Ethics

What are Healthcare Ethics?

Ethics 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.

Common ethics questions are:

• 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.

From the bedside to the boardroom, ethics shapes every dimension of healthcare delivery. And from the porter to the president, we are all involved in ethics work. 

This is why we have an Ethics Program.

About the Ethics Program at St. Joseph’s Health System

The Ethics Program’s purpose is to: 

• Promote decision-making that reflects our core values of dignity, justice, respect, responsibility, service, and enquiry, and our collective commitment to equity, diversity, inclusion, and Indigenous reconciliation 
• Provide leadership in fostering an ethical climate and culture across every level of our institutions

Our Ethics Program 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. This later became the Centre for Clinical Ethics at Unity Health Toronto, which now supports St. Joseph’s Health System across Brantford-Dundas-Guelph-Hamilton-Kitchener.
• We average more than 200 consults annually, participate on 20 to 25 internal and external committees, and provide regular education sessions across our partner sites. 

When to contact the Ethics Program

Why do ethical tensions or uncertainties arise?

Ethical questions are an expected part of everyday life. They can arise from:  

• Societal inequities and power imbalances 
• Coexistence of diverse faiths, traditions, and worldviews in a pluralistic society 
• The complexity and constraints of our healthcare system
• Lack of knowledge about current ethical standards and duties of relevant parties
• Different values and beliefs held by patients, essential care partners, and healthcare professionals
• Misunderstandings or unclear communication
• Breakdowns in trust 

When can a Healthcare Ethicist help? 

Our team can help when no single “right” answer to an issue seems evident and easy to implement. For example, when:

• You feel caught between different values, goals, or beliefs that seem to be in conflict
• You want support to make a difficult decision 
• You feel stuck or confused about the right thing to do – or how to act well – in a particular situation
• There is disagreement about what is best and how to proceed 
• You are concerned about the risks, harms, or implications of a decision
• Barriers are getting in the way of providing mission-based care
• You feel distressed that we are not doing the right thing or the best we can
• You want to develop your ethical thinking skills  

How can a Healthcare Ethicist help?

Our team seeks to guide good processes for ethical reflection and decision-making. We can help:

• People think through the values that are most important to them
• Keep patients’ goals, values, and wishes at the centre of our care 
• Ensure patients have the information and support they need to make informed decisions 
• Ensure appropriate parties are included in decision-making processes
• Identify and explain laws, policies, guidelines, and ethics concepts applicable to a situation 
• Uncover shared interests and concerns among disagreeing parties 
• Facilitate respectful conversations to work through conflicts 
• Explore different options and develop consensus on the most appropriate course of action 
• Ensure that all risks, harms, benefits, implications, and alternatives are considered
• Set fair and transparent boundaries in care relationships
• Work through feelings of moral distress or injury in relation to a situation
• Enhance individual and team capacity for ethical reflection

Our service is advisory in nature. We do not make final decisions. Instead, we help guide discussion, offer advice, and act as a resource in the decision-making process of patients, substitute decision makers, clinical teams, and leaders.

Pillars of the Ethics Program

The Ethics Program includes four areas of ethics activity: 

• Clinical ethics consultation
• Organizational ethics support
• Ethics education
• Ethics scholarship 

Clinical Ethics Consultations: 
Enhancing care relationships and quality through the recognition and resolution of ethical issues 

• We provide consultation options, ranging from brief individual phone conversations to larger team meetings (in-person or virtual). 
• As embedded members of the interprofessional team, we participate in team huddles, unit-based rounds, and patient and family meetings. We offer case reviews and operational debriefing for challenging situations.
• We often address issues like: 
  • Concerns about capacity and consent (to start, continue, stop, or refuse treatment) 
  • Uncertainty or differing opinions about care plans and care transitions
  • Questions about who should make healthcare decisions 
  • Patient dignity, autonomy, privacy, and safety 
  • Boundary setting 
  • Protecting the interests of those experiencing social marginalization 
  • End-of-life decision-making 
• We encourage consultation before issues become urgent or result in breakdowns in communication, relationships, or trust.

Organizational Ethics: 
Supporting our integrity through the alignment of organizational processes with our values 

• We consult on corporate, business, and workplace ethics, the allocation of scarce resources, and the implementation of new technologies. In doing so, we aim to facilitate preventative ethics (i.e., identify trends and implement proactive measures) and foster an ethical climate of trust, transparency, fairness, and equity.
• We provide ethics needs assessments to identify ethical concerns within a team, unit, or organization and options for addressing them.
• We also participate in committee meetings, policy development and review, and the preparation of ethical analyses and recommendations on emerging ethical concerns.

Ethics Education: 
Building capacity for ethical reflection at all levels of the health system

• Contact Ethics to arrange a recurring or ad hoc in-service, seminar, lunch and learn, or facilitated group discussion on topics of interest. We are available to present at rounds and Board/staff orientations, as part of leadership development programs, and to record modules for online learning platforms. 
• We provide virtual Ethics Grand Rounds on a monthly basis through Unity Health’s Centre for Clinical Ethics (recordings accessible online).
• We supervise Ethics Fellows, academic placement students, trainees, and volunteers.

Ethics Scholarship: 
Contributing to innovation, discovery, and impact in bioethics and academic health sciences 

• We consult and collaborate on research with ethical dimensions and lead scholarly and quality improvement projects in ethics. 
• Our staff are affiliated with the Research Institute of St. Joe’s Hamilton and the McMaster Education Research, Innovation and Theory (MERIT) Program, Faculty of Health Sciences. 
• We participate in the Ontario Practicing Healthcare Ethicists Community of Practice, the Canadian Association of Practicing Healthcare Ethicists, and the Canadian Bioethics Society.

 

Ethics Team

Contact Us

You don’t need to navigate ethical concerns alone! 

Anyone receiving care, working, volunteering, learning, leading, or otherwise affiliated within the St. Joseph’s Health System may contact the Ethics Program directly for free support.

Our service is confidential, except in rare circumstances where the law requires disclosure – or disclosure is necessary to prevent imminent and serious harm.

1. Unsure where to start, contact ethics@stjoes.ca. 
2. Contact your site lead

• Affiliated with St. Joseph’s Healthcare Hamilton, St. Joseph’s Home Care, St. Joseph’s Villa Dundas, or with the St. Joseph’s Health System central services, email Lee (LdeBie@stjoes.ca) 
• Affiliated with St. Mary’s General Hospital, St. Joseph’s Lifecare Centre Brantford, or St. Joseph’s Health Centre Guelph:
  • Tuesday-Thursday or non-urgent, email Steve (SAbdool@stjoes.ca)  
  • Monday and Friday coverage or organizational ethics issues, email Lee (LdeBie@stjoes.ca) 

3. For after hours or urgent 24/7 support, call the on-call ethics pager

• Phone 416-864-5070, input pager ID: 4211, and leave your full 10-digit phone number plus extension. The on-call ethicist will return your call within 15-30 minutes.

When you contact us, we will seek to better understand the nature of your concern and to identify and explore the best available resources and approaches to supporting you.  

Don’t hesitate to call. We’re here to help.