The use of Ethics Decision‐Making Frameworks by Canadian Ethics Consultants: A Qualitative Study

Abstract

In this study, Canadian healthcare ethics consultants describe their use of ethics decision-making frameworks. Our research finds that ethics consultants in Canada use multi-purpose ethics decision-making frameworks, as well as targeted frameworks that focus on reaching an ethical resolution to a particular healthcare issue, such as adverse event reporting, or difficult triage scenarios. Several interviewees mention the influence that the accreditation process in Canadian healthcare organizations has on the adoption and use of such frameworks. Some of the ethics consultants we interviewed also report on their reluctance to use these tools. Limited empirical work has been done previously on the use of ethics decision-making frameworks. This study begins to fill this gap in our understanding of the work of healthcare ethics consultants.

(Mis)understandings and uses of ‘culture’ in bioethics deliberations over parental refusal of treatment: Children with cancer

“…They work from a paradigm of analysing the problem and making recommendations on ethically acceptable ways forward. The US and Canadian models, whilst also having such committees also rely on clinical ethics consultants 21,35,36 ; their role may be more as advisors than as mediators, but mediation also may be part of the process.…”

Clinical Ethical Consultation in Decision Making Process

“…Despite the large number of scien tific articles related to ethical approaches in healthcare decisions, articles that analyse a specific model or framework for dealing with ethical situations and emerging ethical dilemmas are relatively few. There are general frameworks for ethical decision-making that are developed by healthcare institutions and applied as a common framework in different clinical and organizational contexts 9 . An example of such a general frame work is the 'four boxes' approach developed by Jonsen, Siegler and Winslade.…”

“…In many cases, medical staff are trained to use a basic ethical framework such as the four boxes without the involvement of ethics consultants themselves. In this approach, the ethicist maintains neutrality 9 . The clinical moral reasoning appro ach incorporates philosophical insights framed in a structured thought process that is styled after the systematic approaches to medical thinking that clinicians are trained to employ 11 .…”

“…Using this approach, the patients are not always protected from not receiving health care because they cannot meet the standard. At the base of the narrative approach there is the medical care and successful decision-making depends on whether physician and patient share the same goals 9 . Narrative ethics requires that a healthcare practitioner get to know and understand the patient's personal needs and desires, and refrain from making decisions without taking these aspects into consideration.…”

Executive ethical decisions initiating organizational culture and values

“…They also mention the importance of comprehending the nature of the legacy that a leader wishes to leave. Other researchers calling for additional related studies include Kaposy et al (2016), who state that work is needed on the use of ethical decision making frameworks, and Valentine and Hollingworth (2015), who examine relationships between coordinated decision making, communication of business strategy and employee perceptions of corporate ethical values.…”