Megan Bailey and Babitha Paulose highlight the value of clinical ethics education and the need for more training opportunities within Canada.

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We recently completed the clinical ethics internship program in the Ethics Quality Improvement (EQI) Lab at William Osler Health System, in Brampton, Ontario. This internship program taught us how to support physicians, staff, patients, and families with ethical decision making and about the importance of patient-centred approaches to care. We also learned about ethics quality improvement projects that support “upstream” ethics work aimed at preventing ethical dilemmas rather than being forced to react when problems emerge.

Clinical ethics provides a structured approach to responding to moral challenges in healthcare. Education in clinical ethics has become an integral part of medical education and training over the past several decades. More recently, with the COVID-19 pandemic, there has been a notable shift in the culture of medicine and healthcare, inciting the need for more involvement with bioethics as a field. Questions surrounding autonomy and justice are increasingly at the forefront of discussions in healthcare. Training opportunities in clinical ethics help healthcare professionals to improve their abilities to identify and address ethical problems within the scope of their work.

Paula Chidwick (left), Angel Petropanagos (centre), and Jill Oliver (right) working in the Ethics Quality Improvement Lab (2017).

While select universities in Canada offer medical ethics graduate programs, the practical opportunities for hands-on clinical ethics remain few and far between. We did an informal environmental scan and found that in addition to the EQI Lab’s clinical ethics internship program, practical clinical ethics training opportunities are available through graduate programs such as those at the University of Toronto’s Joint Centre for Bioethics and Memorial University’s Master of Health Ethics degree. The Centre for Clinical Ethics in Toronto offers a paid fellowship program in clinical, organizational, and research ethics. Hamilton Health Sciences has also offered fellowship opportunities in clinical and organizational ethics. In British Columbia, there is a clinical ethics fellowship with Providence Health Care and the Provincial Health Service Authority. While there may be others, such opportunities for hands-on clinical ethics training are limited within Canada. Many programs are encompassed within academic institutions, which restricts participation, or they typically only accept one or two interns, fellows, or practicum students each year.

Clinical ethics training programs help learners to bridge bioethics theory and practice. Studies show that small group, case-based learning methods have maximum effectiveness – internship education mirrors this structure. One of the most vital benefits of an internship in clinical ethics is the hands-on work experience that cannot be obtained in the classroom. Internships allow learners to experience ethics on the units and at the bedside. They can observe, ask questions, and build relationships with other people who are committed to healthcare ethics.

The EQI Lab Clinical Ethics Internship Program offers interns and fellows from different academic and professional backgrounds opportunities to learn about healthcare ethics. As interns, we had opportunities to participate in a variety of activities, including attending rounds, observing consultations, and provide education webinars and huddles for staff, physicians, patients, and families. We also supported the development of organizational policies and helped with the hospital’s Accreditation Canada survey preparations related to ethics. We co-created a number ethics frameworks and tools, including one dealing with medical assistance in dying. As interns, we also worked on EQI projects, such as a project on the prevention of error-based transfers (known as “PoET”) as well as on the Checklist for Ethical and Legal Obligations (known as “ChELO”) and learned to identify common ethical challenges and test upstream interventions to help avoid these problems. 

In our internship, we were supervised by an ethicist who guided us through the process of working in a clinical setting. Our supervisor worked with us to develop individualized learning goals throughout the internship to provide us each with a rewarding and fulfilling experience. We were able to dedicate time to projects that interested us, as interns and students, and furthered our academic objectives, such as co-creating an e-learning module for hospital staff for MAiD and co-authoring a publication on COVID and informed consent with other EQI Lab members. The EQI Lab offered us unparalleled opportunities for clinical ethics learning that reflect the dynamics of healthcare in Canada and allowed us to grow our healthcare ethics networks. As we continue on with our academic and professional endeavours, our experiences at the Lab complement and inform our future work.

We know that there are limited opportunities for learners of various backgrounds to gain hands-on, practical experience in clinical ethics within Canada. However, we also know that this type of practical experience is essential to help train and support the next generation of ethicists. It’s also valuable for other professionals who want a deeper understanding of ethics in healthcare. We hope that hearing about our experience will encourage other ethicists and clinical ethics programs in Canada to work towards offering more training opportunities for the next generation of students and professionals alike.

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Megan Bailey is a PhD student in Ethics and Public Affairs at Carleton University and a Senior Intern in the EQI Lab at William Osler Health System. @itsmeganbailey

Babitha Paulose is a Quality Improvement Consultant at William Osler Health System. @BabithaPaulose

Disclaimer: the authors’ internship supervisor in the EQI Lab at William Osler Health System was Dr. Angel Petropanagos, who is also an editor of this blog.