Policy & Procedure / Policy Name:
Joint SFMH/VM Ethics Advisory Committee – Submissions / Manual
Administration
Last Reviewed / Revised Date:
March 2012 / Category :
Ethics
Approved by:
Ethics Chair / Original Date:
May 2010
Signature / Committee/Dept Review:
Ethics Advisory Committee

BACKGROUND

St. Francis Memorial Hospital (SFMH) and Valley Manor (VM) recognize that many staff work at both sites and many residents/patients receive services/care from both organizations. As well, it is recognized that it is beneficial to optimize resources wherever possible. For these reasons, a Joint SFMH/VM Ethics Advisory Committee has been initiated.

PURPOSE

SFMH and VM recognize that many ethical dilemmas arise in the health care environment. Many will be resolved at the front line or with a focused discussion involving the patient/resident/family and interprofessional care team. However, there may be other ethical dilemmas which would derive benefit from a formal consultation with the Ethics Advisory Committee.

SFMH POLICY

The Ethics Advisory Committee will act solely in an advisory and consultative capacity. All patients/family members and staff will be advised of their right to access the Ethics Advisory Committee. The Committee will not entertain submissions that would be defined as personal ethical dilemmas but will be accountable for referring such requests to other appropriate supports (e.g. pastoral care, EFAP, community resource listing).

As a rural, non-teaching hospital, SFMH is not typically involved in research. Should a decision be made by the Senior Management to partner in or lead a research initiative, an external Research Ethics Board (REB) approval of the research proposal would be required. The REB approval would then be forwarded to the Ethics Advisory Committee. The Advisory Committee will then have an opportunity to review the REB comments and Research Proposal and append any Committee comments prior to forwarding to the CQI Committee. Approval by the CQI Committee must take place prior to the initiation of any research.

PROCEDURE

The Submitter:

  • If unable to reach a resolution to identified ethical dilemmas following consultation with other care team members, patient and family, considers the option of submitting the dilemma to the Ethics Advisory Committee. Advises patient and family that they also have the option to consult with the Ethics Advisory Committee and provides appropriate information and assistance.
  • Contacts one of the Ethics Advisory Committee representatives to initiate an informal discussion of the situation
  • Completes a Consultation Request(Appendix A) in collaboration with the representative if the decision is made to submit the dilemma to the Committee. Ensures that any urgency to the situation is clearly communicated to the Committee.
  • Provides further information as requested by the Committee. Retains the option of speaking directly to the Committee.
  • Receives the written Response to Submitter(Appendix B) from the Committee which will include recommendations and options. Asks for clarification and guidance from the Committee as required.
  • Implements selected recommendation(s) in collaboration with the care team, patient and family.
  • Completes an Evaluation – Ethics Committee Consultation (Appendix C) form (optional)

The Ethics Advisory Committee Representative:

  • May receives a request for consultation verbally, electronically or in writing.
  • Arranges to meet with submitter(s) to complete the Consultation Request.
  • Advises Chair of submission and degree of urgency to situation
  • Maintains contact with submitter(s) and gathers additional information as required per Committee request. Ensures that submitter(s) is kept informed of consultation progress.
  • Provides submitter(s) with completed Response to Submitter
  • Acts as a resource to submitter for implementation of recommendations.

The Ethics Advisory Committee Chair:

  • Calls Committee meeting(s) in response to consultation requests recognizing urgency of situation
  • Facilitates Committee process and consultation with additional experts external to the Committee if deemed appropriate

The Ethics Advisory Committee:

  • Considers each consultation request following the SFMH Ethical Framework(Appendix C) using the Consultation Worksheet. (Appendix D)
  • Consults with external ethicist as required
  • Evaluates Committee performance on an annual basis including review of all completed Evaluation – Ethics Committee Consultationforms (Appendix E)

APPENDIX A

Consultation Request

JOINT SFMH/VM ETHICS ADVISORY COMMITTEE

Date referral received: / Received by:
Site/Unit/Program: / Method of referral:
Referring person: / Phone number:
Date referral contacted:
Name of patient: / Role/relationship of
referring person:

To be completed by the Referral Facilitator with the Referring Person.

  1. Brief description of the issue.
  1. Reason for the request
  1. Review of the parties involved in the situation
  1. Background information.
  1. Alternatives already explored and the outcomes.
  1. Urgency.
  1. Would an ethics consultation help?
  1. Who from the patient’s family and/or treatment team should be involved?
  1. Does the referring person have views on the type of consultation (large/small), professionals (ethics, lawyers, spiritual care, physicians)?
  1. Preferred location and time of consult or alternative preferences.
  1. Expectation of the ethics consultation.

The purpose of an ethics consultation is to clearly identify courses of action and analyze the ethical implications of each. It is not the task of the consultation team to make a decision (like a court of law) or to recommend a clear course of action (like a medical consult).

I ______agree with the statement of the problem and understand the role of ethics consultation.

______Signature of Referring Person Date

______

Signature of Referral FacilitatorDate

Is a formal consultation proceeding?
YES: Date/place/time / NO: Reason

APPENDIX B

RESPONSE TO SUBMITTER

JOINT SFMH/VM ETHICS ADVISORY COMMITTEE

Date referral received: / Received by:
Site/Unit/Program: / Method of referral:
Referring person: / Phone number:
Name of patient: / Role/relationship of
referring person:

______Signature of Chair Date

Ethics Advisory Committee

APPENDIX C

APPENDIX D

JOINT SFMH/VM ETHICS ADVISORY COMMITTEE

CONSULTATION WORKSHEET

Statement of Ethical Dilemma / Statement of Facts / Stakeholders / Competency / Culture / Spirituality / Financial / Veracity & Confidentiality / Statement of Options / Evaluate Options
(also see Principles chart) / Make Recommendation & Test It / Reflect on Outcome

Statement of Ethical Dilemma

Ask:Could this decision or situation be damaging to someone or to some group? Does this decision involve a choice between a good and bad alternative, or perhaps between two "goods" or between two "bads"? Is this issue about more than what is legal or what is most efficient?

Statement of Facts

Ask: What are the relevant facts of the case? What facts are not known? Are some concerns more important? Why?

Stakeholders:

Ask: What individuals and groups have an important stake in the outcome? Have all the relevant persons and groups been consulted? What are the stakeholders telling us?

Competency

Is the patient competent and has his/her wishes been recognized and respected? If the patient is not competent, are their wishes known and is there a designated SDM?

Culture

Has the context of the patient’s culture been respected?

Spirituality

Has the context of the patient’s spirituality been respected?

Financial

Have financial concerns been recognized and addressed?

Veracity & Confidentiality

Obligation to full and honest disclosure. Information revealed with consent and for benefit of the patient.

Statement of Options:

Ask: What are the options for acting? Have we identified creative options? Are there legal/professional considerations?

Evaluate Options

Ask: Which option will produce the most good and do the least harm? (The Utilitarian Approach) Which option best respects the rights of all who have a stake? (The Rights Approach) Which option treats people equally or proportionately? (The Justice Approach) Which option best serves the community as a whole, not just some members? (The Common Good Approach) Which option leads me to act as the sort of person I want to be? (The Virtue Approach)

Make a Recommendation and Test It

Ask: Do we know enough to make a recommendation? Considering all these approaches, which option best addresses the situation? If we told someone we respect-or told a television audience-which option we have chosen, what would they say and would we be comfortable doing it?

Reflect on the Outcome

Ask: How can our recommendation be implemented with the greatest care and attention to the concerns of all stakeholders? How did our recommendation turn out and what have we learned from this specific situation?

Option / Autonomy
Respect for the individual’s ability to make decisions with regard to their own health and future. Individuals have the right to accept or refuse treatment, or allow the natural course of events to take place. / Justice & Social Responsibility
Being fair or just to the wider community in terms of the consequences of an action.
Respecting the rights and dignity of each human being.Actions are consistent, accountable and transparent / Beneficence
Actions are intended to benefit the patient or other. Patient’s welfare isthe first consideration. / Non-maleficence
Actions intended not to harm or bring harm to the patient and others. Whenconsidering a medical treatment for a patient, one speaks of ordinary and proportionate care versus extraordinary and disproportionate care.
1
2
3

APPENDIX E

JOINT SFMH/VM ETHICS ADVISORY COMMITTEE

HOW DID WE DO?

The Ethics Advisory Committee benefits from your feedback as we refine the process of ethics consultations. Please complete the following questionnaire and return it in the enclosed stamped, self-addressed envelope.

  1. How did you hear about the Ethics Advisory Committee?

______

  1. Was the process of reaching the Committee easy and timely?

______

  1. Was your experience with the Committee helpful?

______

  1. Was your experience with the Committee what you expected?

______

  1. How would you rate the consult?

 Excellent,  Good,  Fair,  Unsatisfactory,  Very Unsatisfactory

  1. Is there anything else you can suggest to help us improve our service?

______