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. ...

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....

When we think about justice, we are focused on the distribution of benefits and burdens of social cooperation and we seek to ensure that no particular group is consistently made worse off by the ways social and political structures function. In focusing on distribution of workloads, we look to the contributions that various individuals or groups make to social functioning.    In general, we believe it to be fair that effort be correlated with compensation (in terms of financial resources but also in status, power, authority, and influence). This reflects the value of solidarity....

Presenteeism is a new term that describes the phenomenon of employees being physically present at work but not able to perform to their usual standard because of illness, distress, or other distractors affecting their ability to be fully mentally present. When observed in conjunction with ethical issues, presenteeism can be a way of disengaging from aspects of the work situation that are giving rise to moral distress....

When we think about justice, we are focused on the distribution of benefits and burdens of social cooperation and we seek to ensure that no particular group is consistently made worse off by the ways social and political structures function. In focusing on distribution of risk, we look to see which individuals or groups have a greater likelihood of being harmed given their position.  For example, individuals who live in closer proximity to sources of pollution are at greater risk of respiratory disease, and individuals who work in health care settings are at a greater risk of exposure to pathogens. Considerations of reciprocity are especially relevant to discussion of distribution of risk; we are less concerned about individuals taking on risk when they are compensated or rewarded for doing so.  For example, the salaries of health care providers might be seen as one way of offsetting risk. Organizations can also express a commitment to reciprocity by taking steps to minimize exposure to...

Moral distress is experienced when an individual believes they know the right way to act but feels that they are being prevented from acting in accordance with their convictions due to internal or external factors. Common constraints include resource limitations, perceived or actual lack of power or influence, or a lack of confidence in one’s ability or judgement. Moral distress often manifests in burnout, cynicism, and symptoms such as headaches, gastrointestinal distress, anxiety, frustration, and depression.  It is correlated with higher numbers of sick days, greater staff turnover, and individuals leaving their professions. It is a cost, both human and fiscal, that results from the way the health care system is structured, and both individuals and organizations are bearing these costs. The phenomenon of moral distress was first identified and has been most extensively studied in the nursing population, but has been identified in health care professionals of many stripes....

Consistency is the value of treating similar situations similarly, and it lies at the heart of the commitment to justice. In ethics consultation we especially value consistency in part because it demonstrates that the recommendations are not arbitrary but are coherent with reasoning applied and presumably endorsed in other relevantly similar situations. In ethics consultation we are especially concerned with consistency of values and principles applied or with the consistency of interpretation of a particular value, even as facts in particular cases might result in different outcomes. We see the same commitment to consistency in the legal tradition of following precedents....