Toronto Central Community Care Access Centre
People and Roles:
Kevin Reel is the ethicist at the TCCCAC. He has an MSc in Medical Ethics from Imperial College, London, UK and a BSc in occupational therapy from the University of Toronto (UofT). He completed his Fellowship in Clinical and Organizational Ethics at the Joint Centre for Bioethics (JCB), UofT, in 2009.
Kevin is an Assistant Professor and Graduate Faculty Member in the Department of Occupational Science and Occupational Therapy at UofT and a Faculty member of the Global Institute for Psychosocial, Palliative and End-of-Life Care.
In January 2005, the former TCCCAC became the first non-hospital organization accepted as a partner of the JCB. Since then, the TCCCAC has been working closely with the JCB to develop a strategic framework for both clinical and organizational ethics. The goal is to improve staff and board education and awareness; support staff in everyday decision-making; provide guidelines for priority setting and decision-making; and provide mechanisms for identifying systemic ethical issues.
Ethics consultations are designed to help staff deal with difficult ethical issues that arise in caring for clients. The purpose of a consult is not to make client care decisions but to seek to offer support to those involved in the decision making process.
Aims of Ethics Consults:
- bring clarity to ethical questions and, as appropriate, legal questions
- assist in understanding ethical terms and concepts
- identify and help balance various, sometimes conflicting, interests in a particular case
Education of staff members is a significant component of the ethics mandate at TCCCAC. Staff at all levels receive basic training in ethics and ethical decision making. The TCCCAC also offers specialized training in areas of consent and capacity, elder abuse, and end of life decision making.
Another major function includes contributing to curriculum development, teaching, and the training of health professionals through partnerships with the UofT, other universities, and community colleges.
Through the development of organizational infrastructure and accountability mechanisms, the TCCCAC ensures that support is provided to its staff and quality services are offered to its clients.
A priority is placed on the development of policies and guidelines, as well as research ethics reviews, to ensure all research either initiated or in partnership is done in accordance with the Tri Council Guidelines.
Further, the TCCCAC aims to undertake and participate in research initiatives with the goal of becoming a research leader in community health and of using the results of this research to inform policy and best practice.
Hub & Spoke Strategy for Ethics Services at TCCCAC:
The goal of a hub and spoke strategy is to embed ethical considerations and strengthen ethics capacity broadly throughout the different levels of decision-making found in healthcare institutions, so that ethics can directly impact and influence quality patient care.
At the TCCCAC, the onsite bioethicist acts as the 'hub' for the entire organization, and staff and managers with an interest in ethics are encouraged to engage in further training to become 'hubs' of ethics expertise at the unit level, and 'spokes' to link to the ethics program.
Toronto Central CCAC and the Community Ethics Network:
The hub and spoke strategy has also shaped the development of the Community Ethics Network by the former Toronto CCAC (sponsor) and its partner community health and support service agencies. Launched in 2005, this Network provides resources, coordination and support for both clinical and operational ethics GTA-wide, at the Local Health Integration Network level, any beyond.
By educating local community agencies (spokes), the TCCCAC (hub) hopes to support an exchange of information that will provide a forum for the identification of ethical issues, and a transparent approach to their management and resolution. Ultimately, this will better position organizations across the continuum of care to anticipate and manage ethical challenges.
Accreditation & Ethics:
The former Toronto CCAC is accredited through the Canadian Council on Health Services Accreditation (CCHSA). The accreditation team views both organizational and clinical ethics as extremely important to an organization's quality of care. We share this view, and in preparation for accreditation, documented our planning and implementation of the strategic plan for ethics at the TCCCAC.
Kevin Reel, Ethicist
Administrative Assistant, Toronto Central CCAC and Community Ethics Network Steering Committee
Phone: (416) 217-3820 ext. 2526