Exploring a Model Role Description for Ethicists

Abstract

This paper provides a description of the role of the clinical ethicist as it is generally experienced in Canada. It examines the activities of Canadian ethicists working in healthcare institutions and the way in which their work incorporates more than ethics case consultation. The Canadian Bioethics Society established a “Taskforce on Working Conditions for Bioethics” (hereafter referred to as the Taskforce), to make recommendations on a number of issues affecting ethicists and to develop a model role description. This essay carefully assesses this model role description.

Appendix

Model Role Description for Ethicists

Position Title:

Department:

Reports to (Title):

Summary of the role:

The overall goal of the ethicist is to provide leadership and resources to promote ethical decision-making aligned with the values of the organizations. While the ethicist serves multiple stakeholders (patients, families, staff, physicians, managers, directors, researchers, members of the public, etc.) the ethicist does not advocate for any particular stakeholder, but rather serves as an advocate for fair decision-making processes and the creation of a thriving moral community—that is, “a community in which there is coherence between what a healthcare organization publicly professes to be, and what employees, patients and others both witness and participate in” (Webster and Baylis 2000). To this end, the ethicist works to create integrated, sustainable and accountable ethics resources from bedside to boardroom that builds capacity for ethical decision-making, promotes a thriving moral community to provide excellent care (Macrae et al. 2005, pp. 256–261).

Common Areas of Responsibility

• 1. Develop and manage ethics program infrastructure

  • Plan and organize for current resources and prepare for growth of program.

  • Develop a strategic plan that aligns with emerging standards (e.g., Accreditation Canada standards) and organizational strategic directions.

  • Recruit, mentor and supervise internal ethics resource persons (e.g., ethics interns and fellows, students, “spokes”).

  • Clarify role and accountabilities of ethicist and ethics program through on-going communication and evaluation.

  • Develop policies, procedures and resources related to the functioning ethics program (e.g., consultation policy, database, documentation standards).

  • Develop quality improvement processes to measure and enhance effectiveness.

• 2. Organizational ethics leadership

  • Support the enhancement of the moral community in organizations through assessing the ethical culture and developing organizational ethics resources (e.g., management policies, decision-making frameworks, resource allocation strategies).

  • Promote ethical leadership and decision-making at all levels of the organization

  • Provide ethics support for committees (e.g., REB, Ethics Committee).

  • Represent the organization in collaborative initiatives with external partners and stakeholders.

• 3. Identification of ethical issues

  • Assist in the identification and articulation of ethical issues with stakeholders throughout the organization (e.g., articulating “buried” issues, analyzing the use of power and highlighting the organizational obligations to patients and the public).

  • Cultivate reflective analysis of ethical issues to support organizations aligning with values.

  • Advocate for fair, transparent, and inclusive processes for resolving ethical issues and conflicts that arise between patients/clients, employees and the organization.

  • Identify effective means of communicating and reinforcing ethical decisions.

  • Collect and assess information on the nature and context of ethical issues in the organization.

• 4. Ethics consultation

  • Provide consultation to patients, families, staff or administrators on clinical patient/client specific ethics issues.

  • Provide ethics consultation regarding organizations management and governance issues.

  • Provide consultation regarding the ethical conduct of research.

• 5. Policy development

  • Support development or review of relevant organizational policies, standards, guidelines or protocols.

• 6. Education

  • Develop/lead ethics education initiatives and programs to build awareness, knowledge and skills for staff and external partners (e.g., university).

  • Develop and provide ethics education for patients, families and the community.

• 7. Research and dissemination

  • Conduct original individual and collaborative research in the field of ethics.

  • Develop, publish and disseminate innovative practices and research.

• 8. Professional development

  • Maintain knowledge of literature and developments in field of bioethics.

  • Maintain and enhance professional skills and attributes.

  • Contribute to the advancement of the field through participation in ethics networks or communities of practice.

  • Participate in local, provincial, national or international committees, organizations and associations on ethics-related issues.

Education and Specific Training Requirements

• 1. Minimum level of education: Master’s or terminal professional postgraduate degree (e.g., MA, MSc, MD, JD); and

• 2. Practical Experience with mentoring: Ethics internship or fellowship or sustained leadership of Ethics Committee; and

• 3. Demonstrated knowledge, skills and attributes as defined in The Core Competencies for Health Care Ethics Consultation (ASBH).