Community Ethics Network

About the Community Ethics Network:

Traditionally the field of ethics, in the context of the multidisciplinary community health and support sector, has been poorly studied and serviced. In 2000, the former Toronto Community Access Centre (CCAC) sponsored a collaborative effort with multiple community health and support organizations with the objective of promoting a common approach for ethical decision-making. As part of this initiative we have worked closely with the other Community Care Access Centres in the greater Toronto area and with several partner community health and support service agencies in the development of a Community Ethics Network.

The Network's mission is to advance the practice of ethics in the community health and support sector. The purpose of the Network is to provide resources, coordination and support for both clinical and operational ethics at a city-wide and Local Health Integration Network (LHIN) level. This Network serves as a forum for promoting a consistent and transparent approach to ethical decision-making and for supporting the exchange of information.

Since its official launch in 2005, the Network has been actively developing mechanisms to proactively identify emerging issues, trends, and quality improvement; an education strategy; a biannual speaker series specific to community ethics; a data base of community cases for teaching materials; and an ethics curriculum in conjunction with universities and community colleges in inter-professional education for front line workers.

In addition, members of the Community Ethics Network have been involved in conducting case review sessions, participating in weekly ethics rounds at the Joint Centre for Bioethics (JCB) and the JCB Summer Institute, and engaging in ongoing research.

Notably, the Community Ethics Network was the proud recipient of an OACCAC Award for Excellence, Systems Partnership Category in 2007.

Network Documents:

Network Terms of Reference
Steering Committee Terms of Reference
Letter of Understanding

Members of the Community Ethics Network:

Network membership is expanding. Currently members include the following community health and support organizations:

Community Ethics Network Resources:

Ethical dilemmas are frequently encountered by community health and support workers, including case managers, nurses, personal support workers, and others. Some examples of ethical dilemmas include working with individuals living at risk, equitably distributing limited resources, and determining decision-making capacity to name a few.

Responses to ethical dilemmas in the community sector demand tools that to support staff, while dealing with the lack of resources that often exist to support ethics initiatives.

The Community Ethics Networks' goal is to enhance ethical decision-making practice across the community health sector. To meet this challenge, all members of the community health care team, regardless of their discipline or the organization in which they are employed, will have access to the same resources. These tools will also allow for a similar approach to ethical dilemmas that will facilitate collaboration in delivering client-centered care, and achieve greater consistency in practice across the sector.

Community Ethics Toolkit:

The Community Ethics Toolkit was created to facilitate the broader implementation of a common approach for ethical decision-making across the community health and support sector. The toolkit consists of the following components:

A Code of Ethics for the community health and support sector
A decision-making worksheet
Guidelines for using the decision-making worksheet
Guidelines for conducting case reviews
Additional resources

To facilitate sharing, the toolkit has been made available electronically. When used, we ask that authorship be acknowledged or cited.

The Community Ethics Toolkit

The Ethical Decision-Making Worksheet

Community Ethics Case Consultation:

Over 30 community ethics cases have been developed as teaching materials through interviews with front line health care providers and case managers. They are based on real-life dilemmas but have been anonymized for privacy purposes. The goal is to provide relevant and compelling cases which are suitable for those working in the community. Such cases were previously unavailable.

Ethics Consultation Database:

Members of the Network are currently testing a database that allows for easy and secure recording and trending of ethics consultation data. This will help organizations meet changing accreditation standards, and facilitate de-identified sharing of information between organizations in a standard format.

Community Ethics Literature Reviews:

Categorized Literature Review

Code of Ethics for the Community Health and Support Sector:

We, as employees of Community Health and Support Sector organizations, are committed to being an integral part of the communities we serve. We are responsible for: acting professionally and in a client-centred manner; upholding the dignity and honour of our clients; and practising in accordance with ethical principles. This Code of Ethics is intended to provide us with specific ethical principles to address situations that we may encounter, and to guide us in our relationships with clients, family members and others in the support team, other health care practitioners, and the public. This code is intended to complement laws, codes and standards of professional practice.

Advocacy: We have the responsibility to help improve the awareness, the accessibility and the quality of our services by advocating on behalf of our clients. We will seek guidance both internally and externally from our organization for those situations that could place the organization and/or its clients at risk.

Client and Employee Safety: We recognize that the community setting represents a unique environment for community and health sector employees. We will take available steps to assess and minimize risk to clients, while being sensitive to their wishes. We will also take necessary measures to ensure the personal safety of employees, and safety concerns of both clients and employees will be reported and addressed in a supportive and non-threatening way. After all options have been considered, we may withdraw services if employee safety is compromised.

Commitment to Quality Services: We are committed to providing the highest quality services that will benefit our clients within available resources.

Confidentiality: Client information is confidential; we will ensure that clients and their legal substitute are informed of their right to consent to the sharing of necessary information with individuals and organizations directly involved in the client’s care.

Conflict of Interest: We will not compromise services to our clients for our own personal benefit.

Dignity: In all our interactions we will demonstrate profound respect for human dignity. We will be responsive and sensitive to the diversity among our clients and staff groups.

Fair and Equitable Access: We believe that each individual is entitled to an assessment. We will ensure that services are based on clients’ needs, regardless of their income, age, gender, ethnicity or race, physical or mental ability, and any other factors such as diverse behaviors or lifestyle.

Health and Well Being: We will use a holistic approach to clients’ health care needs by acknowledging all things important to them in their community.

Informed Choice and Empowerment: We believe that most individuals have the ability and the right to make decisions about their health. We will assist clients to make care plans and life choices in keeping with the client’s values, beliefs and health care goals. We will ensure that clients are fully informed of their options and have all the information they need to make informed decisions about their health. Following due process, if the client is determined to be incapable of making these decisions, we will take directions from the client’s legal substitute.

Relationships Among Community Agencies: We recognize there may be a competitive element in our working relationships, however we agree to respect one another’s roles and to work together in the spirit of collaboration to maximize the effectiveness of client services.

CEN Newsletter:

As CEN continues to grow and to expand its reach and influence, the Steering Committee decided an additional communications tool was needed to keep members in touch with everything that’s going on. It is proud to present the new quarterly electronic newsletter.

CEN Workshops:

May 29, 2008 workshop “Using the Community Ethics Network Toolkit towards Meeting the Canadian Council on Health Services Accreditation (CCHSA) Standards”
Workshop invitation

CEN 2008 Fall Conference - November 18, 2008 at the Sunnybrook Vaughan Estate
Conference flyer
Registration form
2008 Fall Conference Report
Town Hall Meeting – June 10, 2009
Town Hall Meeting Report
2009 Fall Conference/Workshop
Conference Invitation
Conference Flyer
Registration Form
2009 Fall Conference Report

Contact Information:

Frank Wagner, BA, MA, MHSc, Co-Chair, Community Ethics Network Steering Committee
Toronto Central CCAC
Phone: (416) 217-3820 ext.2466
Email: frank.wagner@toronto.ccac-ont.ca

Frank Wagner is the Bioethicist for the Toronto Central CCAC and Joint Centre for Bioethics, University of Toronto. Frank is also Assistant Professor, Department of Family and Community Medicine, Faculty of Medicine, University of Toronto.

Maria Chau

Administrative Assistant, Toronto Central CCAC and Community Ethics Network Steering Committee

Phone: (416) 217-3820 ext. 2526

E-mail: maria.chau@toronto.ccac-ont.ca