CENTRE FOR HEALTH CARE EHTICS PRESENTATIONS FALL 2002

October 16, 2002 - "Health Care Decision-Making among Aboriginal Canadians"

November 13, 2002 - "Managing Cancer Risks in Women: An Historian's View of Ethical Issues"

December 11, 2002 - "Linking Ethical Issues to Spirituality in Clinical Practice"

COMING TO INTRA-NET

The Ethics Team has prepared information related to clinical ethical issues for posting on the hospital Intra-net. Access this information by following the title TEAMS and go to E -Ethics Team on the drop down menu.

Ethics Team information on the Intra-net includes:

• A Welcome
• How to Contact Us
• Information about our Ethics Team
• Archived Newsletters
• Education Resources
• Policies and Patient Information
• How to send us Comments

ETHICS WEB SITES

The following web sites may be of interest to you. Soon, these sites and others may be accessed from the Thunder Bay Regional Hospital Intra-Net.

• A listing of many bioethics/clinical ethics resources: http://www.nih.gov/sigs/bioethics/
• A Canadian site with excellent clinical references: http://www.ethicscommittee.ca/
• A Canadian site with multiple links: http://www.ethics.ubc.ca/resources/biomed/
• This free site has a 12-module course for physicians in End of Life Care: http://www.epec.net
• Very good Canadian site for nursing ethics and links (also with links to Legal, Professional and Medical Ethics pages in similar style and context): http://www.nursingethics.ca
• This one is just interesting from a global perspective: http://www.ethics.org

ETHICAL DECISION MAKING - A FRAMEWORK

Members of the Ethics Team use the following framework when they participate in Ethical Consults. The framework may assist you in dealing with clinical ethical issues you encounter.

1. Acknowledge Feelings

• What are your "gut" reactions?
• What are your biases?
• Where are your loyalties?
  

2. Determine Facts

• Medical factors: diagnosis, prognosis, degree of certainty?
• What are the alternatives…likely consequences?
• What are the human factors: history, family situation?

3. Examine Values

• Patient Preferences: patient's values, wishes, goals
• Are other' values relevant? ie: Professional/Institutional values
• What are the values in conflict?
• What is the problem?
• Whose values conflict?
• How are economics involved?
  

4. Evaluate Alternatives

• Identify the decision-maker(s)
• Rank values (goals)
• Justify ranking using "Key Principles in the Discipline of Ethics"
• Examine consequences of alternatives in terms of goals
  

5. Arrive at a Decision

• Choose alternative that best saves values - i.e….
• Articulate decision
• Communicate decision appropriately
  

6. Implement Decision

7. Evaluate

Maintain ongoing process
Establish criteria for revision of decision or goals based on observation of outcome

REFERENCES: Curtin, L., Flaherty, J., Nursing Ethics, Theories and Pragmatics, Robert J. Bradly Co., Prentice Hall, 1982. Yeo, M., Editor, Concepts in Cases on Nursing Ethics, Broadview Press Limited, 1991.

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