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Ethics at Trillium Health Centre

Everyone has a role to play in ensuring the ethical delivery of care, from bedside to boardroom. Trillium Health Centre’s vision is to positively impact the lives of patients and their families by providing the best care. Ethical principles and values are incorporated into the way that decisions are made and care is delivered every day.

Trillium Health Centre has an active Clinical Ethics Forum which provides leadership in areas of ethics education, policy development and review, and consultation. The Forum is comprised of hospital staff and physicians including the Senior Ethicist.

What Is Ethics?

Ethics1 can be described as a way of critically looking at issues in health care that encompasses:

  • Deciding what we should do—what decisions are morally right or acceptable based on the values and principles we agree are relevant;
  • Explaining why we should do it—justifying our decision using language of values and principles to explain why; and
  • Describing how we should do it—outlining an appropriate process for enacting the decision.

1 Definition developed by Dr. Barbara Secker, University of Toronto Joint Centre for Bioethics.

If you answer yes to one or more of the following questions you may be facing an ethical issue:

  • Am I trying to determine the right course of action?
  • Am I asking a “should” question?
  • Are values and beliefs involved?
  • Am I feeling uncomfortable?

A Few Examples of Ethical Situations In Hospital

  • A patient has kidneys that are failing and needs dialysis (a medical treatment to remove waste products from blood) to survive. The patient is refusing dialysis. His wife is concerned that her husband does not realize the consequences of his decision. Should dialysis be given?
  • A patient recently experienced a cardiac arrest (heart stopped beating). Although his heart was restarted, he suffered brain damage that is likely permanent. He is in the intensive care unit attached to a breathing machine. The patient has previously stated that he would not want to live connected to machines. Should the machine be disconnected?
  • A family member observes a staff member treating another patient in what appears to be a disrespectful manner. What should happen next?
  • A patient has been diagnosed with a terminal illness. Her family does not want her informed of the diagnosis. Should the patient be informed?

IDEA: Ethical Decision-Making Framework

The purpose of the IDEA Framework is to provide a step-by-step process to help guide healthcare providers and administrators in working through ethical issues. It is comprised of the following four steps:
I -   Identify the facts (consider clinical indications, patient preferences, evidence, contextual features. Ask: What is the ethical issue?
D – Determine the relevant ethical principles (e.g., autonomy, beneficence, non-maleficence, justice). Ask: Have perspectives of relevant individuals been sought?
E – Explore the options (consider strengths & limitations, harms & benefits, laws & policies, consistent with mission, vision, & values). Ask: What is the most ethically justifiable option?
A – Act (recommend, implement, evaluate). Ask: Am I (are we) comfortable with this decision?

Click here to read Trillium’s IDEA Framework (PDF)

How Can an Ethicist Help Me or My Family?

While in hospital you may be faced with making difficult treatment decisions for yourself or a family member. The Ethicist’s role is to facilitate good decision-making processes and support individuals through those processes.

The ethicist may be able to help you...

  • Identify the information you need to make a treatment decision
  • Understand the ethical and legal implications of your treatment decision
  • Explore the benefits and burdens of different treatment options
  • Link you with other persons and resources within and outside the organization

When Might I Consider Contacting an Ethicist?

First, you should discuss any treatment decisions with your health care team. After having discussed your treatment decisions with your health care team, you may wish to contact the Ethicist for any of the following reasons:

  • If you are uncertain about what decision should be made
  • If there are differences of opinion about what decision should be made
  • If you would like to explore further the ethical and legal aspects of a decision

How Do I Contact an Ethicist at Trillium Health Centre?

E-mail: ethics@thc.on.ca
Phone: 905-848-7580, x3083

Ethics Resources on the Internet

The following websites provide information about a variety of ethical issues. We strive to maintain current links. However, as website addresses are constantly changing, we apologize if any of the links are broken.

Advance Care Planning

Consent & Capacity

Decision-making Guides for Patients

End of Life

Organ Transplantation

Mental Health

Privacy

Substitute Decision-Making