Bioethics

Michael Garron Hospital (MGH) supports ethical practice while providing quality healthcare. In our everyday work we aim to live out the hospital's values of compassion, respect, integrity, inclusion, and courage.

The term ‘bioethics’ refers to  thinking about ethical/moral issues that happen in health care and research settings including:

• deciding what we should do (what decisions are morally right or acceptable)
• describing how we should do it (the method or manner of our response)
• explaining why we should do it (justifying our decision in moral terms).

Bioethics helps with discussions when patients, families and healthcare professionals face tough moral or value-based decisions. 

When are we talking bioethics?

Ethical issues often arise when there is disagreement, or differing opinions about what is important, for example when:

• a patient or their Substitute Decision Maker (SDM) says “it does not seem fair”
• health care team members cannot agree on what should be done
• a health care team member has an uncomfortable feeling about a course of action
• a patient or SDM cannot decide what to do
• a team member’s values are not the same as those of the patient or the SDM
• hospital staff want to explore why the hospital is doing something
• hospital administrators want help to explain a decision.

How do I contact a Bioethicist?

Anyone involved in the patient's care may ask for help from a bioethicist. This includes the patient, their family members, the patient’s SDM or members of the healthcare team.

You may ask to speak to a member of the bioethics team by:

• Emailing @email
• Asking a member of the healthcare team to contact a bioethicist

What is the role of the bioethicist?

MGH's bioethicists have advanced training in ethics. They can help to:

• explain ethical issues and facts
• explore other views and values
• make clear the patient’s goals, values and wishes
• review options
• help resolve conflicts
• support good processes for making decisions
• help everyone agree on the best course of action
• explain why the decision is the most fair one.

Bioethicists are also involved with:

• Ethics issues related to research
• Policies and guidelines about how decisions are made
• Educating patients, families, and health care professionals about ethical issues in patient care.

What are some examples where bioethics could help?

Bioethics can help by researching, reviewing, and talking about the law, hospital policies, professional codes of conduct, professional standards of practice and ethical theories to help resolve ethical issues. Bioethicists often help when:

• there is disagreement about the appropriate care or discharge plan
• there are difficult end of life decisions like inserting feeding tubes in patients with advanced dementia or removing life sustaining measures in the intensive care unit or complex continuing care unit
• the patient has questions about medical assistance in dying (commonly referred to as MAID)
• the health care team has questions about who is the proper SDM to make the decision about treatment when the patient is no longer able to make the decision
• the SDM needs help understanding their role in making decisions for an incapable patient.

Resources:

• Advance Care Planning Information Guide
• My Substitute Decision Maker (SDM)

Learn more about bioethics Topics

There are many ethics resources available on the internet. Here is a list of some resources that we find helpful.

Advance Care Planning and Power of Attorney documents

• Materials for advance care planning from Advance Care Planning Ontario 
• Ottawa Personal Decision Guide for People Making Health or Social Decisions from the Ottawa Health Research Institute
• How Powers of Attorney Work from the Ontario Ministry of the Attorney General 
• Powers of Attorney Forms and Booklet from the Office of the Public Guardian and Trustee

Consent and Capacity

• Learn about mental capacity from the Government of Ontario Aid to Capacity Evaluation Tool, a tool which helps clinicians systematically evaluate capacity when a patient is facing a medical decision.
• Consent and Capacity Board (CCB), an independent provincial tribunal. The CCB's key areas of activity include the adjudication of matters of capacity, consent, and substitute decision making.
• Decisions by the Consent and Capacity Board
• Health Care Consent Act, 1996. Ontario legislation which helps to enhance the autonomy of persons by providing rules for determining capacity in treatment decisions and for obtaining informed, voluntary consent from either the capable patient or their substitute decision maker.

Organ Transplantation

• Trillium Gift of Life Network, the Government of Ontario agency responsible for delivering and coordinating organ and tissue donation and transplantation services across the province.

Medical Assistance in Dying Mental Health

• Medical assistance in dying and end‑of‑life care from the Government of Ontario

Dying Mental Health

• Dying with Dignity, a national human-rights charity 
• Centre for Addiction & Mental Health provides a wide range of clinical care services from assessment to brief interventions, inpatient programs, day hospital services, continuing care, outpatient services and family support.
• A Practical Guide to Mental Health and the Law in Ontario, 2023 from the Ontario Hospital Association
• Ontario Psychiatric Patient Advocate Office, and InfoGuides

Privacy

• Your health privacy rights in Ontario from the Information and Privacy Commissioner of Ontario
• A Guide to the Personal Health Information Protection Act, 2004 from the Information and Privacy Commissioner of Ontario

Senior's Rights

• Advocacy Centre for the Elderly, a community based legal clinic for low income senior citizens
• Know your Rights from Elder Abuse Prevention Ontario

Substitute Decision-Making

• A Guide to the Substitute Decisions Act from the Ministry of the Attorney General of Ontario
• A Guide to the Substitute Decisions Act, 199 from the Office of the Public Guardian and Trustee
• The role of the  PGT from the Office of the Public Guardian and Trustee 
• Substitute Decisions Act, 1992. Ontario legislation which establishes the legal criteria determining when a person has the ability to make decisions (apart from healthcare decisions) that are fundamental to their well-being.