Policy Name:
St. Francis
Memorial
Hospital
Policy & Procedure
Manual
Joint SFMH/VM Ethics Advisory
Committee – Submissions
Last Reviewed / Revised Date:
Administration
Category :
March 2012
Approved by:
Ethics
Original Date:
Ethics Chair
May 2010
Committee/Dept Review:
Signature
Ethics Advisory Committee
BACKGROUND
St. Francis Memorial Hospital (SFMH) and Valley Manor (VM) recognize that many staff
work at both sites and many residents/patients receive services/care from both
organizations. As well, it is recognized that it is beneficial to optimize resources
wherever possible. For these reasons, a Joint SFMH/VM Ethics Advisory Committee
has been initiated.
PURPOSE
SFMH and VM recognize that many ethical dilemmas arise in the health care
environment. Many will be resolved at the front line or with a focused discussion
involving the patient/resident/family and interprofessional care team. However, there
may be other ethical dilemmas which would derive benefit from a formal consultation
with the Ethics Advisory Committee.
SFMH POLICY
The Ethics Advisory Committee will act solely in an advisory and consultative capacity.
All patients/family members and staff will be advised of their right to access the Ethics
Advisory Committee. The Committee will not entertain submissions that would be
defined as personal ethical dilemmas but will be accountable for referring such requests
to other appropriate supports (e.g. pastoral care, EFAP, community resource listing).
As a rural, non-teaching hospital, SFMH is not typically involved in research. Should a
decision be made by the Senior Management to partner in or lead a research initiative,
an external Research Ethics Board (REB) approval of the research proposal would be
required. The REB approval would then be forwarded to the Ethics Advisory Committee.
The Advisory Committee will then have an opportunity to review the REB comments and
Research Proposal and append any Committee comments prior to forwarding to the CQI
Committee. Approval by the CQI Committee must take place prior to the initiation of any
research.
PROCEDURE
The Submitter:
 If unable to reach a resolution to identified ethical dilemmas following
consultation with other care team members, patient and family, considers the
option of submitting the dilemma to the Ethics Advisory Committee. Advises
patient and family that they also have the option to consult with the Ethics
Advisory Committee and provides appropriate information and assistance.
 Contacts one of the Ethics Advisory Committee representatives to initiate an
informal discussion of the situation
 Completes a Consultation Request (Appendix A) in collaboration with the
representative if the decision is made to submit the dilemma to the Committee.
Ensures that any urgency to the situation is clearly communicated to the
Committee.
 Provides further information as requested by the Committee. Retains the option
of speaking directly to the Committee.
 Receives the written Response to Submitter (Appendix B) from the Committee
which will include recommendations and options. Asks for clarification and
guidance from the Committee as required.
 Implements selected recommendation(s) in collaboration with the care team,
patient and family.
 Completes an Evaluation – Ethics Committee Consultation (Appendix C) form
(optional)
The Ethics Advisory Committee Representative:
 May receives a request for consultation verbally, electronically or in writing.
 Arranges to meet with submitter(s) to complete the Consultation Request.
 Advises Chair of submission and degree of urgency to situation
 Maintains contact with submitter(s) and gathers additional information as
required per Committee request. Ensures that submitter(s) is kept informed of
consultation progress.
 Provides submitter(s) with completed Response to Submitter
 Acts as a resource to submitter for implementation of recommendations.
The Ethics Advisory Committee Chair:
 Calls Committee meeting(s) in response to consultation requests recognizing
urgency of situation
 Facilitates Committee process and consultation with additional experts external
to the Committee if deemed appropriate
The Ethics Advisory Committee:
 Considers each consultation request following the SFMH Ethical Framework
(Appendix C) using the Consultation Worksheet. (Appendix D)
 Consults with external ethicist as required
 Evaluates Committee performance on an annual basis including review of all
completed Evaluation – Ethics Committee Consultation forms (Appendix E)
APPENDIX A
CONSULTATION REQUEST
JOINT SFMH/VM ETHICS ADVISORY COMMITTEE
Date referral received:
Site/Unit/Program:
Received by:
Method of referral:
Referring person:
Date referral contacted:
Name of patient:
Phone number:
Role/relationship of
referring person:
To be completed by the Referral Facilitator with the Referring Person.
1. Brief description of the issue.
2. Reason for the request
3. Review of the parties involved in the situation
4. Background information.
5. Alternatives already explored and the outcomes.
6. Urgency.
7. Would an ethics consultation help?
8. Who from the patient’s family and/or treatment team should be involved?
9. Does the referring person have views on the type of consultation
(large/small), professionals (ethics, lawyers, spiritual care, physicians)?
10. Preferred location and time of consult or alternative preferences.
11. Expectation of the ethics consultation.
The purpose of an ethics consultation is to clearly identify courses of
action and analyze the ethical implications of each. It is not the task of the
consultation team to make a decision (like a court of law) or to recommend
a clear course of action (like a medical consult).
I ______________________agree with the statement of the problem and
understand the role of ethics consultation.
______________________________
Signature of Referring Person
___________________
Date
______________________________
Signature of Referral Facilitator
___________________
Date
YES:
Is a formal consultation proceeding?
Date/place/time
NO: Reason
APPENDIX B
RESPONSE TO SUBMITTER
JOINT SFMH/VM ETHICS ADVISORY COMMITTEE
Date referral received:
Site/Unit/Program:
Referring person:
Name of patient:
Summary Ethical Dilemma
Primary Considerations/Impacting Factors
Received by:
Method of referral:
Phone number:
Role/relationship of
referring person:
Options Considered & Rationale
Recommendation(s)
Additional Comments
______________________________
Signature of Chair
Ethics Advisory Committee
___________________
Date
APPENDIX C
JOINT SFMH/VM ETHICS ADVISORY COMMITTEE
ETHICAL FRAMEWORK
1. Identify the problem. Are
ethical principles involved? Is it
an ethical problem?
8. Evaluate the outcome.
7. Determine best option
2. Identify all concerned parties.
ETHICAL PRINCIPLES
Autonomy
Beneficence
Justice
Non-maleficence
3. Develop options.
ETHICAL VALUES
Confidentiality Respect
Compassion
Advocacy
Dignity
Competence
4. Determine benefits and risks
6. Consider any precedents
and/or legal issues.
5. Discuss selected options
with identified parties.
Initiated By: Ethics Committee
Approved By: Ethics Committee
Date: 2005, R 2007 R 2010
APPENDIX D
JOINT SFMH/VM ETHICS ADVISORY COMMITTEE
CONSULTATION WORKSHEET
Statement of
Ethical
Dilemma
Statement of
Facts
Stakeholders
Competency
Culture
Spirituality
Financial
Veracity &
Confidentiality
Statement
of Options
Evaluate
Options
(also see
Principles
chart)
Make
Recommendation
& Test It
Reflect on
Outcome
Statement of Ethical Dilemma
Ask: Could this decision or situation be damaging to someone or to some group? Does this decision involve a choice between a good and bad alternative, or perhaps between two "goods" or between
two "bads"? Is this issue about more than what is legal or what is most efficient?
Statement of Facts
Ask: What are the relevant facts of the case? What facts are not known? Are some concerns more important? Why?
Stakeholders:
Ask: What individuals and groups have an important stake in the outcome? Have all the relevant persons and groups been consulted? What are the stakeholders telling us?
Competency
Is the patient competent and has his/her wishes been recognized and respected? If the patient is not competent, are their wishes known and is there a designated SDM?
Culture
Has the context of the patient’s culture been respected?
Spirituality
Has the context of the patient’s spirituality been respected?
Financial
Have financial concerns been recognized and addressed?
Veracity & Confidentiality
Obligation to full and honest disclosure. Information revealed with consent and for benefit of the patient.
Statement of Options:
Ask: What are the options for acting? Have we identified creative options? Are there legal/professional considerations?
Evaluate Options
Ask: Which option will produce the most good and do the least harm? (The Utilitarian Approach) Which option best respects the rights of all who have a stake? (The Rights Approach) Which option
treats people equally or proportionately? (The Justice Approach) Which option best serves the community as a whole, not just some members? (The Common Good Approach) Which option leads me to
act as the sort of person I want to be? (The Virtue Approach)
Make a Recommendation and Test It
Ask: Do we know enough to make a recommendation? Considering all these approaches, which option best addresses the situation? If we told someone we respect-or told a television audience-which
option we have chosen, what would they say and would we be comfortable doing it?
Reflect on the Outcome
Ask: How can our recommendation be implemented with the greatest care and attention to the concerns of all stakeholders? How did our recommendation turn out and what have we learned from this
specific situation?
Option
1
2
3
Autonomy
Justice & Social Responsibility
Respect for the individual’s ability to make
decisions with regard to their own health
and future. Individuals have the right to
accept or refuse treatment, or allow the
natural course of events to take place.
Being fair or just to the wider community in terms
of the consequences of an action.
Respecting the rights and dignity of each human
being. Actions are consistent, accountable and
transparent
Beneficence
Actions are intended to benefit the patient
or other. Patient’s welfare is the first
consideration.
Non-maleficence
Actions intended not to harm or bring harm to
the patient and others. When considering a
medical treatment for a patient, one speaks of
ordinary and proportionate care versus
extraordinary and disproportionate care.
APPENDIX E
JOINT SFMH/VM ETHICS ADVISORY COMMITTEE
HOW DID WE DO?
The Ethics Advisory Committee benefits from your feedback as we refine the process of
ethics consultations. Please complete the following questionnaire and return it in the
enclosed stamped, self-addressed envelope.
1. How did you hear about the Ethics Advisory Committee?
_________________________________________________________________________
2. Was the process of reaching the Committee easy and timely?
_________________________________________________________________________
3. Was your experience with the Committee helpful?
_________________________________________________________________________
4. Was your experience with the Committee what you expected?
_________________________________________________________________________
5. How would you rate the consult?
 Excellent,  Good,  Fair,  Unsatisfactory,  Very Unsatisfactory
6. Is there anything else you can suggest to help us improve our service?
_________________________________________________________________________