Bioethics Consultation Practices and Procedures: A Survey of a Large Canadian Community of Practice

Abstract

The literature fails to reflect general agreement over the nature of the services and procedures provided by bioethicists, and the training and core competencies this work requires. If bioethicists are to define their activities in a consistent way, it makes sense to look for common ground in shared communities of practice. We report results of a survey of the services and procedures among bioethicists affiliated with the University of Toronto Joint Centre for Bioethics (JCB). This is the largest group of bioethicists working in healthcare organizations in Canada. The results suggest there are many common services and procedures of JCB bioethicists. This survey can serve as a baseline for further exploration of the work of JCB bioethicists. Common practices exist with respect to the domains of practice, individual reporting relationships, service availability within business hours and the education and training of the bioethicist.

Appendix 1: Case Scenarios

Hybrid: Primarily Organizational with a Secondary Clinical Component

Patient presents to the Emergency Department with bowel perforation due to Cancer, urgent surgery is provided and follow up chemo is the recommended standard of care. It is anticipated that dialysis will soon be required. Despite co-morbidities, patient’s prognosis is reasonable if chemo is provided. Patient was a landed immigrant (i.e. permanent resident) in Ontario for 10+ years but is severely autistic and has let all documentation for his Ontario Health Insurance Plan (OHIP) lapse. Subsequently, he has been unable to get assistance from country of origin’s consulate or OHIP. The patient has one local relative that has cared for the patient but does not have the ability to pay for many of the patient’s recommended treatments. The patient no longer has any family living in his country of origin and dialysis is not available there. The organization does not have a policy addressing treatment of uninsured patients.

Hybrid: Primarily Organizational with a Secondary Clinical Component

In response to increasing occurrences of substitute decision makers (SDM) attempting to restrict patient visitation based on complex family dynamics, personality conflicts, etc. the institution decides to develop a visitation guidelines which will provide guidance on this purview of the SDM to restrict patient visitation. The guideline will also address staff concerns that their workload is being heavily impacted by trying to implement or accommodate SDM restrictions and any associated conflicts that arise with denied visitors.

Hybrid: Research-Organizational-Clinical

Increasingly, research sponsors are including language in the informed consent form indicating that in the instance of an accidental needle stick, the patient/participant will consent to undergo HIV testing. An institutional policy exists that indicates the process to be applied requires seeking the patient/participant’s consent to undergo HIV blood testing. The institutional policy states that consent is voluntary; however, an Ontario law has a provision through which staff can under some circumstances compel a patient to undergo HIV testing. This provision is neither mentioned nor incorporated into the existing policy. The informed consent form template is silent on this point.