Bioethics Consultation Practices and Procedures: A Survey of a Large Canadian Community of Practice

Abstract

The literature fails to reflect general agreement over the nature of the services and procedures provided by bioethicists, and the training and core competencies this work requires. If bioethicists are to define their activities in a consistent way, it makes sense to look for common ground in shared communities of practice. We report results of a survey of the services and procedures among bioethicists affiliated with the University of Toronto Joint Centre for Bioethics (JCB). This is the largest group of bioethicists working in healthcare organizations in Canada. The results suggest there are many common services and procedures of JCB bioethicists. This survey can serve as a baseline for further exploration of the work of JCB bioethicists. Common practices exist with respect to the domains of practice, individual reporting relationships, service availability within business hours and the education and training of the bioethicist.

Here for the people: The argument for making clinical ethics more patient-centred

“…We are noticing, however, that clinical ethics work is not often aimed at the patient, or community itself, but rather focuses on the staff looking after them. 16 Clinical ethics service providers ought to consider how they can improve patient experience directly. Furthermore, healthcare organizations should think about how they can leverage clinical ethics services to directly meet their goal of providing excellent, patient-centred care to individuals and the community.…”

“…Distinctions must be made, for example, between clinical ethics and the legal department, patient relations, and spiritual care, despite all of these departments frequently collaborating to support patients and families more holistically. 16 Furthermore, organizations should ensure that patients and families have full access to ethics services, such as consultation, education, and collaboration. This is a direct method of improving the visibility of ethics and promoting patient and family-centred care.…”

“…We are noticing, however, that clinical ethics work is not often aimed at the patient, or community itself, but rather focuses on the staff looking after them. 16 …”

Documenting Clinical Ethics Consultation

“…In the Canadian jurisdictions where I have worked in clinical ethics, the bulk of requests for consultation have come from health care providers and/or administrators who are working through ethically challenging situations, rather than from patients or family members directly (3). Requestors often ask ethics consultants to participate in or facilitate a small group conversation, providing those in the circle of care a dedicated opportunity to come together to share information, improve mutual understanding, analyze their moral distress and possible options before they engage the patient or family further (4).…”

“…I do not want to overstate the differences in practices among health ethics consultants in Canada. There appears to be a lot of common ground (3,9). Still, there do seem to be questions related to documentation (and access to documentation) that I think warrant broader conversation, particularly as they relate to accountability, trust and privacy.…”