It’s 7:30 in the morning on a cold January day. Yet 14 people gather around a table at Royal University Hospital to talk about something as important as it is nebulous: ethics. These people make up the Saskatoon Health Region’s joint ethics committee with the Saskatchewan Cancer Agency. They’re all passionate about ethics in health care; among them Doug Cooney.

As Saskatoon Health Region’s lead chaplain and acting manager of spiritual care, Cooney sees his responsibility as a unique one on the committee. “I see my role as bringing or at least putting forward a spiritual and cultural component when we get into ethical discussions. Not to force it, but to put it out there as part of the discussion,” he says. “I think ethics brings a different perspective to a highly scientific and technological business (health care). Our role is a little more humanizing.”

Members of the Saskatoon Health Region and Saskatchewan Cancer Agency Joint Ethics Committee (l-r) Dr. Qaiser Fahim, Jade Chaboyer, Denise Budz, Dr. Philip Wright, Shawna Weeks , Doug Cooney, Lynn Dwernychuk, Greg Chartier.

Members of the Saskatoon Health Region and Saskatchewan Cancer Agency Joint Ethics Committee (l-r) Dr. Qaiser Fahim, Jade Chaboyer, Denise Budz, Dr. Philip Wright, Shawna Weeks , Doug Cooney, Lynn Dwernychuk, Greg Chartier.

The ethics committee meets monthly to discuss issues and policies on an ethical and moral level and has approximately 14 members including Dr. Philip Wright, an oncologist with the Saskatchewan Cancer Agency. “Participating on the committee allows us to provide feedback on both policies and individual situations in regards to clinical care and how to ensure that ethical principles are being followed and that optimal care is allowed to proceed,” explains Wright.

The committee deals with a lot of difficult topics such as end of life care and the recent overcapacity issues the Region experienced this past summer, as well as clinical research studies. However, when the committee is asked to provide recommendations on complex decisions, what it really boils down to is providing the best possible outcome for a patient.

“In many cases, there are divergent opinions when it comes to ethical and even moral issues,” says Cooney. “The issues are complex and life touching. It’s not just abstract; it’s people’s lives or deaths or families. And ,at the risk of sounding overdramatic, it’s somewhat daunting to realize that we are giving opinions or guidance on issues so close to the gut.”

Did You Know?
During the Health Region’s recent accreditation survey, the Region met 100 per cent of the criteria for the priority process of principle-based care and decision making. Accreditation Canada praised the bio-ethics program and its ethical decision-making framework.

“Many times employees, patients or families experience significant moral distress in their work and care environments,” says Dr. Qaiser Fahim, bioethicist for the Health Region and the Saskatchewan Cancer Agency who serves as the chair of the joint ethics committee. “They know what the right thing is, they know what they should be doing and yet they are not able to do so because of various constraints. And this is where we come in: in providing guidance to them, in supporting them to move forward in the most appropriate and ethically justifiable position.”

Committee members try to reach consensus on every decision but that isn’t always possible. “We provide organizational, clinical and research guidance to leadership and we try to develop consensus on our recommendations and move forward with that,” explains Fahim. “We’re not always successful in doing so, but whatever decision is reached, we will provide that to leadership.”

Although the committee is mandated to be secular in its approach, sometimes it can be difficult to be impartial or unbiased due to differing ideologies or cultural and religious factors. However, Cooney is impressed with the diversity of the committee. “I think we recognize that everyone comes to the table with a bias or lens of some kind,” he says. “However, we try to balance that out by being objective and being open to the other lenses that people are looking through.”

Most importantly, the ethics consultants and committee are there to support employees. That’s not to say that patients and families can’t approach the ethics team as well. However, it’s point-of-care staff who often request the support and Fahim wishes they would seek it out more often. “Part of our role is to bring about ethics awareness within the organization and we do various talks on ethics for new recruits and to various different departments almost every month,” he explains.

Cooney agrees and hopes that employees understand that the committee is here to help and not hinder. “When ethics is asked to come in and give guidance or opinions, we’re not there to muddy the waters, or to dictate anything, but to try to be a resource and give some kind of perspective or guidance,” he says.