JCB Partners:
North York General Hospital, Ethics Program
People and Roles:
Ethicist: Jonathan Breslin, PhD
Program Description:
The Ethics Program was officially formed in 2005 when North York General Hospital (NYGH) joined the Joint Centre for Bioethics. Prior to that there was no formal ethics support in the organization, though there was a group of staff members who provided ethics consultation. Thus, in terms of the "lifespan" of a program, the Ethics Program at NYGH could be described as situated in the earliest building stage. Our five-year priorities, developed during a planning process in early 2006, are centered around raising awareness, education, and capacity-building.
One of the key components of the program is the newly-formed Ethics Team, an interprofessional group of staff members dedicated to their own capacity-building in ethics. It is based to a degree on the philosophy of the “Hub and Spokes” model, insofar as the members represent a wide range of professional groups and areas in the organization, and they help build capacity throughout the organization by building their own capacity. Team members are expected to develop a set of goals related to the mandate of the Team at the beginning of each year (Sept.-June) and are accountable to the Ethicist for fulfilling their goals.
Consultation:
Ethics consultation is provided for clinical, organizational and research ethics issues. The Ethicist is the primary point of entry for consults but others may be involved in various stages of the process where appropriate (e.g., JCB Fellows, Ethics Team members). Anyone has the right to request an ethics consult, including patients, family members, staff, physicians, and administrators. Consults often center around such issues as: informed consent, substitute decision making, disagreements over feeding tubes and CPR, and withholding information from patients.
Education:
Education, both formal and informal, is a major component of the Ethics Program at NYGH. The goals of ethics education are to raise awareness about ethical issues in health care and to help staff develop the capacity to recognize and address ethical issues as they arise. We employ a variety of methods to achieve these goals, including:
- unit-based rounds, inservices and lunch ‘n learns as requested
- informal ethics discussion groups
- Ethics Grand Rounds
- Annual Ethics Week
- bi-weekly ethics orientation for new staff
- Ethics Program intranet site
In addition, the Ethics Team is an interprofessional group of NYGH staff members who are committed to developing their own ethics capacity, so that they can in turn help develop ethics capacity throughout the organization. This Team meets monthly to discuss ethical issues and cases, and each Team member develops a personalized learning plan at the beginning of each year (Sept.-June) in consultation with the Ethicist. The learning plans help each Team member tailor his or her ethics learning to his or her own needs.
Policy Development:
The Ethics Program has played a key role in the development, revision, and implementation of several organizational policies. Notable initiatives include:
- assisting with the educational rollout and evaluation of the revised Consent to Treatment policy
- led the revision, educational rollout, and evaluation of the revised Resuscitation Status policy
- currently developing a new Ethics Consultation policy
Research:
Our current priority is the development of the NYGH Ethics Program, so research has not played a major role in our work thus far. However, areas of research interest include disagreements over life-sustaining treatment and the effect of Ethics support on staff moral distress.
Website:
Contact information:
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Ethicist: Jonathan Breslin, PhD |
