Sunnybrook Health Sciences Centre, Ethics Centre
People and Roles:
Bioethicists: Blair Henry, Sally Bean
Sunnybrook Ethics Centre's 2010 & 2011 Two Year Report:
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 consultation, education, policy review & development and academic scholarship. Our objectives are achieved through collaboration with all of Sunnybrook's stakeholders including staff, managers, senior administrators, physicians, board members, patients and families.
What does a Bioethicist do?
Bioethics emerged in part from medical advancements, capable of prolonging life, or assisting in human reproduction (for example), that raised complex ethical or moral questions for healthcare providers as well as society as a whole. Bioethicists or as they are referred to at Sunnybrook as “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 value-based challenges in health care ranging from the patient bedside to the boardroom. Ethicists are consultants and facilitators to those who make the important daily decisions impacting patient care.
Hub and Spoke Strategy (HSS):
Several years ago a new model for the delivery of clinical ethics services was developed through a University of Toronto Joint Centre for Bioethics consultation group to address the need for greater accountability, sustainability and integration of hospital based 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 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 for addressing everyday ethical concerns.
- What is the “Hub”?
The Ethics Centre (EC) located on the second floor of H Wing is the coordinating "Hub" for Sunnybrook Health Sciences Centre. Blair Henry and Sally Bean are full-time ethicists working with the EC. They provide educational and consultative services throughout the hospital; develop and review policies and guidelines; serve on key organizational committees; contribute to academic scholarship and work collaboratively to help support the activities and projects undertaken by clinicians and Ethics Advisory Group members participating in the hub and spoke model. Office coordinator and administrative assistant Andy Marshall offers administrative support to the EC and its contributors.
- What are “Spokes”?
Our Spokes are called Ethics Advisory Groups (EAG). EAGs are essentially embedded ethics committees located within each of the seven strategic programs of Sunnybrook Health Sciences Centre. Ethics Advisory Group members are hospital staff and physicians who have demonstrated an interest in clinical ethics, have pursued their own learning about ethics, and work within interdisciplinary EAGs to organize educational ethics rounds and liaise with colleagues about Ethics Centre activities and resources. These individuals play an important role in the HSS as they promote ethics learning, knowledge and understanding within their program. 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 EC offers consultative, educational and administrative support to EAG members in bringing ethics activities to their local areas.
- High-Level Spoke
The Ethics Strategic Advisory Group (ESAG) is an advisory group created with EC and Senior Leadership representatives with the purpose of providing guidance to the EC on existing and emergent organizational ethics matters and reciprocally to provide Senior Leadership with input on ethics issues with an organization-wide scope. This group meets quarterly, with the opportunity for ad hoc meetings to be called at the discretion of the chair.
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.
Succeeding Dr. Hébert as Director of the CEC was Karen Faith. She led the Centre effectively for several years, retiring in 2009. Shawn Winsor subsequently accepted the position of Director in July 2009. Shawn demonstrated leadership in several areas such as co-chairing a task force that developed supplementary triage criteria for inclusion in pandemic plans. Additionally, he led development and implementation of the Hub and Spoke model through establishment of Ethics Advisory Groups across the institution. He left the Ethics Centre in late 2010 in the capable hands of Blair and Sally.
Blair Henry became a Clinical and Research Ethicist in 2007 after spending the previous year at Sunnybrook as a Senior Fellow. Sally Bean began as a Senior Fellow in the fall of 2008 and in early 2009, joined Blair as a Clinical and Research Ethicist. In 2011, the role of Policy Advisor was added to Sally’s title. Currently, Sally & Blair both focus on Clinical and Organizational Ethics.
The EC offers consultation support to staff, physicians, patients and their families confronted by the difficult ethical or moral challenges arising in health care delivery. 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 or when appropriate, 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 Ethicist will assess whether an ethics consult is needed, or whether a referral to a more appropriate resource within the hospital or externally is recommended. Ethics consultations remain confidential to the extent permitted by law.
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. We also provide educational opportunities to enhance ethics knowledge and skill in decision-making for EAG members, medical clerks and residents. Additionally, we supervise graduate students and ethics fellows in collaboration with the Joint Centre for Bioethics and present educational sessions or formal seminars to its members and students.
Ethicist: Blair Henry, MTh
Sunnybrook Health Sciences Centre
Ethicist & Policy Advisor: Sally Bean, JD, MA
Office Administrator: Andy Marshall
Sunnybrook Health Sciences Centre
2075 Bayview Avenue, H242
Toronto, ON M4N 3M5
Phone: (416) 480-6100 ext.4818
* Any inquiries regarding research ethics should be directed to Sunnybrook’s Research Ethics Office. Contact Catherine Parry at email@example.com .