Acting as the substitute decision-maker (SDM) for a loved one can be an incredibly challenging and distressing job, practically, emotionally, and ethically. Most SDMs are not aware that our healthcare legislation contains decision-making principles which they are expected to follow when giving or refusing consent. And even once they are made aware of these principles, many SDMs continue to face challenges in their role. In this session, we'll look at the complexities that can arise even for thoroughly well-informed and conscientious SDMs, and we'll discuss strategies for working with these individuals as they make decisions for our patients.

Acting as the substitute decision-maker (SDM) for a loved one can be an incredibly challenging and distressing job, practically, emotionally, and ethically. Most SDMs are not aware that our healthcare legislation contains decision-making principles which they are expected to follow when giving or refusing consent. And even once they are made aware of these principles, many SDMs continue to face challenges in their role. In this session, we'll look at the complexities that can arise even for thoroughly well-informed and conscientious SDMs, and we'll discuss strategies for working with these individuals as they make decisions for our patients.

Curious about the implications of the recent legalization of recreational cannabis? Seeing cannabis use more in your practice? This month’s ethics grand rounds will examine ethical issues in health care delivery stemming from the legalization of recreational cannabis. Food for thought as you respond to legal and social changes relating to cannabis use in your practice.
Learning Objectives:
Participants will:
- become more familiar with federal and provincial rules around cannabis use
- uncover assumptions about how cannabis should be approached in the health care context
- identify ethical issues that could arise in clinical practice associated with cannabis use

"What's the Story?: The ethical value of sharing patients' narratives as a team"
Presenter: Marnina Norys, PhD, Clinical and Organizational Ethics Fellow, Centre for Clinical Ethics
In this talk I'll be discussing narrative medicine and will aim to show how showing how patients’ narratives can support their autonomy by giving patients a say in the identity team members confer upon them. Secondly, I shall demonstrate, using examples from assertive community treatment team meetings I observed, how sharing stories can disrupt the entrenchment of biased or one-dimensional perceptions of patients and thereby contribute to better patient-centred care. Thirdly, I will show how sharing stories helps cultivate care for clients while also helping workers demonstrate this care to clients. In the end I shall address concerns that I am recommending workers spend time simply gossiping about patients by contrasting the type of storytelling I am endorsing with “triangling,” a way of communicating about others identified in psychotherapeutic literature that is dysfunctional (Bowen, 2012), and likely unethical.

Learning Objectives:

• Describe narrative medicine and understand how its proponents view patient narratives.
• Gain an understanding of how ACT teams (sometimes) treat narrative in practice.
• Begin to appreciate the ethical value of sharing patients’ narratives as a team.
• Appreciate the difference between sharing stories for a therapeutic purpose and dysfunctional ways of discussing others.

Exploring the Ethical Dimensions of Adapting to Cannabis Legalization in Health Care
Presenter: Jamie Robertson, Clinical and Organizational Ethics Fellow, Centre for Clinical Ethics
Curious about the implications of the recent legalization of recreational cannabis? Seeing cannabis use more in your practice? This month’s ethics grand rounds will examine ethical issues in health care delivery stemming from the legalization of recreational cannabis. Food for thought as you respond to legal and social changes relating to cannabis use in your practice.

Learning Objectives:

Participants will:
- become more familiar with federal and provincial rules around cannabis use
- uncover assumptions about how cannabis should be approached in the health care context
- identify ethical issues that could arise in clinical practice associated with cannabis use

"What's the Story? The ethical value of sharing patients' narratives as a team"
Presenter: Marnina Norys, PhD, Clinical and Organizational Ethics Fellow, Centre for Clinical Ethics
In this talk I'll be discussing narrative medicine and will aim to show how showing how patients’ narratives can support their autonomy by giving patients a say in the identity team members confer upon them. Secondly, I shall demonstrate, using examples from assertive community treatment team meetings I observed, how sharing stories can disrupt the entrenchment of biased or one-dimensional perceptions of patients and thereby contribute to better patient-centred care. Thirdly, I will show how sharing stories helps cultivate care for clients while also helping workers demonstrate this care to clients. In the end I shall address concerns that I am recommending workers spend time simply gossiping about patients by contrasting the type of storytelling I am endorsing with “triangling,” a way of communicating about others identified in psychotherapeutic literature that is dysfunctional (Bowen, 2012), and likely unethical.

Learning Objectives:

• Describe narrative medicine and understand how its proponents view patient narratives.
• Gain an understanding of how ACT teams (sometimes) treat narrative in practice.
• Begin to appreciate the ethical value of sharing patients’ narratives as a team.
• Appreciate the difference between sharing stories for a therapeutic purpose and dysfunctional ways of discussing others.

What’s the story? The ethical value of sharing patients’ narratives as a team

Marnina Norys, PhD
Clinical and Organizational Ethics Fellow, Centre for Clinical Ethics

In this talk I'll be discussing narrative medicine and will aim to show how showing how patients’ narratives can support their autonomy by giving patients a say in the identity team members confer upon them. Secondly, I shall demonstrate, using examples from assertive community treatment team meetings I observed, how sharing stories can disrupt the entrenchment of biased or one-dimensional perceptions of patients and thereby contribute to better patient-centred care. Thirdly, I will show how sharing stories helps cultivate care for clients while also helping workers demonstrate this care to clients. In the end I shall address concerns that I am recommending workers spend time simply gossiping about patients by contrasting the type of storytelling I am endorsing with “triangling,” a way of communicating about others identified in psychotherapeutic literature that is dysfunctional (Bowen, 2012), and likely unethical.

Learning Objectives:

• Describe narrative medicine and understand how its proponents view patient narratives.
• Gain an understanding of how ACT teams (sometimes) treat narrative in practice.
• Begin to appreciate the ethical value of sharing patients’ narratives as a team.
• Appreciate the difference between sharing stories for a therapeutic purpose and dysfunctional ways of discussing others.

Curious about the implications of the recent legalization of recreational cannabis? Seeing cannabis use more in your practice? This month’s ethics grand rounds will examine ethical issues in health care delivery stemming from the legalization of recreational cannabis. Food for thought as you respond to legal and social changes relating to cannabis use in your practice.

Learning Objectives:

Participants will:

• become more familiar with federal and provincial rules around cannabis use
• Uncover assumptions about how cannabis should be approached in the health care context
• Identify ethical issues that could arise in clinical practice associated with cannabis use

Curious about the implications of the recent legalization of recreational cannabis? Seeing cannabis use more in your practice? This month’s ethics grand rounds will examine ethical issues in health care delivery stemming from the legalization of recreational cannabis. Food for thought as you respond to legal and social changes relating to cannabis use in your practice.

Learning Objectives:

Participants will:

• become more familiar with federal and provincial rules around cannabis use
• Uncover assumptions about how cannabis should be approached in the health care context
• Identify ethical issues that could arise in clinical practice associated with cannabis use

"Just give them everything!" Understanding Why Patients and Families Might Want Aggressive Medical Management Despite a Poor Prognosis

Presenter:  Sean Hillman, PhD, Clinical Ethicist, Centre for Clinical Ethics (Lakeridge Health)

Healthcare providers regularly have to deliver bad news in the form of a terminal diagnosis, or a poor prognosis, to a patient and/or their family. Quite often, there comes a fork in the road in choosing between continuing active medical management or pursuing comfort measures, and the clinical recommendation is towards palliation. Despite this, in many of these cases patients and/or families not only opt to continue a curative route, but are upset by the mere mention of anything other than aggressive interventions. But where are they coming from? How can healthcare providers cope with these challenging cases, and best help patients and families navigate such difficult decision-making?

Learning Objectives:
(1) To explore some of the possible causes for patients and families to want everything medically available, contrary to strong clinical recommendations otherwise.
(2) To empathize with and reduce stigma towards such patients and families.
(3) To provide practical strategies and legislative guidance for healthcare teams to cope with such cases, and in assisting such patients and families in their decision making.