Research: Clinical Ethics

Project Examining Effectiveness in Clinical Ethics (PEECE)
The field of clinical ethics is relatively new, and good practices have not yet been systematically studied, evaluated, or shared. Clinical ethics practice has been described as a “black box” because of the lack of evidence for effectiveness and for good practice in the discipline.


Conceived by the JCB’s Clinical Ethics Group, PEECE is an innovative study designed to address the pressing need to identify good practices for clinical ethics. PEECE involved a series of nine case studies at JCB partner hospitals across Toronto. The specific objective was to examine perceptions of effectiveness and good practice in clinical ethics through the eyes of the bioethicists, clinical staff, hospital senior management, and patients and families. By including the views of all key stakeholders, the aim was for PEECE to provide a solid basis for further research and development in clinical ethics.


Among the key findings of PEECE was that senior managers indicated great enthusiasm and support both for the JCB and for their respective on-site clinical ethics services. Clinical ethicists are increasingly viewed as an important voice on “boardroom” issues such as transparency, resource allocation, priority setting, and accountability. Many senior managers spoke of the positive impact of clinical ethics on hospital policy development, and indicated a need for greater input from and involvement of clinical ethicists across the entire organization. Thus, the PEECE data signal an ongoing shift in the emphasis of clinical ethics services from a purely clinical role to one that is institution-wide (bedside-to-boardroom).


Another significant finding was the complexity of clinical ethics requires a broad and varied set of skills and knowledge. Different institutions may require different approaches to clinical ethics and clinical ethicists need to play multiple roles including a consultant, policy maker, educator, mediator, and researcher. Clinical ethicists need knowledge of ethics theory and literature, the health care system, health law, leadership skills, and medical terminology. They are expected to show wisdom, impartiality, fairness, honesty, and humility and must continuously attempt to balance competing individual, institutional, and societal needs and interests.


A major recommendation flowing from the PEECE data is that health care organizations adopt a capacity-building approach for clinical ethics, such as the Hub and Spokes Strategy, in order to build clinical ethics programs that are more sustainable, accountable, and integrated. The PEECE investigators also recommend that health care organizations develop tools and/or mechanisms to measure the impact of clinical ethics on the quality of care delivery.


Following PEECE, the Clinical Ethics Group has worked with accreditation authorities in Canada to ensure that hospital accreditation standards for ethics are based on the best available evidence.


Selected publications:

  • Godkin D, Faith K, Upshur REG, MacRae SK, Tracy CS, the PEECE Group, on behalf of Investigators. (2005). Project Examining Effectiveness in Clinical Ethics (PEECE): phase 1—descriptive analysis of nine clinical ethics services. Journal of Medical Ethics, 31(9):505-12.


Research Ethics Blog

A blog about human-subjects research ethics. It is written primarily by Nancy Walton, Ph.D., (with occasional postings by Chris MacDonald, Ph.D). To go to blog click here.