Category: Definitions

A list of individuals who may be called upon to make decisions on behalf of a patient who lacks the capacity to decide for themselves. The next-of-kin hierarchy is used only if the patient has not assigned someone as their power of attorney. The exact order in which family members are listed varies by jurisdiction. Some of the relevant legislation for Canadian Provinces and Territories can be found here: https://cnps.ca/article/consent-for-the-incapable-adult/. ...

A document that authorizes one person to act on behalf of another. In Canada, a power of attorney for personal care can be used to assign someone to make health care decisions on your behalf if you lack the capacity to make them yourself. See also, advance directive. ...

Informed consent is a cornerstone of contemporary medical practice in the West.  It is the primary means through which the principle of respect for autonomy is translated into practice.  Informed consent procedures acknowledge that the patient has the right to make care decisions. Consent makes it permissible to do things, such as inserting foreign objects into another person’s body, that would otherwise be considered illegal (without consent, inserting foreign objects into another person’s body would be a clear example of assault). Legal precedents regarding informed consent have established that patients have a right to know what their health care provider intends to do, what risks are entailed by the proposed action, and any other information that would be pertinent to a reasonable person in the patient’s position....

Capacity refers to the ability to understand health care information and make health care decisions (and is sometimes used interchangeably with competence in colloquial discussion, although there is a legal distinction whereby competence is a more global property).   Capacity is specific to a particular decision, and requires that the person making the decision understands information relevant to the decision and the consequences of choices (including refusing to act). Capacity is required as an aspect of informed consent, along with disclosure (being provided with the information needed to make the decision in accordance with the reasonable person standard) and voluntariness (freedom from coercion)....

In health care, organizational values are explicitly or implicitly focused on outcomes for patients and families.  One reason for this is because providing care for patients and families is the reason that health care organizations exist.  Another reason for the emphasis on patients and families is that they are understood to be the more vulnerable parties in health care interactions, given both imbalances in power and knowledge and the ways in which needing health care generates vulnerability, and to compensate for this their needs are given greater weight....

Bedside allocation occurs when health care providers make decisions about how to distribute health resources (including provider time, treatment, and devices) while providing care to a particular patient (as opposed to health care rationing that occurs at other locations within the health care system, such as senior leadership tables, boardrooms, and caucus meetings). It is broadly recognized that this sort of allocation is inevitable, but concerns arise regarding the criteria that individual physicians are using as they make these decisions....

Organizational values are given as broad, aspirational statements.  The challenging ethical task is working out the implications of those values in particular situations.  Organizational ethics consultations often identify various options for action aligned with different values, and it is valuable to explicitly identify the ways in which options reflect and interpret the organizational values and principles....

Do not attempt resuscitation orders are a way for patients to indicate the care that they would like to receive in the event of a life-threatening cardiac event.  Other terms for documents with similar purposes include do not resuscitate orders (DNR) and allow natural death orders (AND). The goal is avoiding interventions that are unwelcome or traumatic for the patient or are unlikely to be effective.  The intention is to support patient self-determination and facilitate a “good death”. There is often a concern that if such an order is in place this will result in a patient receiving a reduced level of care, and so discussions around DNAR orders do need to be approached with particular attention to transparency....

Organizational values indicate what an organization hopes to achieve through its activities.  They are generally aspirational and fairly abstract, providing general as opposed to specific guidance.  These values are translated into practice through policies, procedures, budgets, and business plans. In the context of ethics consultation, questions around organizational values arise in terms of both how to achieve these goals in practice and how to find an appropriate balance when two or more of the values are in tension with each other; the desire to provide particular care (genetic testing, for example) to everyone who might want it can clash with stewardship of resources, for example....

In ethics consultations and in dealing with ethical issues as they arise in health care practice, we often draw on reasoning used in previous situations.  Coherence of our ethical judgment relies on drawing upon and and being consistent->consistency with previously-adjudicated cases. In ethics work, we often focus on similarities in the values and principles pertinent to a situation and similarities in features of the situation that determine which values and principles are pertinent.    The choice of comparator often determines the focus or direction of a particular consultation....