JCB Partners:
Sunnybrook Health Sciences Centre, Clinical Ethics Centre
People and Roles:
Bioethicists: Shawn Winsor (Director), Blair Henry, Sally Bean
Program Description:
The Ethics Centre at Sunnybrook Health Sciences Centre is committed to improving patient-centered care by promoting ethics knowledge and skill in decision-making throughout the organization. We endeavor to provide leadership in the provision of clinical and organizational ethics services through scholarship, education, and research. This is to be achieved through collaboration, cooperation and consultation with all of Sunnybrook's stakeholders: staff, managers, senior administrators, physician, board members, patients, and families.
Hub and Spoke Strategy (HSS):
Several years ago a new model for the delivery of clinical ethics services was developed through the University of Toronto Joint Centre for Bioethics consultation group to address the need for greater accountability, sustainability and integration of hospital based clinical ethics services. The metaphor for the HSS is that of a wheel containing a core centre or hub, with spokes radiating out to a rim.
The Hub consists of clinical ethics leadership along with administrative support. Spokes consist of clinicians and ethics education resource leaders who develop & promote local ethics activities.
Important goals of this model for clinical ethics services are building ethics capacity while promoting an interdisciplinary team approach to addressing daily ethical concerns.
- What is the “Hub”?
- What Does a Clinical Ethicist do?
Clinical ethics grew from the need created when advancements in biotechnology, capable of prolonging life, assisting in human reproduction (for example) raised complex ethical or moral questions for hospital staff as well as for society as a whole. Clinical ethicists have advanced degrees in bioethics or philosophy and many have professional backgrounds in medicine, nursing, law or social work. Their work is devoted to enhancing ethical understanding, knowledge and decision-making regarding the challenges found in health care not just at the bedside, but all the way to the boardroom. Clinical ethicists are consultants and facilitators to those who make the important daily decisions impacting patient care. They work with medical teams, hospital consultants, managers, patients and the patients’ families. - What is a Clinical Ethics Spoke?
Clinical Ethics Spokes are clinicians at the hospital who are ethics resource leaders with advanced degrees and training in ethics. These Clinical Ethics Spokes help to integrate ethics awareness, knowledge and decision-making skills in their local areas of service as well as throughout the hospital. Their work can include clinical ethics consultation, policy development, ethics related research and ethics education. All Clinical Ethics Spokes work closely with the Hub in providing and promoting the ethics program here at Sunnybrook. Consultative, administrative and financial support is offered through the CEC to sustain these important roles and related ethics activities. Currently there are 2 Clinical Ethics Spokes, Dr. Scott Berry in oncology, and Dr. Andrew Cooper in critical care. - What is an Ethics Education Facilitator?
Ethics Education Facilitators are hospital staff who have demonstrated an interest in clinical ethics, have pursued their own learning about ethics and who have organized educational rounds. These individuals play an important role in the HSS as they promote ethics learning, knowledge and understanding locally. They are active members within their own area of management, service or care with an intimate knowledge of the common ethical challenges and the need for ethics consultation or education. The CEC offers consultative, educational as well as administrative support to Ethics Education Facilitators in bringing ethics activities to their local areas. -
What does the Hospital Ethics Committee Do?
The Hospital Ethics Committee (HEC) is composed of CEC affiliated clinical ethicists, Clinical Ethics Spokes, some of the Ethics Education Facilitators as well as a member of the community and staff interested in supporting the ethics program. This committee serves as an advisory group to the CEC and has an important role in reviewing ethics related policies and providing guidance on complex organizational ethics issues. Another function of the HEC is to provide its members with opportunities to increase knowledge, language and skills pertaining to clinical ethics.
The Ethics Centre (EC) located on the second floor of H Wing is the coordinating "Hub" for Sunnybrook Health Sciences Centre. Shawn Winsor is a bioethicist and the Director of the EC. Blair Henry and Sally Bean are full-time bioethicists working with both the EC and the Research Ethics Office. Both serve on the hospital's Research Ethics Board (REB), where Blair is vice-chair.
As the Director, Shawn is responsible for the daily executive & administrative decisions pertaining to the Ethics Centre, and attends the relevant senior management fora on behalf of the EC. Shawn, Blair, and Sally provide educational and consultative services throughout the hospital, develop and contribute to policy and guideline development, serve on key organizational committees, and work collaboratively to help support the activities and projects undertaken by clinicians and Ethics Education Facilitators participating in the hub and spoke model. Office coordinator and administrative assistant Darnell Charlemagne offers administrative support to the EC and its contributors.
History:
The Ethics Centre was established in 1988, initially as the Clinical Ethics Centre (CEC), by Martin Barkin, CEO of Sunnybrook Health Science Center, in a response to a proposal by Dr. John Senn. Dr. Senn, a haematologist, was the first person to provide a resource in health care ethics to Sunnybrook staff members, other medical centres and community organizations.
Under Dr. Senn's leadership, Sunnybrook Health Sciences Centre became a partner in establishing the University of Toronto's Joint Centre for Bioethics. Dr. Senn attracted Eric Meslin, PhD (Georgetown University) to act as the CEC's first bioethicist - a position he ably filled until his departure for the National Institutes of Health in Washington D.C., and subsequently Indiana University.
In 1997, Dr. Philip Hébert, (who is a bioethicist with a PhD in philosophy from York University, and a physician in the Department of Family Medicine) became the CEC's first Director with Leigh Turner joining him as hospital bioethicist from 1998 until 2000 when he left to take up a position at McGill University in Montreal.
Blair Henry assumed his current position of Clinical and Research Ethicist in 2007 after spending the previous year at Sunnybrook as a Senior Fellow. Sally Bean was hired as an Ethicist to the Ethics Program in 2008, and in 2009 joined Blair as a Clinical and Research Ethicist.
In 2009, Karen Faith retired from Sunnybrook and Shawn Winsor accepted the position of Director in July of that year. Also that year, the CEC was renamed the Ethics Centre (EC) to reflect its growing involvement in organizational ethics issues, as well as clinical.
Consultation:
The EC offers consultation support to staff, physicians, patients and their families confronted by the difficult ethical or moral challenges found in health care. Our consultative services are offered in a supportive and advisory manner recognizing that treatment decisions are ultimately the responsibility of the treatment team in collaboration with the capable patient's wishes and/or the patient?s substitute decision-maker(s).
Any member of the medical team, hospital staff, patients, and patient families can make a confidential request for ethics consultation services. After receiving a request, the bioethicist will assess whether an ethics consult is needed, or whether a referral to a more appropriate resource within the hospital or within the community is required. Ethics consultations remain confidential unless there is any threat of harm or abuse to a patient, staff or family member.
Education:
The Ethics Centre helps to coordinate and provide ethics education throughout Sunnybrook Health Sciences Centre in the form of unit based rounds, in-service workshops, and formal hospital-wide presentations. Many of these educational activities are done in collaboration with other departments and hospital services, such as medical education. We also offer those invovlved in the hub and spoke model to provide educational opportunities to enhance ethics knowledge and skill in decision-making. We also supervise graduate students and clinical ethics fellows in collaboration with the Joint Centre for Bioethics and present educational seminars to its members and students.
Website:
Sunnybrook Health Sciences Centre 
Contact information:
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Director/Bioethicist: Shawn Winsor Email: shawn.winsor@sunnybrook.ca |
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Clinical and Research Ethicist: Blair Henry Sunnybrook Health Sciences Centre |
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Clinical & Research Ethicist: Sally Bean |
Office Administrator: Darnell Charlemagne
Sunnybrook Health Sciences Centre
2075 Bayview Avenue, H242
Toronto, ON M4N 3M5
Phone: (416) 480-6100 ext.4818
Email: clinical.ethics@sunnybrook.ca 
