Volume 2, Issue 10 -- December 1999

Ethical Reflection in Canada

As part of its exploration of values, the Values Working Group commissioned research which analysed the current structure and functioning of the various federal, provincial and regional ethics boards in Canada. Research has also been conducted into the structure and functioning of national ethics bodies in other countries to see whether the existing framework in Canada needs a more national centralized body for ethical reflection (Leroux et al., 1997).

It is clear from the research that Canada's approach to confronting ethical considerations can best be described as ad hoc. For instance, when faced with the ethical dilemmas emerging from the rapid development of new reproductive techniques, a royal commission was established; when confronted with the AIDS epidemic, the Federal Centre for AIDS was created; to investigate the legal problems surrounding assisted suicide and euthanasia, the Senate of Canada mandated a special committee to examine the issue. These of course, are not isolated examples, but serve as a testament to lack of a universal approach in addressing ethical issues.

This is not to say that there are not some quasi-stable mechanisms for addressing some of these issues. At the national level, we note that the Canadian Medical Association is the only body documented among Canadian professional associations to have a permanent ethics committee. Some of its member associations have created their own ethics committees. Other organizations such as the Canadian Nurses Association choose to resolve ethical issues by means of particular committees. Research involving human subjects does receive more ongoing consideration with the involvement of such national bodies as the Medical Research Council of Canada and the National Council on Bioethics in Human Research.

In some nations, ethical reflection enjoys a more permanent, respected role in the operations of research and medicine. Where national ethics committees are in existence (Belgium, Australia, France, for example), all were established by either executive or legislative power. This institutionalization provides these bodies with legitimacy, not only in the medical/research arena, but also with the public. Of course, the legal, political and even cultural contexts which many of these nations offer, allow this legitimacy to exist.

Additionally, understanding the current and emerging importance of institutionalized processes for ethical reflection appears much more advanced in these nations. For example, the Australian Health Ethics Committee is mandated to carry out studies and to advise government on ethical, legal and social issues related to public health, medical practice and research on human beings, as well as to play a part in developing rules of conduct in the field of health. Clearly this demonstrates political willingness not only to create these bodies but also to engage in necessary discussion, which is central to their effectiveness.

Without question, a just-in-time method of creating specific working groups and committees to address ethical questions is not a sustainable method for ethical debate. There is a multitude of ethical dilemmas that face societies today -- from debate on reproductive methods to implications on privacy posed by the advancing capability of information technologies. It is clear that the ad hoc approach cannot definitively answer these questions. It is also clear that the trend in other countries is towards national oversight bodies characterized by greater communication and coordination in which consensus is achieved on issues and solutions. However, none of the solutions found by other countries is ideal for Canada.

A viable direction for advancing ethical debate in Canada is that of strengthening the links between existing organizations and networks. As research commissioned by the working group notes, there is little, if any, communication and collaboration among ethics bodies at the local and provincial levels. There are no provincial federations of local ethics bodies and, save for Quebec and Alberta where institutional ethics networks exist, there is little evidence that the organizations communicate with each other. The obvious result is duplication of work, lack of information and resource sharing and, most important, the risk of not achieving global consensus on issues when one is necessary. Encouraging permanent links where there were none before can be the first step in addressing fragmentation of efforts in the current ethical debate.

Key Message

The Values Working Group has concluded that the present ad hoc approach in Canada of linking values with health policy issues is not acceptable. However, there were no obvious structural solutions in other countries that are ideal for Canada. We need to find a Canadian solution. As an inaugural step in the process of enhancing and improving ethical reflection in Canada, the federal Minister of Health should take the lead in discussing with his provincial /territorial counterparts and key groups with a substantial interest in ethics ways to establish permanent linkages among ethics networks and bodies.

An action plan to accomplish this objective should be developed. Moreover, Ministers should also consider the ways and means of involving the public in discussions of ethical problems related to health. Because decisions on these issues will undoubtedly address areas of life formerly considered private, the public will demand, and should be granted, the opportunity to be heard and considered as part of the decision-making process.

PHEN Internet Discussion Forum

A reminder to all that conversations on PHEN's new internet discussion list will begin in the new year. Those interested in participating or just hanging around to read the comments of other members are encouraged to sign up by contacting the Network's Research Assistant, Marika Warren, at warren@phen.ab.ca.

Discussion on the list will address issues in health ethics from an uniquely Albertan perspective, beginning in January!  

PHEN Membership Renewal

A reminder to all that PHEN memberships expire on December 31, 1999. In order to avoid missing out on the benefits of your membership, and in this way continue supporting the discussion of ethical issues in health care throughout the province, please complete the accompanying form and submit it together with payment to the Northern Alberta Office of the Network. Thank you for your continued support of PHEN's work.  

Discussion of CCHSA Ethics Standards

In light of stronger ethics related content in the standards outlined by the Canadian Council of Health Services Accreditation, PHEN has initiated a number of forums around the province to engage discussion about these standards. These sessions are set to take place from January 25, 2000 to February 7, 2000 , in Grand Prairie, Edmonton, Calgary, and Lethbridge. Please contact either PHEN office for more details are consult the Network's web site at http://www.phen.ab.ca  

Ethics at the End of Life Conference

PHEN, in conjunctions with Pallative Care Association of Alberta and Grant MacEwan College, is please to announce an upcoming conference titled, "The Fabric of Goodness: Weaving Ethical Practices in Decision-Making at the End of Life". The conference is to be held on March 24, 2000 at the Grant MacEwan College in Edmonton.

Keynote speakers at the conference include Dr. Elizabeth Latimer, Dr. Laura Shanner, Dr. Michael Stingl, and Dr. Rozalie Staromskie. For more information please call (780) 497-5188 or e-mail ethics.conference@gmcc.ab.ca

Views offered in this article are those of the author and do not necessarily reflect the position of the Provincial Health Ethics Network.