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Ethics Framework

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July 2019 Harbour View Haven Ethics Framework

Table of Contents

Preface……………………………………………………………………..…………………………………………………….3 Purpose and Goal of Ethics Framework…………………..…………………………………………….……..…..3 Definitions.............................................................…………………………………………………………………………3 Components of an Ethical Framework............................................................................................................4 Values Component....................................................................................................................................................5 Mission, Vision, Values.............................................................................................................................5 Objectives of the Organization..............................................................................................................6 Implementing the Values Component..............................................................................................................7 Organizational Component................................................................................................................................13 Ethics Committee.....................................................................................................................................13 Roles and Objectives...............................................................................................................................13 Monitoring and Evaluation..................................................................................................................15 Implementation Requirements..........................................................................................................15 Terms of Reference.................................................................................................................................15 Purpose........................................................................................................................................................15 Reporting.....................................................................................................................................................16 Responsibilities........................................................................................................................................16 Quorum........................................................................................................................................................16 Meetings.......................................................................................................................................................16 Support.........................................................................................................................................................17 Procedural Component........................................................................................................................................18 Meetings.......................................................................................................................................................18 Process of Decision Making.................................................................................................................18 Process for Research Related Activities……………………………………………………………….19 Ethics Sub Committee...........................................................................................................................................20 Roles and Objectives...............................................................................................................................20 Reporting.....................................................................................................................................................21 Membership...............................................................................................................................................21 Procedure....................................................................................................................................................21 Appendices Appendix 1 – Ten Step Decision Making Framework.............................................................................22 Appendix 2 – Ethical Checklist.........................................................................................................................23 References...............................................................................................................................................................24

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Preface

Harbour View Haven is a home dedicated to providing quality, resident focused care. It is a progressive, forward thinking facility providing a high quality of services to its residents. We offer a broad range of nursing, medical and other professional services to meet the needs of our residents. All residents receive multi-disciplinary care based on a holistic approach to ensure physical, mental and spiritual well being, while recognizing the right to individuality, respect and dignity.

Harbour View Haven opened its doors for service on April 25, 1971. It is a non-profit organization, officially named "The Lunenburg Home for Special Care Corporation". Harbour View Haven is licensed by the Province to provide 24-hour care to 144 residents.

Purpose and Goals

The purpose of the Harbour View Haven Ethics Framework is to provide guidance and direction to the facility when assessing and considering a variety of situations occurring within. Situations may vary from day to day uncertainty amongst individuals involved to a larger scale of scenarios involving in depth discussions. Residents, staff members, families, volunteers, are all examples of people that may be affected regularly by ethical dilemmas at HVH.

Goals of Framework are to…

• Provide the highest possible ethical standards while maintaining a positive and supportive atmosphere for residents, families, staff and volunteers.

• Provide a tool that enables fair and consistent behaviour and decision making for ethical circumstances throughout the organization.

• Provide ethical support and decision making tools which encourage the facilities mission, vision, values.

Definitions For purpose of this document, several items will be defined. Values – Basic beliefs/ideas upon which our behaviour (decision and actions) are based. Ethics – How these values are used to do right or wrong. Ethical Questions – Questions about what to do when values are in conflict.

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Autonomy – People should have control over their lives and be allowed to make their own decisions as appropriate. Justice – Actions that are fair to all involved. Beneficence – Actions that promote good and prevent harm. Non-maleficence – To do the least amount of harm possible or to the fewest people. Components of an Ethical Framework An ethical framework contains four components – values, how to implement the values, an organizational element and a procedural component. Below is a summary of these components, with detail throughout the rest of the framework.

• Component 1 - Values: the organization’s mission, vision, values and objectives; the direction it wants to go and what aspects it values the most.

• Component 2 - Implementing the values: a translation of the values into guidelines for behaviours and actions.

• Component 3 – Organizational: bringing constructive support in dealing with ethical inquiries, continuing to improve decision making and monitoring implementation of values.

• Component 4 – Procedural: a process for how the values are to be applied in cases where there are ethical questions or conflict in varying values.

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#1 - Values Component Harbour View Haven has an established Mission, Vision, Values and Objectives statement which is an important component in an Ethical Framework. This statement is clearly outlined in the facility and reviewed with staff routinely. We as an organization strive to ensure we are working to meet our mission, vision, values and objectives on a daily bases.

MISSION: Harbour View Haven is a home dedicated to providing quality, resident-focused care.

VISION: We are a community for quality care.

VALUE STATEMENTS:

INTEGRITY We will provide a fair, honest and transparent approach to resident-centered services that exceed the expectations of our residents. INNOVATION We are invested in maintaining a skilled team that is able and enthusiastic in developing comprehensive, evidence-based care solutions. QUALITY CARE We are leaders in resident-centered services committed to continuous quality improvement that promotes an optimal quality of life for people living and working within our home. RESPECT We place great emphasis on dignity, personal choice and balance as we strive to meet the needs of individuals in a community based environment. TEAM

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Everyone has a role in the services we provide as we endeavour to link resident, family, staff, and community in collaboratively achieving the goals we set for our services. SAFETY We are committed to actively fostering a culture of safety through risk management that focuses on prevention while fairly considering resident, employee and community satisfaction.

OBJECTIVES of the ORGANIZATION:

OBJECTIVE 1: “Enhance Resident Experience” HVH will provide enhanced home-like care that supports the provision of optimal quality of life for residents; including resident-centered care as a key component of services and care provided. OBJECTIVE 2: “A Safe and Satisfying Workplace” HVH will build on employee satisfaction, quality of work life and health and safety of the work environment. OBJECTIVE 3: “Family Engagement” HVH will increase the opportunities for family members to become more engaged in resident life and improved quality of services.

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#2 - Implementing Values Component Having values set out in an organization helps everyone involved to know how to proceed in a manner that is consistent and ethical. Values encompass a guiding sense of direction for all members of Harbour View Haven; Board of Directors, management, staff, volunteers, residents and families.

Critical factors of each value are identified below:

Integrity Integrity • Innovation • Quality Care • Respect • Team • Safety

HVH is committed to... Employees are expected to... Residents and Families are asked to...

- offer a fair, honest and transparent approach to resident-centered services - respect the dignity and contribution made by all employees, residents and their families - communicate in a non-judgemental, respectful fashion - maintain confidentiality and privacy of all residents, families, employees and volunteers - develop, communicate and distribute policies to give guidance and direction to all involved - include residents and families in planning processes - maintain a warm, friendly manner with residents and families - respect the rights of residents and their choices within reasonable scope

- approach with an honest and fair attitude, keeping residents best interests in mind - offer residents best choices within HVH resources and provide consistent, continuous care - respect the dignity of residents, their families, other staff, volunteers and the facility - respect the rights of residents and their choices within reasonable scope - communicate in a non-judgemental, respectful fashion - maintain confidentiality and privacy of all residents, families, employees and volunteers - maintain a warm, friendly manner with residents and families -respect and inform other employees in the facility -respect and follow policies and procedures put in place

- have involvement in decision around their loved ones care - respect the dignity of other residents, families, staff, volunteers and the facility - communicate in a non-judgemental, respectful fashion - maintain confidentiality and privacy of all residents, families, employees and volunteers - respect and follow policies and procedures put in place - maintain a warm, friendly manner with residents and families - appreciate care givers and their responses to resident needs by balancing residents quality of life and time restraints - respect the rights of residents and their choices within reasonable scope

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Innovation Integrity • Innovation • Quality Care • Respect • Team • Safety


- provide a skilled team to offer evidence based solutions - approach solution development with a positive, passionate attitude - ensure proper and adequate training for all staff within available resources - develop, communicate and distribute policies to give guidance and direction to all involved - include residents and families in planning processes - maintain a warm, friendly manner with residents and families - respect the rights of residents and their choices within reasonable scope

- work collaboratively as a team to approach with the best solutions - bring forth a positive, enthusiastic attitude to help provide the best resident focused care - offer residents best choices within HVH resources and provide consistent, continuous care - respect the dignity of residents, their families, other staff, volunteers and the facility - respect the rights of residents and their choices within reasonable scope - communicate in a positive, non judging fashion - maintain a warm, friendly manner with residents and families -respect and inform other employees in the facility -respect and follow policies and procedures put in place

- offer positive involvement in their loved ones care and decisions - respect the dignity of other residents, families, staff, volunteers and the facility - work with HVH as a team to develop the best care solutions for residents - respect and follow policies and procedures put in place - maintain a warm, friendly manner with residents and families - appreciate care givers and their responses to resident needs by balancing residents quality of life and time restraints - respect the rights of residents and their choices within reasonable scope

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Quality Care Integrity • Innovation • Quality Care • Respect • Team • Safety


- provide a safe and caring atmosphere for residents, staff, families and volunteers - ensure there is a high level of service to residents - offer continuous quality improvement for residents’ quality of life - promote and advocate for quality of life for residents - foster relationships amongst individuals living and working at HVH - raise ethical concerns and participate in the resolution process - provide a safe working environment - take ownership for decision and work quickly to resolve issues - be clear about expectations, roles and responsibilities of HVH - ensure employees have the proper qualifications to perform their duties - be accountable for affairs within the facility (finances, documentation, legal, etc)

- act in a caring manner that promotes attention, thoughtfulness and nurturing - provide residents with opportunities to maximize their well-being and quality of life - become familiar with residents and families expectations - raise ethical concerns and participate in the resolution process - be honest and hardworking - address concerns with each other as well as supervisors and managers in a collaborative manner - appropriately communicate and report concerns

- be involved in the home and the lives of the residents residing here - participate in quality improvement developments where possible - meet financial obligations - facilitate communication with employees - have a clear understanding of what HVH is able to provide, have appropriate expectations and participate in the ongoing quality improvement process at HVH - raise ethical concerns and participate in the resolution process - communicate and work with team members for all aspects of resident care including end of life wishes - accept personal responsibility for own actions and choices - appropriately communicate and report concerns

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Respect Integrity • Innovation • Quality Care • Respect • Team • Safety


- respect the dignity and contribution made by all employees, residents and their families - communicate in a non-judgemental, respectful fashion - maintain confidentiality and privacy of all residents, families, employees and volunteers - ensure proper and adequate training for all staff within available resources - develop, communicate and distribute policies to give guidance and direction to all involved - maintain a warm, friendly manner with residents and families - respect the rights of residents and their choices within reasonable scope

- offer residents best choices within HVH resources and provide consistent, continuous care - respect the dignity of residents, their families, other staff, volunteers and the facility - respect the rights of residents and their choices within reasonable scope - communicate in a non-judgemental, respectful fashion - maintain confidentiality and privacy of all residents, families, employees and volunteers - maintain a warm, friendly manner with residents and families -respect and inform other employees in the facility -respect and follow policies and procedures put in place

- have involvement in their loved ones care - respect the dignity of other residents, families, staff, volunteers and the facility - communicate in a non-judgemental, respectful fashion - maintain confidentiality and privacy of all residents, families, employees and volunteers - respect and follow policies and procedures put in place - maintain a warm, friendly manner with residents and families - appreciate care givers and their responses to resident needs by balancing residents quality of life and time restraints - respect the rights of residents and their choices within reasonable scope

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Team Integrity • Innovation • Quality Care • Respect • Team • Safety


- work together with all persons involved to provide the highest quality of care to all residents - promote team building, relationship building and a home-like atmosphere - create an environment where teamwork is expected and reinforced - respect and encourage everyone’s opinions, skills, concerns and knowledge - recruit caring, compassionate staff prepared to work in a team setting - involve and empower employees to participate in team decision opportunities - ensure families are an essential part of the team

- work together, support one another and respect all aspects of the teams contributions - communicate with families and residents to ensure they feel a part of the team - understand tasks and goals expected of them and take ownership for their work - understand the roles of everyone at HVH, recognizing every individual is a part of the team for supporting residents quality of life - communicate openly, honestly but respectfully to other team members - respect the diversity of the team and individuals’ contributions - develop and maintain positive relationships with other team members

- understand and respect the values and team at HVH - recognize they are part of the team in providing quality care to residents - respect and understand the various members of the team, their rolls and skills and experiences - participate in their loved ones activities of daily living - provide input to their loved ones care by communicating and or participating in Continuing Care Conferences, Admission Meetings, Family and Resident Counsel and Family Counsel - engage team members in discussions about residents care - participate/volunteer in activities at HVH - include other family members such as children, grandchildren, etc

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Safety Integrity • Innovation • Quality Care • Respect • Team • Safety


- use a risk management approach to promote prevention while keeping residents, families and staffs needs in mind - deal consistently and transparently with issues - have clear policies, procedures and roles - collaborate with the community of infectious outbreaks or other relevant issues to protect the community, residents and employees - listen and be open to suggestions from all team players - respect and value all departments contribution - seek collaboration from outside professionals and other homes

- participate in risk management meetings and other safety committees - provide high quality care, based on best practice guidelines and policies put in place by HVH - abide by safety procedures put into place to ensure the well being of all - be consistent and reliable - communicate positively and opening - participate in opportunities for growth, education, development within self as well as the facility - be tolerant and patient of others differences - work effectively in teams - participate in quality improvement developments where possible

- be involved in residents care and planning processes - follow through to commitments to residents - communicate family history and information that would help evolving quality care -appropriately and respectfully raise concerns - participate in quality improvement developments where possible - provide input and identify barriers -respect and follow facility policies around risk management and procedures put in place - be familiar with the HVH Handbook to understand procedures and systems - work with HVH as a team to create a safe culture

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#3 - Organizational Component Given the variety of interests involved in Harbour View Haven and the potential ethical issues, the best approach is a multi-disciplinary approach involving a variety of team members, skills and experiences. The next section outlines the purpose, role, functions and membership of the Ethics Committee. The Ethics Committee

It is the goal of Harbour View Haven to provide to all residents the most appropriate care possible within allowable circumstances. Maintaining resident autonomy, respecting values and beliefs of staff members, and considering the interests of family members in accordance with the values of HVH will accomplish this. Since ethics are the moral principles that control a person’s or group’s behavior, ethical dilemmas arise when our values are in conflict. Our values are one’s standards of behavior or judgment on what is important in life.

The Committee will act as an advisory committee and assist in ethical discussions. It shall not be a decision making forum, but more so to complement the various roles of the team and provide a place where all perspectives are heard. The committee comprises a multi-disciplinary membership to ensure sensitivities to ethical dimensions in resident care.

Committee Roles and Objectives

The role of the committee is to advise, consult, educate and deliberate with staff, residents and families as ethical issues arise. These issues may be, but are not limited to:

Resident Autonomy/Self-Determination Life Threatening Application of Family / Facility conflict Nutrition/Hydration Conflict of Interest Privacy Confidentiality Life Sustaining/Life Prolonging Promotional Activities Physical and Chemical Restraints Consent Quality of Life Death & Dying Resident Advocacy Concerns

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Objectives defined for the committee are to: Provide facilitation regarding organizational, program and/or provincial policy

requirements and development related to ethical issues as requested. Identify educational needs to promote ethically sound practice for committee

members, staff and community. Provide advice on or develop educational programs to address these needs.

Ensure that a case-by-case ethical consultation process is developed and known to residents, families, staff, service providers, and alternate decision-makers.

The Ethics Committee should be a balanced structure made up of a multi-disciplinary group, responsive to the HVH community – residents, managers, staff, families, board members and the broader community. Membership should entail enough representatives to function with absenteeism and to ensure diverse view points.

The committee membership will be composed of standing positions to include:

CEO Medical Director Director of Resident Care Pastoral Care Committee Member Director of Dietetics Nursing Manager Representative of the Board Manager of Resident and Staff Safety Resident and Family Advisor Programs Manager

Ad Hoc positions will include appointments made by the Chairperson to attend the committee meeting when problems arise relative to their area of expertise. These may include, but are not limited to CCA, HVH lawyer, RN/LPN, Pharmacist, OT and PT.

Key characteristics in appointing members should be their:

Openness – the nature of ethical questions is that they defy simple answer. Members should be open to learning so that they can consider carefully all of the expressed option about an issue.

Optimism – given that many ethical dilemmas are difficult to resolve, the members must be optimistic in such efforts.

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Compassion – committee members need to be able to deliberate ethical issues from the resident’s perspective.

Patience – establishing an appropriately functioning ethics committee may take two to three years so patience is needed.

Monitoring and Evaluation

Monitoring and evaluation is an important part of any process to ensure efficiency, accuracy and to make certain goals are met. Committee monitoring and evaluation helps to assure things are running effectively and input from others can help the Committee identify new needs and initiative for continuous improvement.

Implementation Requirements

In Committee implementation, certain requirements must be addressed and in place in order to function properly.

Reporting relationships Policy and Terms of Reference for the Committee Guidelines for bringing forth issues for consideration for the Committee and the

confidentiality of both the Committee decisions and minutes Frequency of meetings Agenda and minutes for each meeting to have proper documentation Education for Committee members

Terms of Reference

The Ethics Committee is a voluntary body that will advise, consult, educate and deliberate with employees, residents and families about ethical issues. Some of these may include such matters as a degree of residents’ freedom of choice, difference with family expectations about resident care, quality of care and integrity and collaboration.

It is the intention of the Committee to deal with ethical dilemmas that cannot be resolved by the care team or individuals involved. It is the mandate of this Committee to develop recommendations to be brought forth to the care team and/or Board of Directors if policy revision or serious implication may arise.

Purpose

The Harbour View Haven Ethics Committee will provide a mechanism for consideration of ethical issues relevant to the residents living in the facility. The Committee works to

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promote the achievement of quality resident care which is ethical and promotes Resident Rights.

Reporting

The Harbour View Haven Ethics Committee will review any issue brought forward, including suggestions for consideration when discussing the complaint. The Chair of the Committee will submit minutes of the quarterly meetings to the Board of Directors. The CEO will ensure there is an agenda item for Ethics at regular Board meetings. The Board member representative attending HVH Ethics Committee meetings will report on quarterly ethics meetings to the Board Directors. Responsibilities

The Ethics Committee will be responsible to: provide a process for discussion of ethical issues – listening to issues brought forth

and aiding in possible resolutions if the facility is unable to do so help all persons of Harbour View Haven (employees, residents, families, etc) to

better address issues that have ethical implications ensure any ethical principles are recognized support the development of an atmosphere that is sensitive to ethical issues be involved in the facility’s ongoing development of quality improvement develop guidelines relating to ethical issues in the delivery of care help all involved with Harbour View Haven better understand and apply the values assist in educating employees, residents and families about ethical principles and

concerns assist in the development and implementation of policies relating to ethical

dilemmas assist with the approval process for research projects within the facility as per the

organization’s Research policy. *Refer to “Research in the Organization” policy.

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Quorum

The Ethics Committee will proceed with regular meetings and event-driven meetings will require a quorum of at least 50% of the members to be present. Meetings

There are three types of meetings that may arise for ethical consideration which are described in more detail under the upcoming Procedural Component. A quick over view is as follows: 1) Regular Meetings – will be scheduled 3-4 times a year 2) Event-Driven Meetings – will be called by the Chair for specific ethical concerns 3) Sub-Committee Meets – will be called as necessary. The Sub-Committee is a smaller division of the full Ethics Committee. Support for the Committee Support required for the Committee to operate may consist of: Administrative support External educational support Financial support depending on funding (the Chair will consult with the CEO

regarding these supports)

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#4 - Procedural Component This section of the Framework indicates how the Ethics Committee will operate, review the types of meetings and the methods for decision making.

Meetings

There are three types of meetings that may arise for ethical consideration: 1) Regular Meetings – these will be scheduled with a goal of 4 times a year, 3 will be the minimum. These will review ethical cases, ongoing matters, risk statistics within the facility, education and consultations when needed. 2) Event-Driven Meetings – these will be called by the Chair when a specific ethical concern arises that cannot be resolved in house. These are rare but certainly needed if a resolution is not possible within the facility or with family. 3) Sub-Committee Meeting – these will be a smaller division of the Ethics Committee, known as the Ethics-Sub Committee (3 members at a minimum) to have an on-the-spot discussion around an ethical concern that has arouse. The Ten Step Decision Making Framework will be utilized to ensure final decisions are fully analyzed and quantified. Often, Sub-Committee Meetings will take place in conjunction with Risk Management Meetings where individual resident cases are discussed. *Refer to Ethics Sub Committee section for further information Minutes will be recorded of attendance, recommendations and decisions made by the Committee. Minutes will be submitted to the Board of Directors for reviewing. Process for Ethical Decision Making In order to properly make decisions around ethically sensitive matters, a process must be followed to ensure all aspects are taken into consideration and that the final decision is made with confidence. Tools used for ethical decision making guide the user through a step by step process of gathering information and recognizing if it is an ethical issue or not. There are various forms of Decision Making frameworks used for ethical dilemmas. The form shown in Appendix A is the Ten Step Decision Making Framework developed for use at Harbour View Haven. This form consists of a process on recognizing ethical concerns, collecting all the facts, coming up with several alternatives, making a decision and then testing it. On the reverse (see Appendix B) there is an Ethical Checklist. This check list contains a scale ranging from 1-5 for each test available. Once completed, a confidence score is totalled,

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confirming if the decision is very confident or not. With this type of scoring, it allows the decision to be quantified so the team can assess their verdict. In a situation where a resolution is not agreed upon, the Ethics Committee can be consulted. Process for Research Related Activities

Harbour View Haven’s participation in research projects will be considered on an individual basis with consideration of the significance of the study for advancing knowledge in Long Term Care; the potential usefulness of the results for improvements to care services for seniors; and the availability of the necessary facility resources required for the research.

As described in the HVH policy referring to research, a process must be followed to ensure the protection and privacy of the residents living at Harbour View Haven. All research in the facility will be coordinated through and approved by the CEO. All research must abide by the organization’s ethical framework and be approved in part by the organization’s Ethics Committee. In this way, Harbour View Haven ensures that research in the facility shall not infringe upon the rights of the people living at Harbour View Haven. *Refer to the policy “Research in the Organization”.

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Ethics Sub Committee Considering ethical dilemmas arise on a daily bases in work places and some are more difficult to resolve, an Ethics Sub Committee was developed for the facility. The following section outlines the purpose, role, functions and membership of the Ethics Sub Committee. The Ethics Sub Committee

The Harbour View Haven Ethics Sub Committee works to promote the quality of resident care which is ethical and promotes Resident Rights. The purpose of the sub-committee is to provide a timely review process for ethical issues relevant to the residents living in the facility and or staff members and make timely recommendations in the facility by attending HVH meetings or reviewing resolved outcomes.

With the goal in mind to provide to all residents the most appropriate care possible within allowable circumstances, the Ethics Sub Committee was developed to address concerns as they arise, with in house consultations and discussions.

The Sub Committee will act as an in house advisory group and assist in ethical decision making. The Sub Committee will work in conjunction with the Risk Management Team to review resident related cases and ensure the ethical cornerstones are being considered.

Committee Roles and Objectives

• Facilitate the integration of ethics throughout the organization by identifying when an ethical issue arises.

• Ensure that systems and processes contribute to/do not interfere with ethical practices.

• Provide a quick and flexible team approach to ethical situations, ensuring the best possible decision is made with the utilization of the Ethics Decision Making Framework.

• Promote ethical leadership behaviors, such as explaining the values that underlie decisions, stressing the importance of ethics, and promoting transparency in decision making

• Report back to the organization’s Ethics Committee on the cases arising and the responses to those cases.

• Ensure cases are being looked at in an ethical manner, considering the four cornerstones of ethics: Autonomy, Justice, Beneficence and Non-Maleficence.

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Reporting:

The Ethics Sub Committee reports to the Ethics Committee. Documentation will be completed by utilizing the Decision Making-Framework which will go on individual resident charts under the “Ethics” tab and a short reference will be made in the resident’s progress notes.

Membership

The sub-committee membership composition includes the chairperson and at least 2 other committee members. Other care team members may be requested to participate in a sub-committee review of a resident case.

Procedure:

The Sub Committee will meet as needed when situations requiring review arise;

The Sub Committee will recommend alternative options to situations and provide a problem solving process; Will work in conjunction with care team venues, such as the Risk Assessment Committee, to identify possible ethical situations and provide support in dealing with ethical issues;

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Ten-Step Decision Making Framework

Recognize an Ethical Issue 1. Could this decision or situation be damaging to a resident or a resident group? (Is there a choice between a

good and bad alternative, or two goods vs two bads?) 2. Is this issue about what is legal or what is most efficient? If so, how? Get the Facts 3. What are the relevant facts in the situation? (What do we know? Can we find answers to what we don’t know?

Do we have enough information to make a decision?) 4. Who are the individuals or groups that have an important stake in the outcome of our decision? Who will be

affected? (Are some viewpoints more important than others? If yes, why? What are the underlying drivers in this situation?)

5. Have all relevant individuals (or groups) been consulted? Who should have input on this decision? (What are

our options?) Evaluate Alternatives or Actions 6. List any alternative or action plans that would:

a) Produce the most good and the least harm to the greater group b) Uphold the values of HVH and respects the autonomy of the individual(s) c) Which option treats people fairly and equally

Alternative One Alternative Two Alternative Three Make a Decision and Test It

7. Which option best addresses this situation? What is the worst case scenario for the preferred option? 8. Do the individuals involved understand and support the decision? 9. Evaluation your decision against the “Ethical Check List” (see reverse)

10. Build an action plan, implement and monitor

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Ethical Checklist

Ethical Checklist – Circle the appropriate answer on the scale: 1= not at all; 5= completely yes

1 2 3 4 5

1 Relevant Information Test – Have we obtained as much information as possible to make an informed decision and action plan?

2 Involvement Test – Have we involved all who has a right to be involved in this decision making process?

3 Consequential Test – Have we attempted to accommodate for the consequences of this decision for those who are affected?

4 Fairness Test – If we have to take the place of the person(s) affected by our decision, would we perceive the decision and action plan fair?

5 Enduring Values Test – Does the decision and action plan uphold the values of HVH?

6 Universality Test – Would we want this decision and action plan to become applicable to similar situations?

7 Light-of-day Test – How would we feel and be regarded by others if the details of this decision and plan were disclosed for all to know?

8 Total Ethics Analysis Confidence Score: Place the total of all numbers here…

How confident can you be that you’ve done a good job of ethical analysis? 7-14 not very confident; 15-21 somewhat confident; 22-28 quite confident; 29-35 very confident Notes: Decision Making Participants: Date:

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References

An Ethical Framework for Windsor Elms Village, June 2010

Ten Step Decision Making and Eethical Checklist: Doug Wallace and Jon Pekel, Twin Cities-based consultants in the Fulrum Group (651-714-9033)

Dietary Treatment in Dysphagia, Majory Macleod, 33rd Congress of Clinical Nutrition & Metabolism, ESPEN, Gothenburg 3-6th September 2011

A Framework for Ethical Decision-Making: Version 6.0, Ethics Shareware: Michael McDonald, Paddy Rodney and Rosalie Starzomski, January 2001

harbour view haven ethics framework eth… · harbour view haven opened its doors for service on...

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