South West Health

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South West Health

60 Vancouver Street, Yarmouth, Nova Scotia

Canada B5A 2P5

Phone: 902-742-3541 Fax: 902-742-0369

South West Health buildings and properties are smoke, tobacco product and scent free.

	Welcome to our Ethics Page! Since the district was formed in 2001, the Ethics Committee has reformed itself to reflect its newly defined district mandate. As a sub-committee of the District Medical Advisory Committee, the Ethics Committee confirmed its Terms of Reference and its four-pronged mandate for education, research, clinical consultation and organizational ethics. Education Research Clinical Consultation Organizational Ethics About the Committee








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To support the education mandate, the committee has committed to sponsor an educational session each, the first being Ethics Research in 2003 (Dr. Charles Weijer, Dalhousie Department of Bioethics) and Clinical Consultation in 2004 (Dalhousie's Ethicists Christy Simpson and Dr. Jeff Kirby).

Since the educational session on Ethics Research in 2003 (Dr. Charles Weijer, Dalhousie Department of Bioethics), the committee has developed a Checklist (available) that must be completed with each research proposal's request for ethics approval. The Checklist is a tool that assists the committee in ensuring a complete process is undergone.

We are party to and support the newly established provincial Research Ethics Network Committee which is developing a framework and process for research submissions for the rural areas of our province that are not directly supported by a Research Ethics Board. The framework will include a recommendation for the government to provide a legislative framework for research ethics.

Researchers, universities, governments and private institutions undertake or fund research involving human subjects for many reasons. For example, to alleviate human suffering, to validate social or scientific theories, to dispel ignorance, to analyze policy, and to understand human behaviour and the evolving human condition.

Research has the potential to produce many social benefits. It also can present difficult ethical questions and situation. Researchers and institutions bear a moral and professional responsibility to carry out research involving human subjects in such a manner as to respect and protect the dignity of these subjects. In doing so, researchers and institutions also preserve a high social regard for the research endeavour itself.

This responsibility has been reflected in the 1998 TriCouncil Policy Statement on Ethical Conduct for Research Involving Humans. Canada's granting Councils (Medical Research Council of Canada http://www.mrc.gc.ca , Natural Sciences and Engineering Research Council of Canada http://www.nserc.ca , and Social Sciences and Humanities Research Council of Canada http://www.sshrc.ca ) wish to promote research that is conducted according to the highest ethical standards. The Councils have therefore adopted this policy as their standard of ethical conduct for research involving human subjects. As a condition of funding, they require, as a minimum, that researchers and their institutions apply the ethical principles and the articles of this policy, in all research where human subjects are involved.

In order to meet it professional responsibility and to comply with the TriCouncil Policy Statement, SWH has developed a policy and procedure that must be applied to all research involving human subjects. SWH's Ethics Committee which is comprised of internal and external members, reviews all the formal research projects that the organization participates in or has accountability for.

As well as the current strengths we have developed regarding research ethics, we are party to and support the newly established Nova Scotia Research Ethics Oversight Steering Group which is developing a framework and process for research submissions for the rural areas of our province that are not directly supported by a Research Ethics Board. The framework will include a recommendation for the government to provide a legislative framework for research ethics. (Terms of Reference available).

In a perfect world, "health care decisions will reflect agreement between the person receiving care and all others involved in his or her care. However, uncertainty and diverse viewpoints sometimes can give rise to disagreement about the goals of care or the means of achieving these goals. Limited health care resources and the constraints of existing organizational policies may also make it difficult to satisfy the person's needs, values and preferences...Disagreements about health care decisions can arise between or among any of the following: the person receiving care, proxies, family members, care providers and administrators of health care authorities, facilities or agencies" (taken from Joint Statement on Preventing and Resolving Ethical Conflicts Involving Health Care Providers and Person Receiving Care, a joint statement developed collaboratively and approved by the Boards of Directors of the Canadian Healthcare Association, the Canadian Medical Association, the Canadian Nurses Association and the Catholic Health Association of Canada. The entire statement is attached and can be found at http://www.cha.ca/documents/joint.htm and on our website http://www.swndha.nshealth.ca following the Ethics link.) The statement offers guidance for the development of policies for preventing and resolving ethical conflicts about the appropriateness of initiating, continuing, withholding or withdrawing care or treatment. It outlines the basic principles to be taken into account in the development of such policies as well as the steps that should be followed in resolving conflicts. The statement has been provided to the members of the Ethics Committee in its entirety to act as a guide for ethics consultation.

A forum for ethics consultation is provided on request from any source to our Ethics Committee. A brochure has been developed by the Committee and circulated throughout the organization in an effort to increase awareness about the Ethics Committee and its mandate. The brochure describes how a clinical consultation can assist the applicant to explore and discuss their dilemma and includes a form that can be used to request a clinical ethics consultation. The Committee attempts to provide a safe environment for discussion and exploration of an ethical dilemma. It does not offer solutions, but does attempt to offer options for consideration. The decision remains at the discretion of the applicant. When appropriate, the Committee may seek advice from experts external to the Committee. The brochure and process for ethics consultation has been shared with our Medical Advisory Committee, the Departmental Managers, the Team Leaders for the accreditation teams, placed in our lobby for easy access and on all nursing units. It has also been posted to our website, click here to download.

The Committee members have participated in an Ethics Consultation Workshop sponsored by Dalhousie's ethicists Dr. Jeff Kirby and Christy Simpson. The ethics decision-making framework was also developed by Dr. Jeff Kirby and adopted by SWH.

Our DHA is committed to working with all DHA's in the development of a provincial network for the general purposes of: connection, coordination and education as it pertains to ethics consultation. A pivotal event in this collaborative effect is the National Conference of the Bioethics Society to be held in Halifax this year (October 21-23, 2005).. The DHA's will be hosting a post-conference workshop in an effort to move this network forward.

Since the workshop on clinical consultation, the committee has developed and circulated an Ethics Brochure, defining the role of the committee and invited requests for facilitated clinical consultation. The brochure has been posted to SWH's website to enhance access for staff and others, and is appended to this section. Communication regarding the process for clinical consultations has been brought to the district departmental managers and to the team leaders of the accreditation care teams as well as to the volunteers that support our organization, including CHB's. It is important that staff and others remain clear as to ethics processes, which support issues and situations being dealt with ethically. To date, several clinical consultations have been facilitated by the committee. The intent is not to solve clinical ethical situations, but to provide a safe environment for staff and others to discuss potential options to the dilemmas they feel they are facing and have brought forward to the committee. A summary report is written and forwarded for reference to those applicants who bring forward the consultation requests.

Ethical reasons for decisions often get presented in the form of principles or values. SWH has undergone a comprehensive and coordinated approach to identifying and communicating its values as part of strategic planning. Seeking input from a wide variety of internal and external stakeholders has ensured a greater understanding and support at all levels.

Ethical challenges and debate can arise when ethical principles/values find themselves in conflict. When this happens, choices must be made.

Some ethical decisions appear to be more obvious than others, such as end-of-life care, resuscitation and so on. Issues in patient care can be far broader. For example, the requirement of "informed consent" prior to embarking on a course of treatment: This requirement is grounded in the principle that we should respect an individual's personal autonomy-their right to make decisions. The debate enters with the discussion of the limits of consent, especially as it relates to their refusal to accept treatment.

Add to that debate, the justice component-the process of allocating scarce resources to one area rather than other. This becomes an ethical choice, which expresses our individual and organizational values. The process of decision-making is a reasoned process where we seek to make the "best" choices we can.

In order to support and reflect ethics and values in decision-making, a Decision-Making Framework has been developed by Dalhousie's Ethicist, Dr. Jeff Kirby and adopted by SWH following review by the Ethics Committee. It will be communicated throughout the organization.

SWH's policies and procedures are developed within an ethical framework and context, both indirectly by increasing capacity throughout the organization through Ethics training and directly by including the Ethics Committee as a potential stakeholder in the policy and procedure development and revision process. In addition, our District Ethics Committee is prepared to review on request any policy or procedure being developed or revised by our organization, and provide input &/or recommendations.

The District Board of Directors have developed and adopted a Code of Conduct which provides guidance to members for ethical behaviour.

In health care settings, ethical questions arise when “the right thing to do” is unclear, or when people disagree about what is best for a patient.

The Ethics Committee is a consultative & advisory body and does not make decisions regarding a person’s care or the organization’s policies.

The Ethics Committee will accept referrals from physicians, staff, volunteers, families and patients where an ethical issue or dilemma regarding patient care exists.

Generally, ethical questions arise when “the right thing to do” is not clear or when people disagree about what is best for a person who requires care.

A referral can be made by filling out the form that is a part of this brochure. If you need help to decide whether or not an Ethics Consultation would help you, please feel free to talk to the Ethics Committee Chair or any of the committee members by calling 742-3542 Ext 798.