Ethics

At Southlake Regional Health Centre, Ethics involves determining the best course of action when presented with difficult moral or values-based choices.  At Southlake, our Ethics Team supports those facing such choices by helping them think through the various aspects of the decision and developing options for action.  The options are then weighed against each other to determine which option is the best in the given situation.

Vision
The Ethics Committee
Making End of Life Decisions

Vision

Ethical reflection permeates every decision made at Southlake Regional Health Centre.

The Ethics Service

The Southlake Ethics Service uses a ‘hub and spoke’ model.  One Ethicist and a group of Ethics Facilitators respond to requests for consults, education and awareness-raising.  Our Ethicist is available at 905-895-4521, extension 6425. The Ethics Facilitators are members of staff with other primary professional roles who have had additional training in facilitating ethical reflection.  We support staff, physicians, patients and families to support ethical decision-making throughout the hospital.

Requests for consultation or education
Requests can be made by patients, families and members of the health care team:

• During regular business hours, call the Southlake Ethicist by calling (905) 895 4521 extension 6425.  If it is urgent, you can call Locating at extension 2216 and ask to have the Ethicist paged.
  
  
• During non-business hours, call extension 2216 (Locating) and ask them to page the Administrator-on-call.
  
  
• Email the Ethicist at ethx@southlakeregional.org

The Hospital Ethics Committee

The Hospital Ethics Committee is a team made up of staff from key areas around the hospital and a community representative.  Its role is to support the Ethicist and Facilitators to help the Ethics Service build Southlake’s abilities to identify and respond to ethical issues everywhere they appear.

The Ethics Service contributes to quality patient care by providing:

• confidential consultation and support to patients, families and health care providers when facing difficult ethical issues in patient care.
• education to enhance staff's awareness and understanding of ethical issues in health care.
• policy guidelines and suggestions in areas of ethical concern.
• debriefs with staff to review recent patient care issues for educational purposes and to reflect on the ethical decisions made.

What Ethical issues can the Ethics Service help with?

• patient capacity and consent
• substitute/proxy decision-making
• end of life care/advance directives/resuscitation choices
• difficult treatment decisions/patient/family/staff conflicts
• resource allocation
• research ethics
• other care delivery issues involving value choices

IDEA – Ethical Decision Making Framework
This is one of many tools to help guide decisions that involve complex ethical issues.

Click here to download IDEA ethical decision making framework worksheet.

Confidentiality

• Committee members are bound by hospital policy and will use appropriate means to preserve confidentiality.
• All records of consultation are kept strictly confidential.

Requests for consultation or education
Requests can be made by patients, families and members of the health care team:

• During regular business hours, call the Southlake Ethicist by calling (905) 895 4521 extension 6425.  If it is urgent, you can call Locating at extension 2216 and ask to have him paged.
• During non-business hours, call extension 2216 (Locating) and ask them to page the Administrator-on-call.

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Making End of Life Decisions

Who Decides? You do…
It is best to make your wishes known to your loved ones before the stress of an illness or hospitalization occurs. However, if you become ill, you are the decision-maker with the support of your family and the health care team.

If you become unable to express your health care wishes, an Advance Directive can communicate on your behalf.  An Advance Directive can take two forms: an explanation of your wishes written on paper; or a proxy directive, which explains who will convey your wishes to the health care team. They can be difficult to write precisely – we can suggest some resources freely available on the world wide web. One good place to start is: http://www.advancecareplanning.ca/

If you do not write anything down, try to have some open discussions with those who will be your decision makers if you are too ill to make them for yourself.  There is a legal framework in Ontario to decide who makes health care decisions on behalf of another – it’s all in the Health Care Consent Act.  You can appoint a specific Power of Attorney for Personal Care – the Act recognizes this.  We can give you more information if you wish.

Plan for End of Life Care
It rarely feels like the right time to talk about end of life plans, but the best time is when there’s no crisis. We should all discuss our end of life care plan with our loved ones and our health care providers.

These are tough conversations that take a lot of thinking and some courage. Let your family, friends and caregivers support you. Discuss your wishes in the event that a decision needs to be made pertaining to your end of life care.

What is CPR?
Cardiopulmonary resuscitation (CPR) is an emergency procedure that is done when a person stops breathing or their heart stops beating. It includes mouth-to-mouth breathing (artificial respiration) and chest compressions to manually restart heart pumping from outside of the body (artificial circulation).

In the hospital, CPR may lead to other treatments, such as medication or electric shock (defibrillation) to restart the heart, and tubes or machines (intubation) to help a person breathe. If successful, CPR restores both breathing and heartbeat.

Does CPR Work?
CPR was intended for use in emergency situations to treat sudden, unexpected death in otherwise healthy people due to heart attack or drowning.

CPR was not intended for people who are terminally ill, who have very complex diseases or those with progressive degenerative diseases. There is little evidence that CPR will benefit these people.

Talk with your family and health care team about your feelings toward CPR. Ask your health care team about your condition and whether CPR would be a suitable treatment for you.

Make your wishes known
A "No CPR" order means that if no signs of life are present, nature is allowed to take its course and no medical intervention is made in an effort to prolong the person's life.

Should you request a "No CPR" order, full medical, nursing and supportive care will continue during your stay to ensure you are kept comfortable and without pain or other unpleasant symptoms. In addition, some lab work and tests may continue to be done to monitor and determine whether or not there are any further treatment needs and/or options.

If further treatment options become available you can always change your mind or cancel the "No CPR" order at any time.

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