Health care ethics gained the limelight during the recent battle over Terry Schiavo's fate, but ethical decision-making is already a growing part of the corporate culture at a number of Toronto hospitals, thanks to a "hub and spokes" strategy pioneered by the University of Toronto's Joint Centre for Bioethics.
"It's important for the public to know that in our technologically-based, resource-strapped system, it is possible to effectively integrate and value ethical decision-making," says nurse and bioethicist Susan MacRae, the Joint Centre for Bioethics (JCB) deputy director. MacRae, who also teaches at U of T's Faculty of Nursing, is lead author of a paper describing this ethics model, published today in the Journal of Medical Ethics.
In a hub and spokes model, there is a central ethics resource – usually the hospital's clinical bioethicist – who shares ethics knowledge and offers guidance to designated frontline employees. These employees, in turn, assist others in their departments in dealing with ethical dilemmas that arise during daily interactions with patients and their families – anything from whether to prolong life with various treatments to whether it is worth allocating hospital resources to a particular, expensive course of medication to whether to give a patient the truth about a dire diagnosis.
"This model allows and encourages ethical responsibility across the whole organization," says MacRae. "Without local buy-in, the clinical ethicist can be seen as the ethics police, rather than as a resource and a support."