With its aim of building capacity for ethical practice, the Nova Scotia Health Ethics Network focuses its work on four different, yet inter-related, aspects of ethics support:
Through each of these forms of support, NSHEN is committed to making connections, fostering relationships, and appropriately developing and using resources so that the ethics questions and concerns we encounter each day in practice are better identified and addressed. Read further to learn more about ethics education, health policy, clinical ethics, and organizational ethics.
Organizational ethics, the ‘new kid on the block’ of health care ethics, addresses and critically appraises the ethics dimensions of decision making at multiple levels within health care organizations and government. It is primarily concerned with ethics-related issues that arise at senior leadership and management tables which may, in turn, have significant, frontline impacts on patients and citizens. Organizational ethics topics include the fair allocation of limited health resources; health priority setting; the disclosure of significant adverse events; ‘responsible partnering’ with private industry; and the non-constructive use of power in policy making.
NSHEN’s organizational ethics work takes a variety of forms including consultations that address specific organizational ethics issues, the use of ethics-informed decision-making frameworks, and the provision of ethics support to the development and review of health policies that direct how organizations govern and ‘live’ their mission, vision and core values.
Much attention in health care ethics has been given to the patient-health care provider relationship and to issues that arise “at the bedside.” Questions in practice, for example, include: who gets to make what decisions; when and on what basis treatments should be initiated, withdrawn, or withheld; what an informed choice requires; and what, when and with whom information should be shared. Clinical ethics consultation is one resource for persons who are struggling with or have questions about these types of issues – whether it is an individual, health care team, and/or patient and family. NSHEN’s activities in clinical ethics include assessment and/or development of a process for clinical ethics consultation, as needed. Assistance with relevant analysis and discussion of the issue/case through mentoring and training is also supported.
“Policy … has an irreducibly moral dimension insofar as it involves a decision about how to act toward affected others who are not involved (or only indirectly involved) in actually deciding what to do about an identified problem”[1]. This ‘deciding for affected others’ and the significant implications of health policy for persons and society as-a-whole, make it a moral endeavor, and those who participate in it, moral actors.
In the health arena, policy provides concrete direction as to how we manage the crucially important moral goods of health and health care. Within health care organizations, policies direct how health care providers, staff and patients treat each other; how patients are cared for; and how, and to whom, limited health resources are delivered.
NSHEN provides ethics support to health care organizations and government for the development and review of health care policies with strong ethics elements. A dynamic ethics review template has been developed to assist members of ethics committees and reference groups to perform comprehensive ethics policy reviews.
NSHEN encourages ‘from the ground up’ policy development through the use of policy working groups that are inclusive of participants from all the primary stakeholders. In this ethics-informed policy development process, the working group authors and stewards the policy from its inception through the solicitation and inclusion of appropriate secondary stakeholder feedback to its final approval and implementation within the organization.
[1] Malone RE. Policy as Product. The Hastings Center Report, 1999; 29(3): 16-22.
Advance Directives
Confidentiality / Privacy
Health Policy / Public Health
Pandemic Planning
Resource Allocation
The challenge of ethical practice in the context of complex health systems, diverse and aging patient populations, rapidly evolving technology and treatments, and limited resources is significant. Questions about ethics arise in the work that each person involved in health care does each day. Ethics education aims both to foster an understanding and awareness of relevant issues and to develop the skills needed for addressing them. Accordingly, a variety of pedagogical techniques – from presentations to conceptual and case-based analysis to role modeling and mentoring to demonstrating practices of reflection – are employed by NSHEN to achieve these goals, build capacity and progressively develop knowledge and skills related to moral analysis and values clarification/evaluation.
Currently, NSHEN is focused on providing ethics committee members around the province with education that meets their needs – as they are the primary ethics resource in each of the NSHA zones, IWK Health Centre and Dalhousie University. NSHEN has held annual conferences since 2008 and each year the audience base continues to grow which is very exciting as it identifies the need for ethics in the workplace.
Each year NSHEN coordinates an annual conference for health care providers, administrators and policy makers, exploring a health ethics issue that is relevant to those working in Nova Scotia’s health care system. Through plenary presentations and smaller breakout sessions, speakers explore these complex issues and facilitate practical application of the topics through the use of case studies and interactive dialogue with participants.