1. Clinical Ethics Consultation Service
What is Clinical Ethics Consultation?
Clinical ethics consultation supports decision-making when there is uncertainty or conflict regarding value-laden concerns that emerge in health care.
Clinical ethics consultation is sometimes referred to as Ethics Facilitation or Bioethics Mediation, which underscores the collaborative nature of this role and its focus on facilitating the building of a principled ethical resolution. This process respects the rightful decision-making authority of the patient, their substitute decision-maker, and the healthcare team while ensuring ethically justified norms and values are upheld to the greatest extent possible.
NB: Where other clinical ethicists may choose to model their consults based on the “authoritarian” or “pure consensus” approach (described by American Society for Bioethics and Humanities: Core Competencies for Healthcare Ethics Consultation), our team at the CIUSSS-CODIM is committed to practicing according to the “Ethics Facilitation” approach endorsed by the by American Society for Bioethics and Humanities.
“We felt like we needed more support and guidance to better understand the requests of the family that seemed so unrealistic ….to connect the clinical reality with the value/belief aspects and elaborate a proper plan of intervention that would make both parties comfortable.”
- Jewish General Hospital Nurse Manager“As a nurse, I am comforted to know that a service such as the [Clinical Ethics Service] exists to provide answers to the very delicate issues that may arise in the course of patients’ care, where neither doctors or nurses feel skilled enough to intervene. In this case, the intervention of the ethicist had a very positive impact on the decision making of [our patient’s] family.”
- Jewish General Hospital Nurse Manager“Thank you for all the help you have given us… thanks to you [our patient] was able to die peacefully”
- Jewish General Hospital Nurse Manager“As a CLSC community social worker, I really appreciated the guidance that I received from the ethics service. I was concerned that my client in the community was at risk and the ethicist and the ethics committee helped me and the team identify the issues and devise a plan to ensure her well-being and safety”
-CLSC René-Cassin Social worker
Additionally, there are times when ethics consultants are called to answer factual questions (“what is our policy on X as it applies to this patient?”) or for help obtaining ethics-related information (“what does the ethics literature say about Y?”). In these cases, the ethics consultant is a resource, expert, and teacher who is available to share his or her ethics knowledge and expertise.
How does a Clinical Ethics Consultation work?
When you request a consult an ethicist will use the Ethics Facilitation approach to support all involved to:
- Identify and distinguish ethical issues
- Analyze the risks and benefits of the proposed and alternative courses of action by considering relevant facts, values, and religious beliefs
- Facilitate an ethical resolution: Plan a fair process & provide mediation
Who can consult the Clinical Ethics Service?
The service is offered to anyone involved in clinical decision-making—patients, family members, and members of the clinical team.
2. Organizational Ethics Consultation Service
Ethics consultation is also available to assist staff, management, and administrators in addressing ethics issues that affect a group of patients. For example, when a team identifies a recurring clinical (single-patient) ethics issue and would like assistance to address the issue for all patients (systems-level).
Organizational ethics consultation often involves consulting on policy development or review, practice guidelines, or quality improvement initiatives.
Organizational ethics consultation also involves assisting with governance level decisions, such as financial decision-making where the outcome is likely to have an impact on clinical care.
Who can consult the Organizational Ethics Service?
The service is offered to members of the clinical team, managers, administrators, and governors.
3. Research Ethics Consultation Service
Research ethics consultation is also available to provide a non-regulatory mechanism where researchers can collaborate with ethicists to increase sensitivity to ethical issues in their work. It is available prior to REB approval as well as throughout the course of a study.
- E.g., protocols involving patients who may lack decision-making capacity and may involve substitute decision-makers
Research ethics consultation is also available to research participants who may have moral questions related to their participation in a study.
Likewise, research ethics concerns may arise in the clinical setting, for example where daily clinical care conflicts with a research protocol. In these cases the consult service is available to provide clinical ethics consultation considering the unique context of participation in research.
Who can consult the Research Ethics Service?
The service is offered to research participants, researchers, members of Research Ethics Boards (REBs), and the Research Review Office. As noted above, it may also be initiated through a clinical team member providing care to a research participant.
4. Ethics Education
The Clinical Ethics Service helps to coordinate and provide expert ethics education throughout the CIUSSS-CODIM. We receive many requests for unit based rounds, in-services, formal presentations, and workshops.
In collaboration with the McGill University Biomedical Ethics Unit, we supervise graduate students and present educational seminars to its members and students. We are also involved in teaching and the development of curriculum for McGill Medical School students and residents.
Who can make a request for Ethics Education?
This service is geared towards staff and employees of the CIUSSS-CODIM, however we welcome requests for ethics education from interested parties outside of our CIUSSS as well.
Confidentiality
Consultation with the ethicist is confidential, except in rare circumstances where the law requires disclosure – or disclosure is necessary to prevent imminent and serious harm.
It is important to be aware that while initial consultation with the ethicist is always confidential (i.e., will be kept between you and the ethicist), as a consult proceeds the ethicist often needs to include other members of the health care team. Team members are also bound by confidentiality, however because more people will be involved, the ethicist will inform you of their intention to consult with the team. If you do not wish to pursue the consultation, you may withdraw your request.
NB: The Clinical Ethics Service does not provide legal advice or address complaints.
The Local Commissioner of Complaints and Quality of Services, can be reached at 514-340-8222, ext. 5833.