The Bioethics Service within the Department of Pediatrics at the Children’s Hospital of Eastern Ontario (CHEO) is provided by one practitioner, Dr. Michelle Mullen, who is a consultant bioethicist and head of the service.

A clinical ethics case conference approach to clinical consultation is a cornerstone of the ethics program and a model for other centres. The bioethicist supports the Research Ethics Board and the Palliative Care Program through Roger’s House.

Comprehensive ethics preparation of pediatric residents at CHEO is case-based and cycles over a two-year time frame.

Resources

• Canadian Bioethics Society
• Canadian Paediatric Society
• Canadian Tri-council core skills tutorial for research ethics

Ethics consultation is supported by the services of a full-time ethicist. When Dr. Mullen is consulted, an initial triage discussion takes place and multi-disciplinary clinical ethics patient meetings are organized as needed. In this way, all of the pertinent expertise such as health care providers, faith, cultural and community supports, can be drawn upon to help move decisions forward.

This approach differs from traditional ethics consultations and clinical ethics committees in that it is highly flexible in providing the precise expertise required to achieve the best answers and provide support to patients, families and the health care team. It is also an inclusive and transparent process.

Inpatient and outpatient care

Any person directly involved in a patient’s care can request an ethics consultation, including patients and family, nurses, physicians, social workers and other health care professionals. The ethicist meets with the person(s) making the request and usually ascertains at this stage whether the concern is an ethics question. The patient chart and relevant literature are reviewed and discussions planned. Any consultation, discussion and recommendations are documented in the patient’s record.

The ethicist is available for ongoing reflection and assistance in decision-making and provides support to patients, families and the CHEO team.

High frequency clinical consultation areas include informed decisions, best interests, substitute decisions, end of life care, cultural difference, privacy and limits.

Bioethics research has been funded at CHEO by various agencies including the Canadian Institute of Health Research (CIHR), Genome Canada and the Ontario HIV Treatment Network. Such research is collaborative and has included partners from Epidemiology, Cardiology, Genetics, Surgery and Infectious Diseases. 

Empirical methodologies, both quantitative and qualitative, may be employed (descriptive ethics). Ethics analyses and policy recommendations are made (normative ethics) within the context of ethics concepts of best interests, justice and critical theory. 

Independently, CHEO investigators from critical care units have also developed funded bioethics research projects. Main areas of research include: 

• Ethical issues in genetic testing
• Empirical research in bioethics and health policy with a focus on genetics, informed decision-making and health care outcomes and policy
• Outcomes of genetics services programs
• Ethical decision-making for youth
• Resource allocation

• Mullen, Michelle MHP, PhD

Undergraduate training opportunities

Bioethics contributions to undergraduate training include Introductory Bioethics, LINK (transition unit from medical school to in-hospital training during the undergraduate career), lecturer and moderator of the Bioethics Interest Group.

Individualized electives may be available for interested undergraduates. Topics may include, but are not limited to: best interests decision-making, substitute decisions, capacity in youth, resource allocation, emerging issues in genethics and pediatric palliative care.

Postgraduate training program

There are no certified postgraduate programs at this time.

Additional postgraduate training

A two-year, six-part comprehensive pediatric bioethics curriculum is available for postgraduate training. The curriculum consists of:

• Best interests / approaches to clinical pediatric ethics
• Withdrawal of treatment / refusal of treatment
• Demands for treatment / futility / resource allocation
• Ability / disability: the geneticized society?
• Parents / patients / privacy and the right to know
• Issues at the end of life/transplantation 

Bioethics offers postgraduates three academic half days per year. Other activities include:

• Divisional bioethics activities such as the annual city-wide endocrine fellows bioethics debate and pediatrics intensive care unit (PICU) fellows ethics case analyses 
• Electives are available for interested postgraduate trainees. These are tailored to the specific clinical and research domains of the learner and his/her specialty and are an adjunct to preparation for the Royal College of Physicians and Surgeons examinations.

Clinical bioethics practica may be available for doctoral bioethics candidates and have been extended to students from McGill University, Queen’s University and Western University. In addition to core activities that include clinical ethics consults, research ethics and palliative care ethics, a personal education plan takes into account the interests, needs and skills of the learner.