Ethics Collaborations

Overview and Yearly Update

The Department of Bioethics is engaged in a number of dynamic ethics collaborations. The collaborations between the Department and Capital Health (Nova Scotia’s largest regional health authority consisting of 9 rural and urban-based health care facilities), and the IWK Health Centre (a maternal-pediatric tertiary care hospital) provide access to ethics expertise and support for these health organizations. A more recent collaboration, with the Department of Bioethics as a full partner in the Nova Scotia Health Ethics Network, has further increased the opportunities for networking and building ethics capacity across the province. Finally, a ongoing collaboration with the Bermuda Hospitals Board Ethics Committee (for the country’s health facilities), initiated in July 2004, further builds on this approach to ethics support.

The Ethics Collaborations Team consists of Drs. Christy Simpson, Jeff Kirby, and Marika Warren, who are the primary faculty members engaged in these collaborations (although others may be involved depending upon their availability and interest). Committed to building ethics capacity, Christy, Jeff, and Marika provide leadership and ethics support for a broad range of activities related to these collaborations.

Collaboration with Capital Health:

Capital Health Ethics Support (CHES) actively contributes to building and enhancing a positive ethics climate within Capital Health. As CHES moves into its seventh year of activity, there have been a number of changes and updates to the model of ethics support. This includes a revised Terms of Reference and a new diagram representing CHES’s organizational structure. Both of these are meant to better capture the various dimensions of ethics support (clinical ethics consultation, policy development & review, organizational ethics, and ethics education) at Capital Health as well as the important inter-connectedness between them.

Of particular note this year, the Ethics Education component of CHES developed a pamphlet for health care providers on Informed Choice. Responding to requests for a quick reference, this pamphlet provides a solid overview of the essential aspects of informed choice and encourages health care providers to engage in a shared decision making process. As well, there has been ongoing revision of the Advance Directives booklet, which supports the implementation of the Advance Directives policy, with a particular emphasis on the nature of advance care planning for persons living with mental illness.

In addition to supporting the activities of CHES, Christy and Jeff continue to provide capacity-building sessions for participants in CHES and the Capital Health community. They are also active in providing ethics support and expertise to various members of Capital Health, such as the Leadershift Enabling Team and a variety of clinical health care teams. Further, Jeff’s recent interest in the ethical dimensions of organ donation (see his paper: Kirby, J. 2009. Organ Donation: Who Should Decide? – A Canadian Perspective. Journal of Bioethical Inquiry 6: 123-8) was stimulated and informed by his work with Capital Health around organ donation after cardiac death.

Collaboration with the IWK Health Centre:

The IWK Ethics Committee and Clinical Ethics Consultation are both actively supported by the Ethics Collaborations Team. Clinical Ethics Consultation is currently in the process of updating its role descriptions and processes, as well as recruiting new consultants. The Ethics Committee continues to address organizational ethics issues, and has been invited to participate in a number of consultations related to key aspects of care at the IWK.

Significantly, this year, an Ethics Tool was developed for health care providers, staff, and volunteers to address difficult care situations. This tool has been rolled out for various health care teams with much positive response. Work is currently underway to develop a parallel document for patients and families. Marika has been heavily involved in supporting this development, with input and feedback from a variety of key stakeholders.

Collaboration with the Nova Scotia Health Ethics Network (NSHEN):

NSHEN is a collaboration between the Department of Bioethics (on behalf of Dalhousie University), Nova Scotia’s district health authorities (DHAs), the IWK Health Centre, and the provincial Department of Health. NSHEN’s mandate of building ethics capacity throughout the province is carried out through education, assistance with policy development & review, support for clinical ethics consultation and a focus on organizational ethics analyses. NSHEN encourages collaboration, networking and sharing of expertise across the province and is committed to developing innovative ways of responding to ethics needs at a variety of levels.

Marika, Christy, and Jeff provide targeted education sessions to various groups around the province, present bimonthly telehealth sessions, and produce materials and manuals to support ethics committee activities. Marika, Christy, and Jeff are also available to provide direct support for ethics consultations and policy development. Of note, in the past year, they delivered the two-day “Clinical Ethics Consultation Education and Training Workshop” twice in the province, with plans to offer this workshop again in Spring 2010.

In addition, NSHEN sponsors an annual conference. The theme for the third annual conference (March 3-4, 2010) is, “Different Landscapes, Similar Views? Health Ethics in the Rural Context.”

Collaboration with Bermuda Hospitals Board Ethics Committee (BHBEC):

The partnership between the BHBEC and the Department of Bioethics continues to flourish with a sixth visit to Bermuda in November 2009, corresponding with their Ethics Awareness Week. This year’s theme was: “Getting Back to Basics.” Talks at the King Edwards Memorial Hospital and a full-day-and-a-half of education and training with the ethics committee canvassed a wide array of topics related to this theme. This included addressing ethics issues related to pandemic planning and how their nursing Code of Ethics translates into practice. Informed choice, truth-telling and confidentiality, professional boundaries, hope and expectations, among others, were addressed with the Ethics Committee. As co-chairs of the BHBEC, Drs. Roslyn Bascombe-Adams and Elaine Campbell continue to provide strong leadership and support for this committee’s work.