaving your full 10-digit telephone number and extension.

Learn more about how your St. Joe’s colleagues practice ethics everyday:

1. Respiratory Rehabilitation Day Program Team (Juravinski Tower, 8th Floor), St. Joseph’s Healthcare Hamilton
2. Peggy Chapman, Family Advisor and Ethics Committee Member, St. Joseph’s Healthcare Hamilton
3. Carla Girolametto, Integrated Director of Innovation and Research, St. Mary’s General Hospital and Grand River Hospital
4. Ibrahim Ahmed, Director of Finance, St. Mary’s General Hospital
5. Madelaine Smith, Executive Assistant to the President and Communications Coordinator, with insights from managers and staff, St. Joseph’s Home Care
6. Nancy Gibbs-Keithlin, Social Worker and Clinical Ethics Lead, St. Joseph’s Health Centre Guelph
7. Dr. Hugh Boyd, Medical Director and Ethics Committee Member, St. Joseph’s Villa

Respiratory Rehabilitation Day Program Team (Juravinski Tower, 8th Floor), St. Joseph’s Healthcare Hamilton 

What do everyday ethics mean to you?  

In the Respiratory Rehab Day Program, everyday ethics are reflected in our team’s commitment to addressing access issues – such as social inequities, limited health literacy, and food and housing disparities – that impact patients’ abilities to attend and participate in the program. From our intake assessment through to discharge, our team works together to identify barriers that might be reduced.   

Everyday ethics can look like: 

• Delaying or timing patient enrollment to align with a patient’s schedule and readiness to attend.  
• Meeting a patient at the front door of the hospital to assist them in managing anxiety and making a referral for further mental health support.  
• Phoning a patient to help work through funding options for transportation or a mobility device needed to get to the program.  
• Designing a lower intensity or alternative program for our frail patients who may not be able to attend our full program stream. 

Through these seemingly small, everyday actions, we ensure that patients have equitable access to care from a team specialized in the management of chronic lung disease. This is one important way that we seek to live St. Joe’s mission to provide compassionate care to people who are under-served.  

How do St. Joe’s mission and values inform the way you approach ethics?  

Ethics is the study of what we value and how we put values into action. Our organizational values of dignity and respect are of paramount importance when caring for people managing chronic diseases. As one example, we recently worked with a woman diagnosed with two lung diseases. Her new diagnosis and disease experience had significantly changed her ability to participate in her roles as a parent and volunteer, and her ability to engage in meaningful social interactions. Initially she met the disease with curiosity, but also perhaps some denial of how it was affecting her.   

As a team, we provided her with information and tools to support her self-understanding and autonomy. These resources empowered her to make changes that facilitated her ability get out of her home and into the community. The team met with her frequently to set realistic goals and encourage and motivate engagement in the care practices necessary for preventing her disease from progressing and causing other medical complications.  

The patient was on a difficult journey to maintain her independence, adapt to new ways of doing things, accept support from others, and relinquish some tasks that were no longer possible. The team took time to listen to her concerns and priorities, understand what was most important to her, and provide support as she made her own decisions. Our job was to guide and listen without judgment. The patient was able to move forward in acceptance while maintaining the dignity and respect she deserved.  

What advice would you give a colleague to encourage their recognition and reflection on the ethical dimensions of their everyday work?  

We encourage our colleagues to recognize personal biases and frustrations when dealing with difficult situations, such as a feeling of “not getting through” to a patient. Patients may make choices that look different than what we might choose in a similar situation. Recognizing and addressing our own biases and judgments and acknowledging how these impact our decision-making, can lead to more collaborative and positive outcomes for patients and their families. We are lucky that our team is very collaborative, often creating space for this kind of self- and ethical reflection. We support each other in working to truly understand our patients and the specific situations they are experiencing. We hope fellow staff will similarly search for and foster team relationships with colleagues who can help you do the same.  

Peggy Chapman, Family Advisor and Ethics Committee Member, St. Joseph’s Healthcare Hamilton 

What do everyday ethics mean to you in your role?  

As a Family Advisor for St. Joe’s, and mostly experienced in the Mental Health & Addictions Program, it is valuable for me to see the complex ethical decisions staff face when caring for those who are not capable of making their own decisions due to mental illness. Hearing conversations about ethical decision-making reassures me that my loved one’s care is not only focused through a medical lens but also an ethical lens.  

Being part of the Ethics Committee has shown me the day-to-day ethical questions staff face and the difficult decisions they must make which might conflict with their own beliefs. Having an Ethics Program at St. Joe’s demonstrates that we are working to be open, transparent, and accountable to the values of patient and family-centred healthcare.  

How do St. Joe’s mission and values inform the way you approach ethics?  

For the eight years I have been a Family Advisor, and a caregiver of my loved with a severe mental illness, I can say that St. Joe’s is an organization focused on living its values and ethical principles. There are many difficult conversations within mental health care, including ethical tensions between a capable patient’s right to privacy and a family member’s desire to be informed, and between respect of patient autonomy and freedom and legal grounds for involuntary hospitalization to keep a person safe. Our organizational values of dignity, respect, and justice are very important for navigating these tensions. 

I appreciate having resources at St. Joe’s to reach out to for clarification and understanding of the legal and ethical rules regarding care for my loved one. My loved one is admitted to a difficult unit for staff as patients are often very unwell, and incapable of making decisions for themselves about their healthcare. Staff regularly reassess patient capacity to ensure they are respecting patient consent and privacy, and only involving substitute decision makers and family when authorized to do so. The Ethics Program plays an important supportive role for staff, families, and patients.   

What advice would you give a colleague to encourage their recognition and reflection on the ethical dimensions of their everyday work?  

As a Family Advisor working with staff, I would encourage staff to support each other, be open, and focus on the key priority – the care of the patient and their wishes and best interests. This seems like a simple ask, but identifying wishes and best interests is not always easy in some care situations. The hospital Ethics Program is a great tool to lean on when facing complexity or uncertainty when making care decisions.  

Carla Girolametto, Integrated Director of Innovation and Research, St. Mary’s General Hospital and Grand River Hospital  

What do everyday ethics mean to you in your role?

Ethics must be embedded in any research we are conducting, whether with living or deceased humans, their tissues, specimens, or data. In research ethics with humans, everyday ethics means adhering to the principles outlined in the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans (TCPS2), which is the national policy in Canada guiding research involving humans.  

History has taught us that when there is a lack of ethical attention and oversight in research, very bad things can happen to people. (For some examples, check out these articles on human experimentation published in The Conversation.)   

How do St. Joe’s mission and values inform the way you approach ethics?  

St. Joe’s values of dignity, justice, responsibility, service, and inquiry align closely with the core ethical principles of TCPS2: respect for persons, concern for welfare, and justice: 

• St. Joe’s value of dignity directly relates to the TCPS2 principle of respect for persons, which emphasizes the importance of respecting the autonomy of research participants and obtaining their informed consent. This must go beyond ticking a box or signing a form, by recognizing consent as an ongoing process and ensuring participants are fully informed in language they understand. 
• Both St. Joe’s and the TCPS2 prioritize a principle of justice. The TCPS2 elaborates this principle as fairness in the distribution of the benefits and burdens of research, addressing power dynamics, and ensuring that populations are not exploited or made vulnerable by the positions they are put in.  
• St. Joe’s values of responsibility and service are reflected in the TCPS2 concern for welfare, where we strive to maximize benefits while minimizing risks to participants. This includes careful attention to privacy, confidentiality, and overall well-being.  
• Finally, St. Joe’s value of inquiry speaks to the ongoing need for ethical reflection and improvement, much like TCPS2’s commitment to promoting ethical integrity and adaptability in research, particularly through an emphasis on inclusivity, diversity, and Indigenous reconciliation. 

Our mission to live the legacy of the Sisters of St. Joseph is reflected in many of the research studies conducted at St. Mary’s and Grand River. For example, during COVID-19, we participated in a Health Canada-approved randomized trial on the effects of blood from people who have recovered from COVID-19 as a treatment for patients hospitalized with the illness. We were at the frontline of innovative care for those most vulnerable from the effects of COVID-19, and research ethics review of the study was critical to ensuring we proceeded in a good way.  

What advice would you give a colleague to encourage their recognition and reflection on the ethical dimensions of their everyday work?  

Researchers must remember that at the end of the data, tissue, or case report, there is a human being. A teaspoon of blood is not just a specimen, it carries valuable information about a unique person’s DNA. We don’t need the person in front of us to recognize their humanity. We must be respectful of how we handle their information and story. 

I would advise colleagues to see ethics not as a set of rules, but as a continuous process of reflection. Consider familiarizing yourselves with the TCPS2 ethical principles and actively applying these in day-to-day research activities. I hope researchers will come to see Research Ethics Board review not as an “extra step,” burden, or something to be afraid of, but as opportunity to reflect on whether the design of their project is ethically sound and consistent with core ethical principles.  

Researchers, and the information and knowledge we discover, can have a great influence on society (e.g., consider Einstein’s indirect influence on the atomic bomb). We must take our social responsibilities seriously.  

Ibrahim Ahmed, Director of Finance, St. Mary’s General Hospital  

What do everyday ethics mean to you in your role?  

Ethics in Finance and Health Records is key to ensuring public trust, accountability, and quality care. Our role is to support the ethical administration of the behind-the-scenes aspects of healthcare. When people enter our hospital, we want them to be confident and reassured of our high ethical standards – not only that the clinical care will be excellent, but that the hospital is appropriately protecting their personal health information, stewarding resources, and distributing limited resources in a fair way.  

How do St. Joe’s mission and values inform the way you approach ethics?  

The value of responsibility is critical to the following ethical dimensions of our work: 

• Confidentiality and Privacy: Finance and Health Records hold sensitive patient and staff information. As information custodians, we are responsible for following strict requirements for handling personal information, such as those outlined in the Personal Health Information Protection Act (PHIPA) and Personal Information Protection and Electronic Documents Act (PIPEDA). St. Mary’s has security measures to protect data from unauthorized access, ensuring patients and staff rights to confidentiality. 
• Financial Transparency: The financial planning and analysis team assumes responsibility for providing transparent information on budgeting processes and principles, to make it clear for all users to follow. 
• Conflict of Interest: Healthcare professionals must avoid conflicts of interest, particularly when financial relationships with pharmaceutical companies or medical device manufacturers could influence patient care. At St. Mary’s we follow our conflict-of-interest policy and procurement policy to ensure that decisions prioritize patient well-being over financial gain. 

 The value of respect informs our support for patient decision-making: 

• Patient Empowerment: Engaging patients in discussions about their health records fosters a sense of ownership and responsibility and supports their health literacy. At St. Mary’s and Grand River, we use “My Connected Care,” a free, secure online tool through which patients can easily view their test results and health record, to help make healthcare decisions.  

 The legacy of the Sisters of St. Joseph to support equity-deserving communities, and our values of justice and service, inform the following areas of work with ethical significance:  

• Resource allocation: Ethical dilemmas often arise in the distribution of limited resources, especially in public healthcare systems. Decision-makers must consider equity and fairness, ensuring that all patients have access to necessary care.  
• Uninsured patients: Patients sometimes present to the emergency department with no health coverage or insurance. St. Mary’s ensures all patients seeking emergent care receive the treatment they need, regardless of their financial status. The Finance department will compassionately follow-up with patients around the billing of any uninsured services.  

 What advice would you give a colleague to encourage their recognition and reflection on the ethical dimensions of their everyday work?  

In healthcare, some rules are black and white. Ethics can help us navigate the grey. For example, when experiencing ethical uncertainty, I encourage staff to seek input and direction from relevant experts (e.g., colleagues at other hospitals) and documents (e.g., funding letters, Codes of Ethics for Chartered Professional Accountants and certified Canadian Health Information Management), and to develop a logical story for how they have arrived at particular decisions. This way, they can clearly point to the careful, deliberative process they have undergone, and the justification and evidence for particular decisions, rather than rushing ahead with insufficient ethical reflection. I ask them to think about how they will answer the questions of an auditor or the Ministry of Health: Will they be able to explain their decisions? By talking about ethics in an intentional and explicit way, we can develop the abilities to understand and apply ethical principles, values, and approaches to the specific context of our everyday work. 

Madelaine Smith, Executive Assistant to the President and Communications Coordinator, with insights from managers and staff, St. Joseph’s Home Care 

 What do everyday ethics mean in your context?  

I reached out to St. Joseph’s Home Care (SJHC) management and staff to learn from their experiences of everyday ethics. One pressing ethical question that came forward is how should we be responding to the increasing impacts of mental health, addictions, and homelessness in and around the apartment buildings that contain our supportive housing units. Unlike fully clinical health facilities such as the hospital, our staff work in clients’ homes and support individual units and floors within mixed public housing buildings. Staff are not providing care within a controlled, therapeutic environment, which can complicate care delivery and strain resources.  

Staff described dilemmas when family members or friends visit clients in these contexts, and behave disrespectfully, aggressively, or in other inappropriate ways, with staff or other clients. We want our clients to be engaged in the community and meaningful social relationships. But we also have to fulfill our duty of care, keeping the hallways and shared spaces of our supportive housing floors safe. We care deeply about our staff and want them to feel well-supported and safe in the workplace, with risks of harm minimized as much as possible.  

We have sought to address arising ethical issues in this context through a year-long collaboration with the Canadian Mental Health Association to provide training to our staff on mental health topics like self-care and burnout. We have also participated in a pilot initiative to engage staff in training on de-escalation. We are working to address stigma and misconceptions, while also setting compassionate boundaries.   

How do St. Joe’s mission and values inform the way you approach ethics?  

St. Joe’s core values of dignity, justice, respect, responsibility, service, and enquiry, profoundly shape home care practices. In particular, staff shared about the importance of empathy, which is the action of understanding, and being aware of and sensitive to, the feelings, thoughts, and experiences of others.  By empathizing with clients and family caregivers we can foster a supportive environment where care respects the uniqueness of each individual, appreciates their cultural context and worldview, and is tailored to their needs.  

What advice would you give a colleague to encourage their recognition and reflection on the ethical dimensions of their everyday work?  

Managers and staff engage in multiple strategies for recognizing and reflecting on the ethical dimensions of everyday work: 

1. Foster Open Communication: By listening to the perspectives of clients, patients, and residents, we can understand their values and story, what matters most to them, and what respectful, dignified, and culturally sensitive care means from their point of view. Open dialogue and discussion are crucial.
2. Engage in Reflection: Questions such as, “Do I feel good about the work I am doing?” can prompt valuable self-assessment. Staff are often drawn to this field because of an internal motivation to care for people. When we are able to provide care fully and well in alignment with personal and professional ethical standards and St. Joe’s values, our work is more likely to feel meaningful and satisfying. When we face constraints or barriers that get in the way of providing good care, we may feel uncomfortable, frustrated, or like we are doing something wrong. By reflecting on our feelings about the work we are doing, staff can tune into experiences of “moral distress” when we feel unable to act in the way we think is good, right, or equitable. By identifying and naming these feelings, we can work together to identify strategies for addressing concerns. 
3. Seek Continuous Learning: Participating in opportunities for learning about ethics—whether through reading, workshops, or discussions—can enhance our understanding and application of ethical principles in our daily roles. We encourage staff to attend the monthly Ethics Grand Rounds sessions available through the St. Joe’s Ethics Program (live on Zoom or recorded and posted online). Our Ethicists are happy to prepare ethics education specific to your team’s needs and schedules.
4. Use the YODA Ethical Decision-Making Framework: The YODA (You, Observe, Deliberate, Act) framework provides a structured approach to ethical decision-making. By following the tool’s steps and reflective prompts, staff can evaluate situations through the lens of SJHC’s mission, vision, and values, increasing comfort and confidence in your choices.

Staff are practicing everyday ethics in home care every time we slow down to better understand a patient’s perspective, pause to reflect on how care is going and feeling, learn something new about ethics, and use an ethics tool to guide good process and decisions. In doing so, we live the St. Joe’s legacy to provide compassionate care.

Nancy Gibbs-Keithlin, Social Worker and Clinical Ethics Lead, St. Joseph’s Health Centre Guelph

What advice would you give a colleague to encourage their recognition and reflection on the ethical dimensions of their everyday work?

Having the opportunity over the last 10+ years to be an active member of our ethics committee and involved in ethics education, capacity building, and case consultations, here are some of my observations and tips that guide my ethics conversations:

Pause to tune into uneasiness: Often in the busyness of our days, we don’t give ourselves time or permission to pause and reflect. It can be very easy to continue in our tasks and push aside thoughts and feelings that may benefit from further ethical consideration. When something doesn’t feel quite right, I encourage my colleagues to give yourself a moment to ask yourself:

• “What about this situation is giving me hesitation or a feeling of uneasiness?”
• “What are the ethical considerations that I/we need to be thinking about?”

Taking a moment to reflect can help to more clearly identify what is at the root of our feelings and guide us in next steps. Talking things through with a trusted teammate may also be helpful. Often teammates share a feeling that something isn’t quite right and are relieved when someone else brings it up for discussion.

Create safe spaces for discussion of divergent ideas: When we work with the same people, we may inadvertently develop “group think,” where we start to see situations through a similar lens. In an effort not to disrupt team cohesion, we may prioritize consensus over sharing potentially differing perspectives.

I encourage teams to engage in meaningful, respectful conversations and create safe spaces to share varying thoughts and feelings on ethical situations and dilemmas. When we are aware of patterns that discourage expression of diverse ideas and experiences, and put energy towards disrupting these, we can grow as individuals, become stronger teams, and provide better quality care.

Don’t be afraid to speak up and voice questions and concerns with your colleagues! If you would like support exploring how to bring things up to your teammates, you are not alone. Please don’t hesitate to come by and talk through these things with me. I am available as an ethics resource to all staff and regularly support these types of informal discussions.

Replace judgment with curiosity: Human beings can be prone to judging other people and situations. I encourage us to instead by mindfully aware when we may be quick to judgment, and work towards replacing judgment with curiosity. When we approach things from a place of curiosity, we open space to reflect and think about things from a variety of angles. For example:

• Judgement: “I can’t believe she would say that!”
• Curiosity: “Hmm…I wonder why that would be her response to this situation?”

The curiosity lens fosters reflection and dialogue that can help inform and guide us in our approach to a situation.

Connect with members of our Ethics Committee: We are here to support individuals and teams as you process the ethical dimensions of your everyday work. We can validate your experiences, share resources, facilitate ethics education, and help you connect with one of our Ethicists for consultation or other support.

Dr. Hugh Boyd, Medical Director and Ethics Committee Member, St. Joseph’s Villa

What do everyday ethics mean to you in your role?

I’d like to share a story about everyday ethics in end-of-life care.

A resident moved into St. Joseph’s Villa when he was middle-aged. After receiving his Huntington’s diagnosis, he had told his wife that when he became worse, he would be ready to pass away like his brother, who voluntarily stopped eating and drinking and died peacefully in his sleep from the same disease.

A few years later, the resident became ill and temporarily incapable of making his own medical decisions. While receiving treatment in the hospital, his wife felt pressured to agree for him to have a feeding tube surgically inserted.  She was later criticized by his neurologist for doing this. She never returned to see the doctor and dealt with her own guilt silently for years. 

The resident’s illness progressed and seven years after moving into the Villa, he could not communicate audible words. He did not seem to find enjoyment in any activities, and we observed feelings of frustration and emotional suffering through the resident’s vocal outbursts.  Visits became distressing for his wife and children, sometimes unable to console him.  One Sunday afternoon, in the midst of his screams and in a moment of remarkable lucidity, the resident yelled out “I want to die”. His wife, stunned. The nurse, also present, shocked. He repeated it a second time “I want to die”. He had not had any clarity of speech for many months.

As a result of this remarkable moment, and reflecting on his wish for himself when journeying with his brother, his wife requested that his feeding tube be stopped.  The staff were supportive of her decision, however, felt that there was an ethical issue: Was the purposeful removal of a feeding tube, which would cause someone’s death, a form of medical assistance in dying? Can a substitute decision-maker consent to this withdrawal of nutrition?

How do St. Joe’s mission and values inform the way you approach ethics?  

We called for ethics consultation, and used our YODA (You, Observe, Deliberate, Act) ethical decision-making framework to work through the ethical issues raised by Mark’s request.

We looked at the resident’s wishes that had been shared while journeying with his brother, and confirmed that Sunday afternoon.  We thought about a comparative situation of force feeding: If the resident was eating orally and he chose to keep his mouth closed or turn his head, we would not pry his mouth open to feed him.  He was now being fed artificially and had no say in whether he eats or not. That is, until he was able to express his wish to die. Would we now be feeding him against his will, if we did not listen to his wish?

The resident had talked about his wish around quality of life when his brother was ill, and said that he would want to die when his illness progressed.  We were able to confirm this wish during a family meeting and through review of his power of attorney paperwork.

Legal precedent and standards of medical practice allow for the withdrawal of life-sustaining treatment (like feeding tubes and ventilators) when this is consented to by a capable patient or, in this resident’s case, his wife, acting as legally authorized substitute decision-maker in alignment with the legal principles of substitute decision-making articulated in section 21 of the Health Care Consent Act. The first principle of this standard states that “if the person knows of a wish applicable to the circumstances that the incapable person expressed while capable and after attaining 16 years of age, the person shall give or refuse consent in accordance with the wish”. In this case, we had a very clear wish expressed while capable and applicable to the present circumstance.

Withdrawal of life-sustaining care like medically assisted nutrition is morally different from medical assistance in dying (MAiD): Withdrawal is about stopping, with consent, a medical intervention that is experienced by a patient as overly burdensome and non-beneficial, whereas MAiD involves providing an intervention that intentionally hastens death.

After the palliative care consultation, dietary consult, conversations with the most responsible physician, family and care team, it was decided that in keeping with the resident’s wishes for his own goals of care, the feeding tube would be removed. The resident’s feeds were slowly weaned and stopped and medications were provided to achieve comfort to allow a peaceful passing, as he wished for, in his sleep, with his wife at his side.

In follow-up with staff, while sad about his passing, they felt that we had honoured his wishes and supported family in allowing a natural death. Discerning and honouring a resident’s prior expressed capable wishes, and offering compassionate comfort-focused care at end-of-life, is one way we practice St. Joe’s values of dignity, respect, enquiry, justice, responsibility, and service.

Message from Elizabeth Buller, President and CEO of St. Joseph’s Health System and Tim Rollins, Chair of St. Mary’s General Hospital Board of Trustees.

It is with gratitude and mixed emotions that the Board of Trustees of St. Mary’s General Hospital, along with Elizabeth Buller, President and CEO of St. Joseph’s Health System, announce the departure of Mark Fam from his role as President of St. Mary’s General Hospital, effective January 17, 2025. Mark has accepted the role of President and CEO of Oak Valley Health in Markham, Ontario, a tremendous opportunity that reflects his strong leadership and contributions to healthcare.

While we will miss Mark’s presence and leadership, his departure does not take away from the important momentum we have toward our integration with Grand River Hospital. We also want to celebrate Mark’s accomplishments at St. Mary’s and the lasting impact he has made on the Hospital and the broader communities it serves. During his tenure, Mark’s focus on high quality patient-centered care, innovation, strategic leadership, and community partnerships that have positioned St. Mary’s as a leading healthcare institution, ready to meet the evolving needs of the community.

As member of the St. Joseph’s Health System (SJHS), SJHS will appoint an interim President to guide St. Mary’s from late January 2025 until the planned integration with Grand River Hospital in April 2025. Mark will work closely with the Hospital’s leadership team to ensure a seamless handover of responsibilities, leaving St. Mary’s well-prepared to continue delivering exceptional care and advancing our integration and redevelopment work.

While Mark’s departure marks the end of a significant chapter for St. Mary’s, it also represents an exciting new beginning for him and Oak Valley Health. We are deeply grateful for Mark’s contributions, which have set a strong foundation for acute care in Waterloo-Wellington, and beyond. His strategic vision, collaborative spirit, and dedication to improving healthcare will undoubtedly serve him well in his new role.

Please join us in congratulating Mark on this next chapter in his career.

Sincerely,

Elizabeth Buller
President and CEO
St. Joseph’s Health System

Tim Rollins
Board Chair
St. Mary’s General Hospital

Mieke Ewen is taking on a new role as Integrated Chief Operating Officer at St. Joseph’s Lifecare Centre Brantford (SJLCB) and St. Joseph’s Villa Dundas (SJVD), effective October 15, 2024. Mieke will continue to serve in her current leadership role as Vice President of Elder Care at St. Joseph’s Health System.

In this integrated role, Mieke will work collaboratively to provide leadership support across Brantford and Dundas’ two campuses of care, which include two long-term care homes, two hospices, a variety of community programs, and senior’s housing. Mieke will work with leaders across both campuses of care to identify opportunities for further collaboration to improve integrated care for those we serve.

“As we continue to build and grow our integrated leadership team, we remain committed to supporting our teams in providing high-quality, compassionate care to our communities,” said John Woods, Integrated President, St. Joseph’s Health Centre Guelph, St. Joseph’s Villa Dundas and St. Joseph’s Lifecare Centre Brantford.

Mieke has worked at SJVD for over a decade and is well-respected for her servant-leadership style. She also served as Director of Care at SJLCB from 2016 to 2017 during which time she was responsible for the day-to-day management of resident care, nursing, and therapy services. Dedicated to living the mission, Mieke’s calm, nurturing manner is deeply felt by those working with her, particularly in complex and challenging situations.

Mieke has more than 20 years healthcare experience, starting as a personal support worker, then registered nurse, and now as a healthcare executive. She holds a Registered Nurse diploma from Mohawk College, a Bachelor of Science in Nursing from St. Frances Xavier University and a Master’s in Business Administration from the University of Fredericton. Mieke also has extended education in palliative care, a graduate of the long-term care Administrators program (AdvantAge Ontario), and Infection Prevention and Control education through Queen’s University.