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Christy Simpson NSHEN Conference 2013

This presentation explores the similarities and differences between boundary issues in ethics work and other professional boundaries in healthcare. It delves into case examples and examines the values and processes involved in addressing these issues.

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Christy Simpson NSHEN Conference 2013

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  1. Professional Boundaries in Ethics Work Christy SimpsonNSHEN Conference 2013

  2. Opening questions… • Do you believe “boundary” issues in ethics work are similar or different from other types of professional boundary issues in healthcare? • Can you think of any examples of “boundary” issues in ethics work?

  3. Consider… • During an ethics consultation, you begin to wonder whether the patient might be at risk as she is taking medications which are contra-indicated. • While you are a pharmacist, you are here as an ethics consultant. Is it appropriate to raise this issue?

  4. Consider… • A very controversial change in how care is provided in outpatient clinics has come to the ethics committee for discussion. You are neighbours with one of the key proponents of the proposed change. • Should you share this with the committee? Participate in the meeting? How will you address your neighbour later?

  5. Consider… • One of the new VPs to your health organization wants to join the ethics committee. In fact, the current chair is thinking of stepping down…and poses the question as to whether this person should be invited to act as chair. • What would your response be? Why? • Would it be different if this was someone with training in healthcare ethics?

  6. Overview • Background context • Historical • Current • Similar and different boundary issues? • Values, process • Revisiting the cases

  7. Some (historical) concerns about “boundaries” in ethics work…

  8. Notice… • Key questions about where and how we do ethics work in health organizations • Brings our attention to who draws these boundaries and at what levels (e.g., in individual cases versus the ethics committee versus the larger organization)

  9. Current work on “boundary” issues… • Practicing Healthcare Ethicists Exploring Professionalization (PHEEP) • Conceptual Working Group • Presentation at Canadian Bioethics Society conference (2012), “Playing with and at the Margins? Questions about Boundaries for Health Care Ethicists”

  10. Starting point... • Much of our work as ethicists and in ethics work is precisely about boundaries, about negotiating and understanding the margins • We can learn about the practice of ethics by identifying, describing, and examining our boundaries and boundary issues

  11. Focus... • Group is examining whether, in ethics work, there are some boundary issues that are “just like” other boundary issues for all health professionals…and whether there are some that are unique or take on a unique “flavour” because of the nature of the work we do in ethics

  12. Consider, for example: • When doing ethics work, the possibilities related to being an: Insider/Outsider

  13. Doing ethics work as: Insider/Outsider • As “insiders” – we may sacrifice neutrality, and perspective on the issues that arise with a particular team • May gain trust because you know what the context is and the challenges that arise • Suggest we are “in” enough to experience some of the same boundary issues as other health care professionals - e.g., dual roles, conflicts of interest

  14. Doing ethics works as: Insider/Outsider • Yet, we are “out” enough that we often see things in a different way (not of the team) or have a different perspective • We sometimes intentionally use this “outsider” position to, e.g., gain access to some ethics issues or decision-making tables, encourage requests • Gain trust by being separate

  15. Doing ethics work as: Insider/Outsider • We need to be attentive to the benefits and risks of occupying these “positions”…and the related boundary issues that may arise

  16. “Just like”? May include: • Confidentiality • Negotiating dual roles • Several possibilities for these • Power and trust in relationships

  17. “Different”? May include: • Subject matter – values • Perception of being a “moral expert” or claiming “moral authority” • Limits of taking only one theoretical position • Power and trust in relationships

  18. So? • New(er) boundary issues with respect to what we do • Includes triaging of requests, conflict of roles and responsibilities, accountability • Importance of process – the “how” • Importance of clarity re: values, expectations

  19. So? Revisiting the cases… • What values are relevant? • What processes/resources may be helpful for addressing these issues?

  20. http://piccsy.com/2011/07/tightrope-dancers/ We’re not taking this journey alone….

  21. For more information about PHEEP Chair, PHEEP Steering Committee Dianne Godkin, PhD Dianne.godkin@trilliumhealthpartners.ca www.bioethics.ca/about/groups/pheep.html

  22. Related readings Heesters, A. 2012. 500 Hats: Exploring the Challenges of Boundary and Community – Reflections on Professionalization. HEC Forum 24(3): 171-178. Simpson, C. 2012. Mapping Our Practice? Some Conceptual “Bumps” for Us to Consider. HEC Forum 24(3): 219-226.

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