Volume 5, Issue 3 - May 2002

Every day staff working in our health care system face ethical issues. The issues can range from deciding who gets a service and who has to wait, to discontinuing a treatment for someone who is at the end stages of a terminal illness. Many of you can probably think of situations where you were faced with an ethical issue and didn't know what to do. On behalf of the Lakeland ethics steering committee, I'd like to share with you our experience of developing an approach to support front-line health care providers in resolving ethical issues in their day to day work.

Our story is not yet complete. At this point what we can talk about is the approach we've chosen and how we plan to implement it. In time, we would like to share the rest of the story with you. We are eager to get on with it and to share with others what we learn along the way.

Often, stories begin with a dedication. We wouldn't be telling this story if it were not for Bashir Jiwani of the Provincial Health Ethics Network. He has been our inspirational guide and teacher as we have developed our approach to ethics resolution in the Lakeland Health Region. We want to thank him for his dedication and support and are ever grateful for his continued involvement.

Our Approach

Our story starts with a vision - we envision that Lakeland will have a strong ethical culture in which governors, management and staff have well developed ethical decision-making skills and sensitivity for those working within and served by the Lakeland Health Region.

The main characters in the broader telling of our story will be our staff. They will play a large part in achieving our vision. But to make it happen, in the early chapters we feel we must build capacities and expertise at the front lines in order to address ethical issues. How will we do this? We will do it by developing "local health ethics resources".

By "local health ethics resources" we mean people - people who will function as the first line of support for those in our region who are grappling with ethical issues. Our idea is that when an issue is faced in the health care setting, those facing the issue will be able to turn to the local ethics resource for assistance.

How It Will Work

In particular, our approach calls for the local ethics resource to:

1. be a sounding board for those facing the ethical issues. Any staff member will be able to contact the ethics resource with ethics related questions. The ethics resource will assist the person facing the issue to consider its relevant ethics-related aspects and will share decision-making frameworks or guides that can help the staff member come up with a thoughtful, justifiable response to the issue in question. The local ethics resource will not provide answers, but rather assist individuals to arrive at the best possible answer for themselves.

2. provide support for dealing with the issue. This could include meeting with the relevant parties to gather and share information or facilitating communication and shared decision-making between those involved.

3. identify other expert resources available, such as professional ethics consultants, and facilitate consultation with these resources.

4. carry out ethics education events in their respective geographic area. Indeed, a key part of the ethics resource's work will involve facilitating proactive thinking about important ethical issues that arise in the clinical setting.

5. identify broader ethical issues raised in consultations and recommend them to the appropriate body for consideration. Local ethics resources will play a key part in identifying systemic ethical concerns facing the health region.

The People We Will Recruit

The ideal local ethics resource person will have a passion for ethics, a willingness to learn more and to help educate others. They will have, or be open to acquiring, effective communication and conflict resolution skills. And they will demonstrate respect for the opinions of others, flexibility, and self-reflection skills. Expertise in group leadership and a commitment to work in a multidisciplinary environment will be desirable traits.
We know that at first the individuals we recruit will have varying degrees of expertise in ethics. In recognition of this, the Lakeland Health Region has made a commitment to their ongoing support and education.

Why This Approach

Lakeland is a very large rural geographic region. We have over 30 facilities and health units spread far and wide throughout our region, which extends from Fort Saskatchewan in the south to Lac La Biche in the north and Cold Lake in the east. We wanted an approach that we could implement in key geographic catchment areas in stages over time. We believed the likelihood of success would be greater by starting in one or two areas and spreading to other areas as we learn what works and what could be improved in our approach. We want to make sure that our staff throughout the region can readily access human resources who can help them with their ethical questions.

Implementing the Plan

To kick off our implementation plan, we held two workshops in April entitled "An Ounce of Ethics" in two of our communities. The purpose of these workshops was primarily to initiate ethics education and raise awareness of the role ethics plays in our daily work. The workshops also provided an opportunity to introduce the local ethics resource approach and to initiate the recruitment process.

Recruitment will occur mainly by word of mouth between April and June. We have already had numerous individuals expressing interest. In June, we will select a maximum of six candidates in our pilot project. Training and education of the selected local ethics resources will happen between July and October. A training program is being developed by PHEN that will consist of reading materials, teleconferences, videos and practical training sessions. The local ethics resources will start their work in November, 2002. They will be remunerated for up to the equivalent of a half-day per week at either a flat hourly rate or time off in lieu of time worked.

Supporting our Local Ethics Resources

As mentioned, we see supporting these resources as crucial to our plan. For the first two months, our ethics committee will host weekly teleconferences with the local ethics resources to debrief and share experiences. This will facilitate the development of a network of support and also allow for an opportunity to identify any systemic issues that may arise out of their work. We'd like to meet face to face with our local ethics resources twice a year to discuss issues, share learning and celebrate success.

Will it work?

We are convinced that this approach is the best possible for our staff. We expect bumps and maybe even roadblocks along the way; but, as one of our committee members said, "if you have a group of individuals with the willingness and heart to develop something new - it can be done!"
We are excited about our approach and will be tireless in our efforts to support the local ethics resources to succeed. We will be evaluating the approach as we go along and look forward to reporting on our progress in a future issue.

Announcements

• PHEN Conference and General Meeting- May 24, 2002

  For those who have already registered for this year’s annual PHEN conference, please note that all registrations are being confirmed within a few days of submission. If you have not yet received your confirmation of registration, please contact Deb Fisher at PHEN’s Northern Alberta Office.

• Summer Seminar in Health Care Ethics
  
  This year, the University of Washington’s annual one-week bioethics seminar will be held August 5-9, 2002. Chaired by Dr. Albert R. Jonsen, it is an intensive introduction to the concepts, methods, and literature of health care ethics. The seminar aims to provide participants with skills and information sufficient to enable them to make competent ethical decisions in clinical situations and to assist others in doing so. For additional information or to receive a course brochure,please contact: Marilyn J. Barnard, Manager, Continuing Education Program: Phone: (206) 616-1864; Fax: (206) 685-7515; Email: mbarnard@u.washington.edu.
  
• Staff Changes:
• PHEN is pleased to welcome Christina Matteotti and to welcome back Rosemarie Muto to the Network staff. Christina will serve as a Programming Assistant and Rose will be the Senior Programming Assistant with PHEN’s Northern Alberta Office for the summer. PHEN received grants from HRDC to help support these two summer student positions.

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