To act on these recommendations for ethics analysis, we offer these three steps forward: acknowledge and use relevant expertise, further develop models for conducting and reporting ethics analyses, and make use of untapped resources in the literature.

Many people have contributed to ethics analysis in HTA in Canada, and more are willing to do so. Given the absence of a reliable credential for ethics expertise, HTA producers should exercise caution when enlisting ethics experts.

Health care providers' interpretation of law can have intended and unintended effects on health care delivery in Canada. At times, health care providers encounter situations where they perceive the law to conflict with their sense of what is most ethically justified. In many cases, these health care providers feel especially torn because they assume that the legal requirements must dictate the decision, and cannot be explored or questioned. We challenge this assumption: the law is not as cut-and-dried as some assume; therefore, its significance to health care decisions should be carefully considered. Within a systematic ethics process, legal considerations can be a source of values and information and can create opportunities for further dialogue. This approach is justified because it appropriately reflects the relationship of the law to ethics. This way of thinking about the law and ethics also avoids potentially harmful consequences of legalistic approaches to decision-making, such as breakdowns in communication, adversarial relationships, and a reduction of ethically complex decisions to simple rule following.

As transgender persons have gained a stronger voice within 21 st century Western society, their stories have received greater prominence within the media and academia. This has spurred further social change, bringing questions about gender identity and expression into public discourse, leading for calls for systemic changes regarding how gender is defined and understood. Health leaders have ethical obligations to respond to this call and to develop and sustain health systems where safer, respectful and welcoming care and spaces are available for all patients.

The importance of an ethics-informed approach to healthcare leadership has been emphasized by the Canadian College of Health Leaders (CCHL) on several fronts including the College's Code of Ethics. 1 As part of an update of its Code of Ethics, the CCHL, in partnership with Accreditation Canada, recently developed an ethical leadership self-assessment tool to strengthen healthcare leaders' ability to explore the ethical dimensions of decision-making (personal communication). The tool comes in response to an identified need for policy and other decision-making processes to be informed by an exploration of the relevant values at stake in these decisions. In this article, we discuss another approach that may help to fill this need. This column introduces a Values-Based Decision-Making (VBDM) framework to illuminate and resolve three ethically contentious cases of preferential access. Given the limited space, we hope to briefly describe VBDM, demonstrate the role it can play in facilitating complex decision-making, and identify the potential benefits of VBDM for health leaders.