Ethics Grand Rounds

  • Beyond Dreamcatchers: Native Spirituality Conference

    Native dreamcatchers are popular with many people. (Those are the hoops with a web through the centre, decorated with feathers and beads.) They’re seen as a protective charm. But there’s more to them than that – and a lot more to native spirituality than most of us know.

    Interview on CBC, All in a Weekend, Montreal, Canada

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  • Ethicist Details Principles that Guide Massive Genome Project

    Michael Szego, Centre for Clinical Ethics at the University of Toronto and the Personal Genome Project ethicist, says the program is very clear they can not promise any kind of confidentiality or privacy in this project.

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  • What is Medical Ethics Consultation?

    Giles Scofield, JD, MA, is a clinical ethicist at the Centre for Clinical Ethics in Toronto. In the selection below, Scofield argues that the scope and limits of ethics consultation is not well defined. Because ethics consultation has no clear boundaries, it is impossible to know when boundaries have been crossed, and whether such crossings are justified. Scofield also notes that, unlike other consultation services in the health care setting, ethics consultation lacks a credentialing process of any kind. Whereas ethics consultants typically are regarded as professionals, they lack all of the formal attributes traditionally associated with a profession, such as a code of ethics, standards of accreditation, and conditions of licensure. Scofield concludes that the field of ethics consultation is without any means of ensuring that its practitioners have expertise or perform in a competent manner.

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  • My Journey from Bench Scientist to Clinical Ethicist

    Four and a half years ago I was introduced to the field of clinical ethics while nearing the end of my Doctorate in Molecular Genetics at the University of Toronto. After attending a talk given by Kerry Bowman, a clinical ethicist at one of the University teaching hospitals, I approached him with some additional questions. The ensuing discussion led to a productive working relationship. Initially, I helped him perform an ethics analysis of a complicated genomics project. He then invited me to participate in some of his other professional responsibilities, opening a door into a new profession. This foray into clinical ethics had a lasting effect; in short order I decided to retire my pipette and pursue a career in clinical ethics.

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  • Conversations about Challenging End-of-Life Cases: Ethics Debriefing in the Medical Surgical Intensive Care Unit

    Clinicians frequently encounter and grapple with complex ethical issues and perplexing moral dilemmas in critical care settings. Intensive care unit (ICU) clinicians often experience moral distress in situations in which the ethically right course of action is intuitively known, but cannot be acted on. Most challenging cases pertain to end-of-life issues. Researchers have shown that moral distress and moral residue are common among critical care nurses. It is, therefore, essential that all ICU clinicians (and nurses, in particular) have an ongoing opportunity to work safely through these ethical dilemmas and conflicts. In this article, we describe the medical surgical intensive care unit (MSICU) experience with its monthly ethics initiative and explore the next steps to enhance its use through maximizing attendance and value to MSICU clinicians.

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  • Making Ethical Choices: An Ethical Decision-Making Handbook for Health Care Practitioners & Administrators Second Edition

    About the book:

    Health care practice and administration is fraught with complex moral issues and dilemmas. Shifting paradigms in the health care system, such as limited resources, increased emphasis on patients’ rights, and moral diversity, have profound and far-reaching ramifications that impact us all – health care recipients and their families, health care professionals and administrators, and other stakeholders.

    On the one hand, advances in medical technology have created renewed hope and exciting horizons in our quest for cures and treatments of illnesses that cause pain, suffering and, frequently, premature death. On the other hand, the development of new investigative and treatment techniques have added complex and baffling ethical questions to old moral quandaries in health care.

    Generally, health care professionals and administrators conscientiously follow personal or interdisciplinary frameworks for making decisions. These processes are enmeshed with a wealth of professional and personal experiences. Yet, how often is the health care professional or administrator baffled by difficult and perplexing circumstances that possess a value foundation. Commonly asked questions include: Which of these difficult alternatives should I choose? What course of action is most appropriate in this situation, and who should so decide? Answers to questions such as these often have very far-reaching ramifications, and they may on some occasions determine whether a patient is treated fairly or, indeed, whether he lives or dies.

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