Putting bioethics theory into practice

We work with others to tackle practical bioethics problems. We put theory into practice by developing tools, frameworks and processes to provide guidance for decision-makers. Alongside our faculty, we regularly contribute through expert consultations, network development, media interviews, or resource development. We have provided links to some of the policy outputs below.

Recent policy contributions

Some of our faculty are contributing their expertise to policy, regulatory and research bodies, such as:

• Canadian Agency for Drugs and Technologies in Health
• Canadian Association of Practicing Healthcare Ethicists/Association canadienne des éthiciens en soins de santé
• Canadian Bioethics Society
• Canadian College of Family Physicians Ethics Committee
• CIHR Institute Advisory Board on Research Excellence, Policy, and Ethics
• Ontario Health Technology Assessment Committee
• Ontario Ministry of Health
• Royal College of Physicians and Surgeons Ethics Committee
• Trillium Gift of Life Network Ethics Committee
• World Health Organization
• various local or regional REBs, networks and committees

AI and data governance

We have received support via a partnership with AMS Healthcare with the aim to accelerate knowledge and inform practice on ethical artificial intelligence (AI) in health care.

→ Ethics & AI for Health: Symposium Report
→ Digital Health Technologies for More Equitable Health Systems: A Discussion Paper

Lecture Series on Ethics and Governance of AI for Health
→ Assessing Risk, Automating Racism: Reimagining the Default Setting of Technology in Healthcare
→ Digital Fit for Purpose?: Possibilities and Pitfalls of Data Integration in Health Systems
→ Policy Solutions for Big Data and AI Innovation in Health

Public health

We have been actively engaged in developing resources to guide ethical decision-making in public health research, policy, and practice in collaboration with organizations like Public Health Ontario and the Canadian Institutes of Health Research.

→ A Framework for the Ethical Conduct of Public Health Initiatives
→ Population and Public Health Ethics: Cases from Research, Policy, and Practice | Éthique en santé publique et des populations: Cas tirés de la recherche, des politiques et de la pratique

Do you need our bioethics expertise in developing public health policy and ethics frameworks? You can reach us at jcb.research@utoronto.ca.

Pandemics and infectious disease outbreaks

In response to COVID-19, the Ontario Ministry of Health announced the creation of a Bioethics Table to support the province's novel coronavirus health system response, which we are coordinating from the JCB.

We have actively been contributing to pandemic and infectious disease outbreak policy since Toronto experienced the severe acute respiratory syndrome (SARS) outbreak in the early 2000s. We have continued to collaborate with policymakers, scholars, health professionals, and health care organizations on ethics and epidemics up to and including the recent COVID-19 global pandemic. Our faculty have also contributed their expertise to the World Health Organization and the Ontario Ministry of Health and Long-Term Care in their pandemic preparedness planning. The following guidance documents explore ethical issues that arise in the context of pandemics and infectious disease outbreaks and they aim to complement existing guidance on ethics in public health.

COVID-19 Ontario Bioethics Table
→ Vaccinating Ontarians Aged 12-17: Legal and Ethical Requirements for Consent
→ Critical Care Triage for Major Surge in the COVID-19 Pandemic – The Role of the Ontario COVID-19 Bioethics Table
→ Ontario COVID-19 Health System Response – Bioethics Table Charter & Terms of Reference
→ Ethics Framework for Ramping Down Elective Surgeries and Other Non-Emergent Activities During the COVID-19 Pandemic
→ Priority Setting of Personal Protective Equipment – Provincial/Regional Distribution
→ Priority Setting of Personal Protective Equipment – Within Health Care Institutions and Community Support Services
→ Ethical Framework for Drug Shortages That Occur During the COVID-19 Pandemic in Ontario
→ Ethical Framework for COVID-19 Vaccine Distribution

Pandemic flu planning
→ Stand on Guard for Thee: Ethical Considerations in Preparedness Planning for Pandemic Influenza
→ Pandemic Influenza Planning: Ethical Framework

Ebola
→ One year into the Ebola epidemic: A deadly, tenacious and unforgiving virus
→ Ethical issues related to study designs for trials on therapeutics for Ebola Virus Disease
→ WHO Consultation on potential Ebola therapies and vaccines: Meeting summary

Infectious diseases
→ Guidance for Managing Ethical Issues in Infectious Disease Outbreaks

Priority setting of health resources

We have been working with health institutions and systems on priority setting for 20 years, including the development of decision-making tools and frameworks. In 2012, faced with a province-wide drug shortage, we were asked by the Ontario Ministry of Health and Long-Term Care (MOHLTC) to provide guidance on ethical principles to guide allocation decisions in two areas: drug inventory allocation, and modification of services. Our ethics working group produced an ethical framework for resource allocation during a drug supply shortage, which was endorsed the MOHLTC and released across the Ontario health system. We have also informed Ontario policy on health system integration and most recently, priority setting in the COVID-19 pandemic.

Priority setting in health institutions and systems
→ Ethical Decision-Making About Scarce Resources: A Guide for Managers and Governors
→ Evidence, Economics, and Ethics: Resource Allocation in Health Services Organizations
See also Pandemics and Infectious Disease Outbreaks above.

Ethics and drug supply shortages
→ Ethical Framework for Resource Allocation During a Drug Supply Shortage
→ Trigger Points for Transitioning Between Stages in the Ethical Framework

Health system integration
→ Priority Setting in Ontario's LHINs: Ethics and Economics in Action
→ Rehabilitating Care for People with Disabilities and Chronic Illnesses

End of life

We have been at the forefront of studying and contributing toward the ethical implementation of Medical Assistance in Dying (MAiD) in Canada. Following the Supreme Court of Canada’s Carter decision in 2015, we commissioned a task force on MAiD to anticipate and respond to ethical issues related to the implementation of MAiD in Canada. Several JCB faculty and alumni provided expert testimony to parliamentary committees on Canada’s MAID legislation and co-chaired or served on national and provincial expert panels, including the Canadian Council of Academies Expert Panel on Medical Assistance in Dying. We are home to the Ontario MAID Bioethics Community of Practice in collaboration with the Ontario Hospital Association to develop ethically sound and evidence-informed guidance for policymakers, health professionals, patients, and the public. We also partnered with the Ontario College of Family Physicians to create a provincial MAID and palliative care mentoring network for primary care providers. In so doing, we seek to advance understanding of MAID, facilitate collaboration across different stakeholders, and promote consistency across the health system where possible.

→ CCA Expert Panel Report on Medical Assistance in Dying
→ After Carter v. Canada: Physician Assisted Death in Canada - Report and Recommendations
→ A Review of the Literature on Capacity Assessment Tools within Mental Health Practice
→ Provincial Territorial Expert Advisory Group Report on Physician-Assisted Dying

Aid to Capacity Evaluation .

The purpose of the Aid to Capacity Evaluation (ACE) is to help clinicians systematically evaluate capacity when a patient is facing a medical decision. Capacity is the ability to understand information relevant to a decision and the ability to appreciate the reasonably foreseeable consequences of a decision (or lack of a decision).
→ Aid to Capacity Evaluation