Who may request an
ethics consultation?
Anyone directly involved in a situation that
raises ethical questions may request an
ethics consultation.
Ethics consultations or discussions on ethical
problems may be requested by any person
receiving care, families or significant others,
or any member of the health care team. Any
staff member may request educational help on
ethical issues.
Legal Information is not the same as legal
advice, where legal advice is the application
of law to an individual’s specific
circumstances. We recommend that you
consult a lawyer if you want professional legal
advice in a subject area that is appropriate to
your particular situation.
*Adapted from Catholic Health Alliance of
Canada (CHAC)
If you are facing a difficult ethical situation and are
unsure of the best course of action, we may be able
to assist. Any patient, resident, client, family
member, staff member, volunteer, or student can
contact, in confidence, the Centre for Clinical
Ethics during regular hours 416-285-3666 x4069 or
after hours through the on-call pager 416-664-1153.
Consultations are provided in keeping with the
Mission, Vision and Values of Providence
Healthcare.
© Providence Healthcare, St. Joseph’s Health
Centre, & St. Michael’s Hospital, 2016
3276 St Clair Avenue East
Toronto, ON M1L 1W1
Phone: 416-285-3666
A Principle Based
Framework for
Ethical Decision
Making:
YODA*
Making difficult
ethical decisions
Trying to make difficult
decisions?
Patients, residents, clients and other persons
receiving care, families and health care
professionals sometimes face difficult decisions
about treatments and placement. Sometimes we
struggle with what should be done.
When involved in making difficult decisions
Clinical decisions in health care often have
some ethical aspects to them because they
involve choices about what should be done, the
individual’s beliefs and values, emotions or
professional guidelines must be considered.
Healthcare ethics aims to enable others to have
thoughtful discussion of how to make good
choices based on beliefs and values about life,
health, suffering and death.
Common Ethical Questions
Generally, ethics questions arise when the right
thing to do is not clear or when people disagree
about what is best for a person who is ill. Some
examples of questions are:
• When should life-support treatments like
ventilators or feeding tubes be started or
withdrawn?
• What should family members and health
professionals do when there is disagreement about
treatment for the person receiving care?
• Should a patient "at risk" be allowed to go home?
YOU
OBSERVE
1. Identify the problem as clearly as possible.
2. Consider how your feelings affect the
decision.
3. Gather as much information or facts as you
can so you are making an informed decision.
Ask the health care team if there are other
supports to help you make this decision or
are there any rules (principles) that should be
considered?
DELIBERATE
4. Consider alternative options, or other choices
by consulting with the health care team.
5. Examine the values involved. What are the
preferences of the person receiving care? Are
other values relevant? Which of the values
conflict?
6. Evaluate the alternatives by ranking the
values and justify this ranking by appealing to
ethical principles. (Those laid out in the CHAC
Health Ethics Guide may provide help) Evaluate
consequences in terms of principles. What
alternatives are excluded?
ACT
7. Articulate the decision by determining:
which alternative best reflects the ranking of
the values, and which alternative best balances
most of the values. Have any new alternatives
arisen?
8. Implement the plan. How should the
decision be communicated? Who needs to
know it, and who needs to act? How best to
document?
9. Concluding review of decision. What are
the feelings of those involved? Decisions are
best made through open discussion among all
those involved: patient, family, physicians,
nurses, and other members of the health care
team. Often, such discussion will be sufficient
to resolve the difficulties. However, sometimes
you may still be unclear or uncertain of your
decision, in such cases you may want to
consider involving the Ethics Consultation
Service.
For help with issues that remain particularly difficult,
Providence Healthcare offers the services of an
Ethics Consultant.
The Ethics Consultant is available to provide help
through ethics case consultation to those directly
involved in situations that pose ethical difficulties.