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In the ever-evolving landscape of health care, ethical considerations play a crucial role in shaping policies, practices, and patient care. At the Osler Research Institute for Health Innovation, an exceptional team of ethicists is addressing some of these complex dilemmas and driving positive change. The research, focused on ethics quality improvement, allows important questions to be addressed while advancing the field of health care ethics and people-centered decision-making.
This approach is enabled by having a team comprised of individuals of diverse backgrounds and expertise, ensuring that ethical considerations reflect the needs and values of the community and, ultimately, lead to improvements in person-centered care. The team includes Dr. Paula Chidwick, Director, Ethics; Dr. Jill Oliver, Ethicist; Angel Petropanagos, Ethicist; and Theresa Nitti, RPN and Provincial PoET Program Coordinator. All are committed to sharing learnings, insights, and best practices with the wider health care ethics’ community and taking on the goal of helping to foster a culture of continuous learning and improvement.
Dr. Chidwick explains the team's approach: “We started ethics quality improvement to see if our ethics services were actually making a difference. How could we tell? What proof did we have that we were making things better?” Dr. Oliver adds, “By keeping an eye on how things change with ethics quality improvement, we can show how ethics issues affect the quality of care in the system.”
The Osler Ethics Research team has achieved meaningful strides towards these goals with ground-breaking research contributing to policy development and practice improvement. They have also secured funding, including support from Health Canada, for innovative research projects. Their research, presented at prestigious conferences and in reputable academic journals, has placed them at the tables shaping the discourse in the field of health care ethics.
By integrating ethics-based interventions into healthcare policies, the team has enhanced the quality of care for patients across Ontario. Acknowledged as leading practices by Accreditation Canada are the Checklist for Ethical and Legal Obligations (ChELO) and the Individualized Summary tool from the Prevention of Error-based Transfers (PoET) project. The PoET project also received the Minister’s Medal Honor Roll (2017) for showcasing its effectiveness in diminishing unnecessary hospitalizations and enhancing end-of-life care in long-term care settings.
ChELO is an innovative tool crafted to streamline people-centered decision-making and aid health care professionals in fulfilling ethical and legal responsibilities. “Having a ChELO discussion is about learning what is important to the patient and providing information about how health care decisions should align with the patient’s wishes, values, and beliefs,” said Dr. Petropanagos. “These discussions can be transformative and help support truly people-centred care.”
As staff embraced the CHELO framework, tangible shifts became evident. Documentation increased by 22% due to the streamlined process, and the team also observed a 38% rise in requests from health care professionals. The identification of the correct substitute decision maker improved by 24%. The biggest change in rates, however, was seen in the surge in the number of patients communicating their wishes for future care, which increased by 43%. “This is important, because asking about and documenting what is important to patients can significantly impact the trajectory of their care,” explains Dr. Petropanagos.
With the PoET project, long term care homes in the Brampton and Etobicoke areas were supported over the last ten years to align their habits, polices, and practices with Ontario’s consent legislation. The results from the PoET Southwest Spread Project, which was a joint venture between William Osler Health System and the Department of Family Medicine at McMaster University, demonstrated the potential of this work to improve care for both individual long term care residents, and the health care system.
“By helping long-term care homes align practices and habits with the Health Care Consent Act, the PoET Project supports and empowers staff while fulfilling obligations of their role,” explains Theresa Nitti, Provincial PoET Program Coordinator. “By treating people where they want to be, and before they get to hospital, we can have both system level impacts and a resident centered approach.”
The evaluation compared 30 long term care homes that had participated in the project with 30 homes that had not. Homes that were involved with the project were 27% less likely to transfer people to acute care. “These results confirmed what we had believed all along, and since the Act applies across the province, there is great potential for adapting the work to other settings,” said Dr. Oliver, lead of the PoET Project.
Another important health ethics issue was touched on in the paper “Trust and conflict in death determination—reflections on the legacy of Taquisha McKitty”. This study delves into the intricate legal, medical, and ethical complexities surrounding the case of Taquisha McKitty, a young woman whose death sparked an incompatibility between her family and health care providers.
Taquisha's case revolved around the question: how do we decide when someone is dead based on brain activity? A decision her family vehemently contested. Despite the initial conflict, the case served as a testament to the potential for building trust and understanding between families and health care providers, even amidst such difficult circumstances.
Through a series of reflections, the paper underscores the importance of communication, empathy, and relationship-building in navigating conflicts surrounding end-of-life care. “This case showed, in a profound way, how we can truly partner with families. It was also the first time for us that a family member was cited as a lead author in an academic journal,” explains Dr. Chidwick. “This article was wholly people-centred and is a great example of how change can be informed by a family’s experience.”
Looking ahead, the team remains committed to advancing ethical practices and policies in health care through research, education, and advocacy. They aim to expand collaborative initiatives to address emerging ethical challenges, such as looking ending race correction (the act of interpreting health tests differently depending on race) while also nurturing the next generation of bioethicists through mentorship and training programs. As champions of ethical decision-making and people-centered care, the Osler Ethics Research team continues to make a great impact on health care ethics, setting a benchmark for excellence in the field.
For an opportunity to learn more about the team, listen to the virtual speakers series recording.
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