lsquoIn this togetherrsquo ethics amp this ldquorisky businessrdquo

We all call ldquocollaborative carerdquo

Collaborative Care Learning Event

In the home amp community health care sector

Toronto February 17 amp 19 2015

1

Christopher E De Bono PhD Ethicist - Toronto Central CCAC

Member - Joint Centre for Bioethics(UofT) Adjunct Faculty Course Instructor (UofT)

Christopherdebonotorontoccac-ontca

COPYRIGHT TC-CCAC Christopher De Bono

Declarations

Other thanhellip

That I work for the TC-CCAC

That wersquoll get you a copy of slides (PDF)

bull (handouts you have are for later)

Thatrsquos allhellip

2 COPYRIGHT TC-CCAC Christopher De Bono

Your ask

bull Introduce a conceptual framework for ethical deliberation - IDEA

bull Explore how principles can be used to work through cases

bull Consider riskdenialself care with ldquodifficult demandingrdquo clients

Your Reality Many of you

bull Have been introduced to the IDEA tool bull Have a great deal of experience in this roomhellip

bull re Riskdenialself carerdquo amp so called ldquodifficult demandingrdquo clients bull Have done some work on working togetherhellip

3 COPYRIGHT TC-CCAC Christopher De Bono

My Learning proposal

1 Think ethically about working togetherhellip

2 Briefly Review the IDEA Framework

ndash It has a new thing in it

3 Practice ethics as ldquoworthwhile conversationsrdquo

1 As ldquoright relationshiprdquo or justicerdquo

4 COPYRIGHT TC-CCAC Christopher De Bono

Whatrsquos my ask

1Access your own experience of ldquobeing in this togetherrdquo (including the messiness)

2Engage the ethics IDEA frameworkhellip (TEST DRIVE IT)

1With an open mind ndash ldquolearn a processrdquo (METHOD) 2With an open heart ndash ldquoremember therersquos a personrdquo

5 COPYRIGHT TC-CCAC Christopher De Bono

6 COPYRIGHT TC-CCAC Christopher De Bono

ldquoIN THIS TOGETHERhelliprdquo

What comes to mind when we think about the phrasehellip

7 COPYRIGHT TC-CCAC Christopher De Bono

Service Gaps

Coordination and continuity between service providers

Multiple providers

Clarity about roles and responsibilities

4 Source existing CCAC slides on collaboration

9

Background

A complex system with various players

Duplication of services

Fragmented care

Lack of communication

between providers

Confusion among clients

and a less than optimal client experience

Source existing CCAC slides on collaboration

Complex

Clientrsquos Psycho Social Needs

Clientrsquos Medical Needs

Low

Low Complex

The Collaborative Care Model

CCAC leads case management unless otherwise agreed with the team

CSS leads case management unless otherwise agreed with the team

10

High MedicalLow Psycho-Social Complexity

Collaborative Care Activities bullShared assessments bullReferral from CCAC to CSS bullTransfer of cases to CSS if appropriate

High Medical High Psycho-Social Complexity

Collaborative Care Activities bullShared assessments bullCoordinated care planning bullJoint home visit bullRegular and frequent communication between CCACCSS and other providers

Low MedicalLow Psycho-Social Complexity

Collaborative Care Activities bullReferral to CCAC if appropriate

Low MedicalHigh Psycho-Social

Complexity Collaborative Care Activities bullShared assessments Assisted Living for at risk clients (Supportive Housing placement) bullSupportive Housing placement

Joint initiatives between the TC CCAC and CSS agencies helped to inform collaborative

activities and practice standards

True Collaboration ndash warrants discussion of lead For medicalchronic conditions CCAC will usually lead and for others where social issues more dominant CSS will usually lead

Work on further

understanding best way

to stratify and identify

the leads underway

In this togetherhellip

11 COPYRIGHT TC-CCAC Christopher De Bono

ldquoLrsquoenfer crsquoest les autresrdquo Sartre

ldquohell is other peoplerdquo

has always been misunderstood It has been thought that what I meant by that was that our relations with other people are always poisoned that they are invariably hellish relations

Such an interpretation is quite negative (but ask if we donrsquot sometimes start here

12 COPYRIGHT TC-CCAC Christopher De Bono

ldquoLrsquoenfer crsquoest les autresrdquo Sartre

But what I really mean is something totally different I mean that if relations with someone else are twisted vitiated [spoiled] then that other person can only be hell hellip

But that does not at all mean that one cannot have relations with other people

Jean Paul Sartre HUIS CLOSNO EXIT 1944 Theatre Blog

13 COPYRIGHT TC-CCAC Christopher De Bono

Your ask

bull Introduce a conceptual framework for ethical deliberation - IDEA

bull Explore how principles can be used to work through cases

bull Consider riskdenialself care with ldquodifficult demandingrdquo clients

Your Reality Many of you

bull Have been introduced to the IDEA tool bull Have a great deal of experience in this roomhellip

bull re Riskdenialself carerdquo amp so called ldquodifficult demandingrdquo clients bull Have done some work on working togetherhellip

3 COPYRIGHT TC-CCAC Christopher De Bono

My Learning proposal

1 Think ethically about working togetherhellip

2 Briefly Review the IDEA Framework

ndash It has a new thing in it

3 Practice ethics as ldquoworthwhile conversationsrdquo

1 As ldquoright relationshiprdquo or justicerdquo

4 COPYRIGHT TC-CCAC Christopher De Bono

Whatrsquos my ask

1Access your own experience of ldquobeing in this togetherrdquo (including the messiness)

2Engage the ethics IDEA frameworkhellip (TEST DRIVE IT)

1With an open mind ndash ldquolearn a processrdquo (METHOD) 2With an open heart ndash ldquoremember therersquos a personrdquo

5 COPYRIGHT TC-CCAC Christopher De Bono

6 COPYRIGHT TC-CCAC Christopher De Bono

ldquoIN THIS TOGETHERhelliprdquo

What comes to mind when we think about the phrasehellip

7 COPYRIGHT TC-CCAC Christopher De Bono

Service Gaps

Coordination and continuity between service providers

Multiple providers

Clarity about roles and responsibilities

4 Source existing CCAC slides on collaboration

9

Background

A complex system with various players

Duplication of services

Fragmented care

Lack of communication

between providers

Confusion among clients

and a less than optimal client experience

Source existing CCAC slides on collaboration

Complex

Clientrsquos Psycho Social Needs

Clientrsquos Medical Needs

Low

Low Complex

The Collaborative Care Model

CCAC leads case management unless otherwise agreed with the team

CSS leads case management unless otherwise agreed with the team

10

High MedicalLow Psycho-Social Complexity

Collaborative Care Activities bullShared assessments bullReferral from CCAC to CSS bullTransfer of cases to CSS if appropriate

High Medical High Psycho-Social Complexity

Collaborative Care Activities bullShared assessments bullCoordinated care planning bullJoint home visit bullRegular and frequent communication between CCACCSS and other providers

Low MedicalLow Psycho-Social Complexity

Collaborative Care Activities bullReferral to CCAC if appropriate

Low MedicalHigh Psycho-Social

Complexity Collaborative Care Activities bullShared assessments Assisted Living for at risk clients (Supportive Housing placement) bullSupportive Housing placement

Joint initiatives between the TC CCAC and CSS agencies helped to inform collaborative

activities and practice standards

True Collaboration ndash warrants discussion of lead For medicalchronic conditions CCAC will usually lead and for others where social issues more dominant CSS will usually lead

Work on further

understanding best way

to stratify and identify

the leads underway

In this togetherhellip

11 COPYRIGHT TC-CCAC Christopher De Bono

ldquoLrsquoenfer crsquoest les autresrdquo Sartre

ldquohell is other peoplerdquo

has always been misunderstood It has been thought that what I meant by that was that our relations with other people are always poisoned that they are invariably hellish relations

Such an interpretation is quite negative (but ask if we donrsquot sometimes start here

12 COPYRIGHT TC-CCAC Christopher De Bono

ldquoLrsquoenfer crsquoest les autresrdquo Sartre

But what I really mean is something totally different I mean that if relations with someone else are twisted vitiated [spoiled] then that other person can only be hell hellip

But that does not at all mean that one cannot have relations with other people

Jean Paul Sartre HUIS CLOSNO EXIT 1944 Theatre Blog

13 COPYRIGHT TC-CCAC Christopher De Bono

My Learning proposal

1 Think ethically about working togetherhellip

2 Briefly Review the IDEA Framework

ndash It has a new thing in it

3 Practice ethics as ldquoworthwhile conversationsrdquo

1 As ldquoright relationshiprdquo or justicerdquo

4 COPYRIGHT TC-CCAC Christopher De Bono

Whatrsquos my ask

1Access your own experience of ldquobeing in this togetherrdquo (including the messiness)

2Engage the ethics IDEA frameworkhellip (TEST DRIVE IT)

1With an open mind ndash ldquolearn a processrdquo (METHOD) 2With an open heart ndash ldquoremember therersquos a personrdquo

5 COPYRIGHT TC-CCAC Christopher De Bono

6 COPYRIGHT TC-CCAC Christopher De Bono

ldquoIN THIS TOGETHERhelliprdquo

What comes to mind when we think about the phrasehellip

7 COPYRIGHT TC-CCAC Christopher De Bono

Service Gaps

Coordination and continuity between service providers

Multiple providers

Clarity about roles and responsibilities

4 Source existing CCAC slides on collaboration

9

Background

A complex system with various players

Duplication of services

Fragmented care

Lack of communication

between providers

Confusion among clients

and a less than optimal client experience

Source existing CCAC slides on collaboration

Complex

Clientrsquos Psycho Social Needs

Clientrsquos Medical Needs

Low

Low Complex

The Collaborative Care Model

CCAC leads case management unless otherwise agreed with the team

CSS leads case management unless otherwise agreed with the team

10

High MedicalLow Psycho-Social Complexity

Collaborative Care Activities bullShared assessments bullReferral from CCAC to CSS bullTransfer of cases to CSS if appropriate

High Medical High Psycho-Social Complexity

Collaborative Care Activities bullShared assessments bullCoordinated care planning bullJoint home visit bullRegular and frequent communication between CCACCSS and other providers

Low MedicalLow Psycho-Social Complexity

Collaborative Care Activities bullReferral to CCAC if appropriate

Low MedicalHigh Psycho-Social

Complexity Collaborative Care Activities bullShared assessments Assisted Living for at risk clients (Supportive Housing placement) bullSupportive Housing placement

Joint initiatives between the TC CCAC and CSS agencies helped to inform collaborative

activities and practice standards

True Collaboration ndash warrants discussion of lead For medicalchronic conditions CCAC will usually lead and for others where social issues more dominant CSS will usually lead

Work on further

understanding best way

to stratify and identify

the leads underway

In this togetherhellip

11 COPYRIGHT TC-CCAC Christopher De Bono

ldquoLrsquoenfer crsquoest les autresrdquo Sartre

ldquohell is other peoplerdquo

has always been misunderstood It has been thought that what I meant by that was that our relations with other people are always poisoned that they are invariably hellish relations

Such an interpretation is quite negative (but ask if we donrsquot sometimes start here

12 COPYRIGHT TC-CCAC Christopher De Bono

ldquoLrsquoenfer crsquoest les autresrdquo Sartre

But what I really mean is something totally different I mean that if relations with someone else are twisted vitiated [spoiled] then that other person can only be hell hellip

But that does not at all mean that one cannot have relations with other people

Jean Paul Sartre HUIS CLOSNO EXIT 1944 Theatre Blog

13 COPYRIGHT TC-CCAC Christopher De Bono

Whatrsquos my ask

1Access your own experience of ldquobeing in this togetherrdquo (including the messiness)

2Engage the ethics IDEA frameworkhellip (TEST DRIVE IT)

1With an open mind ndash ldquolearn a processrdquo (METHOD) 2With an open heart ndash ldquoremember therersquos a personrdquo

5 COPYRIGHT TC-CCAC Christopher De Bono

6 COPYRIGHT TC-CCAC Christopher De Bono

ldquoIN THIS TOGETHERhelliprdquo

What comes to mind when we think about the phrasehellip

7 COPYRIGHT TC-CCAC Christopher De Bono

Service Gaps

Coordination and continuity between service providers

Multiple providers

Clarity about roles and responsibilities

4 Source existing CCAC slides on collaboration

9

Background

A complex system with various players

Duplication of services

Fragmented care

Lack of communication

between providers

Confusion among clients

and a less than optimal client experience

Source existing CCAC slides on collaboration

Complex

Clientrsquos Psycho Social Needs

Clientrsquos Medical Needs

Low

Low Complex

The Collaborative Care Model

CCAC leads case management unless otherwise agreed with the team

CSS leads case management unless otherwise agreed with the team

10

High MedicalLow Psycho-Social Complexity

Collaborative Care Activities bullShared assessments bullReferral from CCAC to CSS bullTransfer of cases to CSS if appropriate

High Medical High Psycho-Social Complexity

Collaborative Care Activities bullShared assessments bullCoordinated care planning bullJoint home visit bullRegular and frequent communication between CCACCSS and other providers

Low MedicalLow Psycho-Social Complexity

Collaborative Care Activities bullReferral to CCAC if appropriate

Low MedicalHigh Psycho-Social

Complexity Collaborative Care Activities bullShared assessments Assisted Living for at risk clients (Supportive Housing placement) bullSupportive Housing placement

Joint initiatives between the TC CCAC and CSS agencies helped to inform collaborative

activities and practice standards

True Collaboration ndash warrants discussion of lead For medicalchronic conditions CCAC will usually lead and for others where social issues more dominant CSS will usually lead

Work on further

understanding best way

to stratify and identify

the leads underway

In this togetherhellip

11 COPYRIGHT TC-CCAC Christopher De Bono

ldquoLrsquoenfer crsquoest les autresrdquo Sartre

ldquohell is other peoplerdquo

has always been misunderstood It has been thought that what I meant by that was that our relations with other people are always poisoned that they are invariably hellish relations

Such an interpretation is quite negative (but ask if we donrsquot sometimes start here

12 COPYRIGHT TC-CCAC Christopher De Bono

ldquoLrsquoenfer crsquoest les autresrdquo Sartre

But what I really mean is something totally different I mean that if relations with someone else are twisted vitiated [spoiled] then that other person can only be hell hellip

But that does not at all mean that one cannot have relations with other people

Jean Paul Sartre HUIS CLOSNO EXIT 1944 Theatre Blog

13 COPYRIGHT TC-CCAC Christopher De Bono

6 COPYRIGHT TC-CCAC Christopher De Bono

ldquoIN THIS TOGETHERhelliprdquo

What comes to mind when we think about the phrasehellip

7 COPYRIGHT TC-CCAC Christopher De Bono

Service Gaps

Coordination and continuity between service providers

Multiple providers

Clarity about roles and responsibilities

4 Source existing CCAC slides on collaboration

9

Background

A complex system with various players

Duplication of services

Fragmented care

Lack of communication

between providers

Confusion among clients

and a less than optimal client experience

Source existing CCAC slides on collaboration

Complex

Clientrsquos Psycho Social Needs

Clientrsquos Medical Needs

Low

Low Complex

The Collaborative Care Model

CCAC leads case management unless otherwise agreed with the team

CSS leads case management unless otherwise agreed with the team

10

High MedicalLow Psycho-Social Complexity

Collaborative Care Activities bullShared assessments bullReferral from CCAC to CSS bullTransfer of cases to CSS if appropriate

High Medical High Psycho-Social Complexity

Collaborative Care Activities bullShared assessments bullCoordinated care planning bullJoint home visit bullRegular and frequent communication between CCACCSS and other providers

Low MedicalLow Psycho-Social Complexity

Collaborative Care Activities bullReferral to CCAC if appropriate

Low MedicalHigh Psycho-Social

Complexity Collaborative Care Activities bullShared assessments Assisted Living for at risk clients (Supportive Housing placement) bullSupportive Housing placement

Joint initiatives between the TC CCAC and CSS agencies helped to inform collaborative

activities and practice standards

True Collaboration ndash warrants discussion of lead For medicalchronic conditions CCAC will usually lead and for others where social issues more dominant CSS will usually lead

Work on further

understanding best way

to stratify and identify

the leads underway

In this togetherhellip

11 COPYRIGHT TC-CCAC Christopher De Bono

ldquoLrsquoenfer crsquoest les autresrdquo Sartre

ldquohell is other peoplerdquo

has always been misunderstood It has been thought that what I meant by that was that our relations with other people are always poisoned that they are invariably hellish relations

Such an interpretation is quite negative (but ask if we donrsquot sometimes start here

12 COPYRIGHT TC-CCAC Christopher De Bono

ldquoLrsquoenfer crsquoest les autresrdquo Sartre

But what I really mean is something totally different I mean that if relations with someone else are twisted vitiated [spoiled] then that other person can only be hell hellip

But that does not at all mean that one cannot have relations with other people

Jean Paul Sartre HUIS CLOSNO EXIT 1944 Theatre Blog

13 COPYRIGHT TC-CCAC Christopher De Bono

ldquoIN THIS TOGETHERhelliprdquo

What comes to mind when we think about the phrasehellip

7 COPYRIGHT TC-CCAC Christopher De Bono

Service Gaps

Coordination and continuity between service providers

Multiple providers

Clarity about roles and responsibilities

4 Source existing CCAC slides on collaboration

9

Background

A complex system with various players

Duplication of services

Fragmented care

Lack of communication

between providers

Confusion among clients

and a less than optimal client experience

Source existing CCAC slides on collaboration

Complex

Clientrsquos Psycho Social Needs

Clientrsquos Medical Needs

Low

Low Complex

The Collaborative Care Model

CCAC leads case management unless otherwise agreed with the team

CSS leads case management unless otherwise agreed with the team

10

High MedicalLow Psycho-Social Complexity

Collaborative Care Activities bullShared assessments bullReferral from CCAC to CSS bullTransfer of cases to CSS if appropriate

High Medical High Psycho-Social Complexity

Collaborative Care Activities bullShared assessments bullCoordinated care planning bullJoint home visit bullRegular and frequent communication between CCACCSS and other providers

Low MedicalLow Psycho-Social Complexity

Collaborative Care Activities bullReferral to CCAC if appropriate

Low MedicalHigh Psycho-Social

Complexity Collaborative Care Activities bullShared assessments Assisted Living for at risk clients (Supportive Housing placement) bullSupportive Housing placement

Joint initiatives between the TC CCAC and CSS agencies helped to inform collaborative

activities and practice standards

True Collaboration ndash warrants discussion of lead For medicalchronic conditions CCAC will usually lead and for others where social issues more dominant CSS will usually lead

Work on further

understanding best way

to stratify and identify

the leads underway

In this togetherhellip

11 COPYRIGHT TC-CCAC Christopher De Bono

ldquoLrsquoenfer crsquoest les autresrdquo Sartre

ldquohell is other peoplerdquo

has always been misunderstood It has been thought that what I meant by that was that our relations with other people are always poisoned that they are invariably hellish relations

Such an interpretation is quite negative (but ask if we donrsquot sometimes start here

12 COPYRIGHT TC-CCAC Christopher De Bono

ldquoLrsquoenfer crsquoest les autresrdquo Sartre

But what I really mean is something totally different I mean that if relations with someone else are twisted vitiated [spoiled] then that other person can only be hell hellip

But that does not at all mean that one cannot have relations with other people

Jean Paul Sartre HUIS CLOSNO EXIT 1944 Theatre Blog

13 COPYRIGHT TC-CCAC Christopher De Bono

Service Gaps

Coordination and continuity between service providers

Multiple providers

Clarity about roles and responsibilities

4 Source existing CCAC slides on collaboration

9

Background

A complex system with various players

Duplication of services

Fragmented care

Lack of communication

between providers

Confusion among clients

and a less than optimal client experience

Source existing CCAC slides on collaboration

Complex

Clientrsquos Psycho Social Needs

Clientrsquos Medical Needs

Low

Low Complex

The Collaborative Care Model

CCAC leads case management unless otherwise agreed with the team

CSS leads case management unless otherwise agreed with the team

10

High MedicalLow Psycho-Social Complexity

Collaborative Care Activities bullShared assessments bullReferral from CCAC to CSS bullTransfer of cases to CSS if appropriate

High Medical High Psycho-Social Complexity

Collaborative Care Activities bullShared assessments bullCoordinated care planning bullJoint home visit bullRegular and frequent communication between CCACCSS and other providers

Low MedicalLow Psycho-Social Complexity

Collaborative Care Activities bullReferral to CCAC if appropriate

Low MedicalHigh Psycho-Social

Complexity Collaborative Care Activities bullShared assessments Assisted Living for at risk clients (Supportive Housing placement) bullSupportive Housing placement

Joint initiatives between the TC CCAC and CSS agencies helped to inform collaborative

activities and practice standards

True Collaboration ndash warrants discussion of lead For medicalchronic conditions CCAC will usually lead and for others where social issues more dominant CSS will usually lead

Work on further

understanding best way

to stratify and identify

the leads underway

In this togetherhellip

11 COPYRIGHT TC-CCAC Christopher De Bono

ldquoLrsquoenfer crsquoest les autresrdquo Sartre

ldquohell is other peoplerdquo

has always been misunderstood It has been thought that what I meant by that was that our relations with other people are always poisoned that they are invariably hellish relations

Such an interpretation is quite negative (but ask if we donrsquot sometimes start here

12 COPYRIGHT TC-CCAC Christopher De Bono

ldquoLrsquoenfer crsquoest les autresrdquo Sartre

But what I really mean is something totally different I mean that if relations with someone else are twisted vitiated [spoiled] then that other person can only be hell hellip

But that does not at all mean that one cannot have relations with other people

Jean Paul Sartre HUIS CLOSNO EXIT 1944 Theatre Blog

13 COPYRIGHT TC-CCAC Christopher De Bono

9

Background

A complex system with various players

Duplication of services

Fragmented care

Lack of communication

between providers

Confusion among clients

and a less than optimal client experience

Source existing CCAC slides on collaboration

Complex

Clientrsquos Psycho Social Needs

Clientrsquos Medical Needs

Low

Low Complex

The Collaborative Care Model

CCAC leads case management unless otherwise agreed with the team

CSS leads case management unless otherwise agreed with the team

10

High MedicalLow Psycho-Social Complexity

Collaborative Care Activities bullShared assessments bullReferral from CCAC to CSS bullTransfer of cases to CSS if appropriate

High Medical High Psycho-Social Complexity

Collaborative Care Activities bullShared assessments bullCoordinated care planning bullJoint home visit bullRegular and frequent communication between CCACCSS and other providers

Low MedicalLow Psycho-Social Complexity

Collaborative Care Activities bullReferral to CCAC if appropriate

Low MedicalHigh Psycho-Social

Complexity Collaborative Care Activities bullShared assessments Assisted Living for at risk clients (Supportive Housing placement) bullSupportive Housing placement

Joint initiatives between the TC CCAC and CSS agencies helped to inform collaborative

activities and practice standards

True Collaboration ndash warrants discussion of lead For medicalchronic conditions CCAC will usually lead and for others where social issues more dominant CSS will usually lead

Work on further

understanding best way

to stratify and identify

the leads underway

In this togetherhellip

11 COPYRIGHT TC-CCAC Christopher De Bono

ldquoLrsquoenfer crsquoest les autresrdquo Sartre

ldquohell is other peoplerdquo

has always been misunderstood It has been thought that what I meant by that was that our relations with other people are always poisoned that they are invariably hellish relations

Such an interpretation is quite negative (but ask if we donrsquot sometimes start here

12 COPYRIGHT TC-CCAC Christopher De Bono

ldquoLrsquoenfer crsquoest les autresrdquo Sartre

But what I really mean is something totally different I mean that if relations with someone else are twisted vitiated [spoiled] then that other person can only be hell hellip

But that does not at all mean that one cannot have relations with other people

Jean Paul Sartre HUIS CLOSNO EXIT 1944 Theatre Blog

13 COPYRIGHT TC-CCAC Christopher De Bono

Complex

Clientrsquos Psycho Social Needs

Clientrsquos Medical Needs

Low

Low Complex

The Collaborative Care Model

CCAC leads case management unless otherwise agreed with the team

CSS leads case management unless otherwise agreed with the team

10

High MedicalLow Psycho-Social Complexity

Collaborative Care Activities bullShared assessments bullReferral from CCAC to CSS bullTransfer of cases to CSS if appropriate

High Medical High Psycho-Social Complexity

Collaborative Care Activities bullShared assessments bullCoordinated care planning bullJoint home visit bullRegular and frequent communication between CCACCSS and other providers

Low MedicalLow Psycho-Social Complexity

Collaborative Care Activities bullReferral to CCAC if appropriate

Low MedicalHigh Psycho-Social

Complexity Collaborative Care Activities bullShared assessments Assisted Living for at risk clients (Supportive Housing placement) bullSupportive Housing placement

Joint initiatives between the TC CCAC and CSS agencies helped to inform collaborative

activities and practice standards

True Collaboration ndash warrants discussion of lead For medicalchronic conditions CCAC will usually lead and for others where social issues more dominant CSS will usually lead

Work on further

understanding best way

to stratify and identify

the leads underway

In this togetherhellip

11 COPYRIGHT TC-CCAC Christopher De Bono

ldquoLrsquoenfer crsquoest les autresrdquo Sartre

ldquohell is other peoplerdquo

has always been misunderstood It has been thought that what I meant by that was that our relations with other people are always poisoned that they are invariably hellish relations

Such an interpretation is quite negative (but ask if we donrsquot sometimes start here

12 COPYRIGHT TC-CCAC Christopher De Bono

ldquoLrsquoenfer crsquoest les autresrdquo Sartre

But what I really mean is something totally different I mean that if relations with someone else are twisted vitiated [spoiled] then that other person can only be hell hellip

But that does not at all mean that one cannot have relations with other people

Jean Paul Sartre HUIS CLOSNO EXIT 1944 Theatre Blog

13 COPYRIGHT TC-CCAC Christopher De Bono

In this togetherhellip

11 COPYRIGHT TC-CCAC Christopher De Bono

ldquoLrsquoenfer crsquoest les autresrdquo Sartre

ldquohell is other peoplerdquo

has always been misunderstood It has been thought that what I meant by that was that our relations with other people are always poisoned that they are invariably hellish relations

Such an interpretation is quite negative (but ask if we donrsquot sometimes start here

12 COPYRIGHT TC-CCAC Christopher De Bono

ldquoLrsquoenfer crsquoest les autresrdquo Sartre

But what I really mean is something totally different I mean that if relations with someone else are twisted vitiated [spoiled] then that other person can only be hell hellip

But that does not at all mean that one cannot have relations with other people

Jean Paul Sartre HUIS CLOSNO EXIT 1944 Theatre Blog

13 COPYRIGHT TC-CCAC Christopher De Bono

ldquoLrsquoenfer crsquoest les autresrdquo Sartre

ldquohell is other peoplerdquo

has always been misunderstood It has been thought that what I meant by that was that our relations with other people are always poisoned that they are invariably hellish relations

Such an interpretation is quite negative (but ask if we donrsquot sometimes start here

12 COPYRIGHT TC-CCAC Christopher De Bono

ldquoLrsquoenfer crsquoest les autresrdquo Sartre

But what I really mean is something totally different I mean that if relations with someone else are twisted vitiated [spoiled] then that other person can only be hell hellip

But that does not at all mean that one cannot have relations with other people

Jean Paul Sartre HUIS CLOSNO EXIT 1944 Theatre Blog

13 COPYRIGHT TC-CCAC Christopher De Bono

ldquoLrsquoenfer crsquoest les autresrdquo Sartre

But what I really mean is something totally different I mean that if relations with someone else are twisted vitiated [spoiled] then that other person can only be hell hellip

But that does not at all mean that one cannot have relations with other people

Jean Paul Sartre HUIS CLOSNO EXIT 1944 Theatre Blog

13 COPYRIGHT TC-CCAC Christopher De Bono

In our context twistedspoiled can be

Polarization that sometimes sets inhellip

bull I say [strongly suggest] you need [heard as will] do something hellip

bull Stop smoking It is not safe for you to be at homehellip

bull The Client says ldquoI wonrsquot do the somethinghelliprdquo

Create labelshellip on non compliance It is never this simplehellip I know

14 COPYRIGHT TC-CCAC Christopher De Bono

Relationships do not need to be HELLISH But remember triggershellip Try curiosity 15 COPYRIGHT TC-CCAC Christopher De Bono

In health carehellip the ldquostrangerrdquo contexthellip

All sorts of relationshipshellip

Often with people who are ldquostrangersrdquo (think about it)

Further more

We are in relationships with people (strangers) who might actually find themselves to be ldquostrangersrdquo too (to themselves)

bull in a new landscape (or ldquocountryrdquo even) (illness)

bull often one they did not wish or ask for

bull one that does not fit (no clear way out)

TRIGGER MOMENT -- IDEA some kind of collision

16 COPYRIGHT TC-CCAC Christopher De Bono

The role of collisionconflict

We encounter strangers with problems

Whatrsquos a problem

bull ldquoThe collision

bull between one belief or hypothesis (comprehensive view)

bull amp

bull And a particular fact that will not fitrdquo

Hans Jonas cited by Richard Zaner Conversations on the Edge (2004) 8)

NEED to find a way out or through

Important in ethics

17 COPYRIGHT TC-CCAC Christopher De Bono

In health carehellip getting to know the other

That collision has to do with illness

Storiestalking are the way into these relationships

Conversation is the way into what matters to a person about the effects of that illness

This can be a challenge hellip It can also be lonely

It just doesnrsquot fit hellip

18

FIT ndash PROM STORY

COPYRIGHT TC-CCAC Christopher De Bono

What never works

Stressing Autonomy abstractlyhellip ldquoitrsquos your decision to makehelliprdquo

BUT

Talking askinghellip listeninghellip (features of dialogue) hellip is a working start

Building trusthellip (which again is a relationship)hellip

What does this have to do with ldquobeing in this togetherrdquo

19 COPYRIGHT TC-CCAC Christopher De Bono

A case which taught me something about ldquobeing in it

togetherrdquo

For me hellip something about ethicshellip AHA MOMENT

20 COPYRIGHT TC-CCAC Christopher De Bono

These are ldquoahardquo moments (akahellip ldquoThreshold Concept TCsrdquo)

Several qualities including

bull Transformative

bull Irreversible

bull Troublesome

helliphellip TC helps us link thingshellip

(Cousins 2006) 21 COPYRIGHT TC-CCAC Christopher De Bono

The ldquoworthwhile conversationrdquo experience of ethics in health care

PART ONE

WHAT IS CLINICAL ETHICS

ldquoClinical ethics is a disciplined way of helping people understand their conditions situations and prospects by helping them (at times insisting that they) grapple with their own moral beliefs what they really truly want and believe is worthwhile

(Richard Zaner 1993 adapted)

Transformative Irreversible Troublesome

22 COPYRIGHT TC-CCAC Christopher De Bono

Signs of an Ethical Issue

My gut tells me

somethingrsquos wrong

I start questioning my own or othersrsquo basic beliefs like

religion culture or lsquoup-bringingrsquo

I canrsquot sleep at night or I take my anxiety at work home with me

Things donrsquot fit - a

conflict

There are no easy or right answers to the

problem

23 COPYRIGHT TC-CCAC Christopher De Bono

PART ONE

WHAT IS CLINICAL ETHICS

ldquoClinical ethics is a disciplined way of helping people understand their conditions situations and prospects

by helping them (at times insisting that they) grapple

with their own moral beliefs what they really truly want and

believe is worthwhile

(Richard Zaner 1993 adapted)

Transformative Irreversible Troublesome

24

REVIEW

COPYRIGHT TC-CCAC Christopher De Bono

start with a thought experiment

1 Think of an unsettling time a powerful moment (experience)

that resulted in a profound shift in your understanding of ldquobeing with other peoplerdquo in home and community health care Please use something from your experiencehellip

2 Briefly on a piece of paper (if you need) hellip Identify a time hellip when you came to see something differentlyhellip

bull Identify what happened as a result

bull What did it provoke in you

bull What did you do with it

Thought experiment designed by Barbara Harrison used with permission 25

THINK PAIR SHARE

COPYRIGHT TC-CCAC Christopher De Bono

Our storiesaha moments

26 COPYRIGHT TC-CCAC Christopher De Bono

Some ethics cases to try

Whatrsquos the ethics grapple (FIT issue)

27

conditions situations and prospects grapple (with)

own moral beliefs what they really truly want and believe is worthwhile

COPYRIGHT TC-CCAC Christopher De Bono

Ethics Case

Conflict of interest case

What should you do How might you justify your position

28 COPYRIGHT TC-CCAC Christopher De Bono

Start with Experience hellipa case

29

Cultural duty to disclose case

What should you do as CCCSS person

How might you justify your position

What about you COPYRIGHT TC-CCAC Christopher De Bono

Todayrsquos key point Ethics is (in part) about ldquoright relationshiprdquo or ldquojusticerdquo

For us that relationship is within the health care relationship

o What is sometimes called the ldquofiduciary relationshiprdquo and the duties which flow from ithellip

I am going to argue that the better wersquore at it (justice) the better we are as personshellip and perhaps the easier it is to sleep at night

I am going to argue we get there by having ldquoworthwhile conversationsrdquo

30 COPYRIGHT TC-CCAC Christopher De Bono

Nothing about me without me

Itrsquos from Valerie Billingham from a session at the Salzburg Global Seminar (session 356) in 1998 ldquoThrough the Patientrsquos Eyesrdquo

Nothing about me without me 31

Ethics begins with self-awareness

COPYRIGHT TC-CCAC Christopher De Bono

Relationships do not need to be HELLISH But remember triggershellip Try curiosity 15 COPYRIGHT TC-CCAC Christopher De Bono

In health carehellip the ldquostrangerrdquo contexthellip

All sorts of relationshipshellip

Often with people who are ldquostrangersrdquo (think about it)

Further more

We are in relationships with people (strangers) who might actually find themselves to be ldquostrangersrdquo too (to themselves)

bull in a new landscape (or ldquocountryrdquo even) (illness)

bull often one they did not wish or ask for

bull one that does not fit (no clear way out)

TRIGGER MOMENT -- IDEA some kind of collision

16 COPYRIGHT TC-CCAC Christopher De Bono

The role of collisionconflict

We encounter strangers with problems

Whatrsquos a problem

bull ldquoThe collision

bull between one belief or hypothesis (comprehensive view)

bull amp

bull And a particular fact that will not fitrdquo

Hans Jonas cited by Richard Zaner Conversations on the Edge (2004) 8)

NEED to find a way out or through

Important in ethics

17 COPYRIGHT TC-CCAC Christopher De Bono

In health carehellip getting to know the other

That collision has to do with illness

Storiestalking are the way into these relationships

Conversation is the way into what matters to a person about the effects of that illness

This can be a challenge hellip It can also be lonely

It just doesnrsquot fit hellip

18

FIT ndash PROM STORY

COPYRIGHT TC-CCAC Christopher De Bono

What never works

Stressing Autonomy abstractlyhellip ldquoitrsquos your decision to makehelliprdquo

BUT

Talking askinghellip listeninghellip (features of dialogue) hellip is a working start

Building trusthellip (which again is a relationship)hellip

What does this have to do with ldquobeing in this togetherrdquo

19 COPYRIGHT TC-CCAC Christopher De Bono

A case which taught me something about ldquobeing in it

togetherrdquo

For me hellip something about ethicshellip AHA MOMENT

20 COPYRIGHT TC-CCAC Christopher De Bono

These are ldquoahardquo moments (akahellip ldquoThreshold Concept TCsrdquo)

Several qualities including

bull Transformative

bull Irreversible

bull Troublesome

helliphellip TC helps us link thingshellip

(Cousins 2006) 21 COPYRIGHT TC-CCAC Christopher De Bono

The ldquoworthwhile conversationrdquo experience of ethics in health care

PART ONE

WHAT IS CLINICAL ETHICS

ldquoClinical ethics is a disciplined way of helping people understand their conditions situations and prospects by helping them (at times insisting that they) grapple with their own moral beliefs what they really truly want and believe is worthwhile

(Richard Zaner 1993 adapted)

Transformative Irreversible Troublesome

22 COPYRIGHT TC-CCAC Christopher De Bono

Signs of an Ethical Issue

My gut tells me

somethingrsquos wrong

I start questioning my own or othersrsquo basic beliefs like

religion culture or lsquoup-bringingrsquo

I canrsquot sleep at night or I take my anxiety at work home with me

Things donrsquot fit - a

conflict

There are no easy or right answers to the

problem

23 COPYRIGHT TC-CCAC Christopher De Bono

PART ONE

WHAT IS CLINICAL ETHICS

ldquoClinical ethics is a disciplined way of helping people understand their conditions situations and prospects

by helping them (at times insisting that they) grapple

with their own moral beliefs what they really truly want and

believe is worthwhile

(Richard Zaner 1993 adapted)

Transformative Irreversible Troublesome

24

REVIEW

COPYRIGHT TC-CCAC Christopher De Bono

start with a thought experiment

1 Think of an unsettling time a powerful moment (experience)

that resulted in a profound shift in your understanding of ldquobeing with other peoplerdquo in home and community health care Please use something from your experiencehellip

2 Briefly on a piece of paper (if you need) hellip Identify a time hellip when you came to see something differentlyhellip

bull Identify what happened as a result

bull What did it provoke in you

bull What did you do with it

Thought experiment designed by Barbara Harrison used with permission 25

THINK PAIR SHARE

COPYRIGHT TC-CCAC Christopher De Bono

Our storiesaha moments

26 COPYRIGHT TC-CCAC Christopher De Bono

Some ethics cases to try

Whatrsquos the ethics grapple (FIT issue)

27

conditions situations and prospects grapple (with)

own moral beliefs what they really truly want and believe is worthwhile

COPYRIGHT TC-CCAC Christopher De Bono

Ethics Case

Conflict of interest case

What should you do How might you justify your position

28 COPYRIGHT TC-CCAC Christopher De Bono

Start with Experience hellipa case

29

Cultural duty to disclose case

What should you do as CCCSS person

How might you justify your position

What about you COPYRIGHT TC-CCAC Christopher De Bono

Todayrsquos key point Ethics is (in part) about ldquoright relationshiprdquo or ldquojusticerdquo

For us that relationship is within the health care relationship

o What is sometimes called the ldquofiduciary relationshiprdquo and the duties which flow from ithellip

I am going to argue that the better wersquore at it (justice) the better we are as personshellip and perhaps the easier it is to sleep at night

I am going to argue we get there by having ldquoworthwhile conversationsrdquo

30 COPYRIGHT TC-CCAC Christopher De Bono

Nothing about me without me

Itrsquos from Valerie Billingham from a session at the Salzburg Global Seminar (session 356) in 1998 ldquoThrough the Patientrsquos Eyesrdquo

Nothing about me without me 31

Ethics begins with self-awareness

COPYRIGHT TC-CCAC Christopher De Bono

In health carehellip the ldquostrangerrdquo contexthellip

All sorts of relationshipshellip

Often with people who are ldquostrangersrdquo (think about it)

Further more

We are in relationships with people (strangers) who might actually find themselves to be ldquostrangersrdquo too (to themselves)

bull in a new landscape (or ldquocountryrdquo even) (illness)

bull often one they did not wish or ask for

bull one that does not fit (no clear way out)

TRIGGER MOMENT -- IDEA some kind of collision

16 COPYRIGHT TC-CCAC Christopher De Bono

The role of collisionconflict

We encounter strangers with problems

Whatrsquos a problem

bull ldquoThe collision

bull between one belief or hypothesis (comprehensive view)

bull amp

bull And a particular fact that will not fitrdquo

Hans Jonas cited by Richard Zaner Conversations on the Edge (2004) 8)

NEED to find a way out or through

Important in ethics

17 COPYRIGHT TC-CCAC Christopher De Bono

In health carehellip getting to know the other

That collision has to do with illness

Storiestalking are the way into these relationships

Conversation is the way into what matters to a person about the effects of that illness

This can be a challenge hellip It can also be lonely

It just doesnrsquot fit hellip

18

FIT ndash PROM STORY

COPYRIGHT TC-CCAC Christopher De Bono

What never works

Stressing Autonomy abstractlyhellip ldquoitrsquos your decision to makehelliprdquo

BUT

Talking askinghellip listeninghellip (features of dialogue) hellip is a working start

Building trusthellip (which again is a relationship)hellip

What does this have to do with ldquobeing in this togetherrdquo

19 COPYRIGHT TC-CCAC Christopher De Bono

A case which taught me something about ldquobeing in it

togetherrdquo

For me hellip something about ethicshellip AHA MOMENT

20 COPYRIGHT TC-CCAC Christopher De Bono

These are ldquoahardquo moments (akahellip ldquoThreshold Concept TCsrdquo)

Several qualities including

bull Transformative

bull Irreversible

bull Troublesome

helliphellip TC helps us link thingshellip

(Cousins 2006) 21 COPYRIGHT TC-CCAC Christopher De Bono

The ldquoworthwhile conversationrdquo experience of ethics in health care

PART ONE

WHAT IS CLINICAL ETHICS

ldquoClinical ethics is a disciplined way of helping people understand their conditions situations and prospects by helping them (at times insisting that they) grapple with their own moral beliefs what they really truly want and believe is worthwhile

(Richard Zaner 1993 adapted)

Transformative Irreversible Troublesome

22 COPYRIGHT TC-CCAC Christopher De Bono

Signs of an Ethical Issue

My gut tells me

somethingrsquos wrong

I start questioning my own or othersrsquo basic beliefs like

religion culture or lsquoup-bringingrsquo

I canrsquot sleep at night or I take my anxiety at work home with me

Things donrsquot fit - a

conflict

There are no easy or right answers to the

problem

23 COPYRIGHT TC-CCAC Christopher De Bono

PART ONE

WHAT IS CLINICAL ETHICS

ldquoClinical ethics is a disciplined way of helping people understand their conditions situations and prospects

by helping them (at times insisting that they) grapple

with their own moral beliefs what they really truly want and

believe is worthwhile

(Richard Zaner 1993 adapted)

Transformative Irreversible Troublesome

24

REVIEW

COPYRIGHT TC-CCAC Christopher De Bono

start with a thought experiment

1 Think of an unsettling time a powerful moment (experience)

that resulted in a profound shift in your understanding of ldquobeing with other peoplerdquo in home and community health care Please use something from your experiencehellip

2 Briefly on a piece of paper (if you need) hellip Identify a time hellip when you came to see something differentlyhellip

bull Identify what happened as a result

bull What did it provoke in you

bull What did you do with it

Thought experiment designed by Barbara Harrison used with permission 25

THINK PAIR SHARE

COPYRIGHT TC-CCAC Christopher De Bono

Our storiesaha moments

26 COPYRIGHT TC-CCAC Christopher De Bono

Some ethics cases to try

Whatrsquos the ethics grapple (FIT issue)

27

conditions situations and prospects grapple (with)

own moral beliefs what they really truly want and believe is worthwhile

COPYRIGHT TC-CCAC Christopher De Bono

Ethics Case

Conflict of interest case

What should you do How might you justify your position

28 COPYRIGHT TC-CCAC Christopher De Bono

Start with Experience hellipa case

29

Cultural duty to disclose case

What should you do as CCCSS person

How might you justify your position

What about you COPYRIGHT TC-CCAC Christopher De Bono

Todayrsquos key point Ethics is (in part) about ldquoright relationshiprdquo or ldquojusticerdquo

For us that relationship is within the health care relationship

o What is sometimes called the ldquofiduciary relationshiprdquo and the duties which flow from ithellip

I am going to argue that the better wersquore at it (justice) the better we are as personshellip and perhaps the easier it is to sleep at night

I am going to argue we get there by having ldquoworthwhile conversationsrdquo

30 COPYRIGHT TC-CCAC Christopher De Bono

Nothing about me without me

Itrsquos from Valerie Billingham from a session at the Salzburg Global Seminar (session 356) in 1998 ldquoThrough the Patientrsquos Eyesrdquo

Nothing about me without me 31

Ethics begins with self-awareness

COPYRIGHT TC-CCAC Christopher De Bono

The role of collisionconflict

We encounter strangers with problems

Whatrsquos a problem

bull ldquoThe collision

bull between one belief or hypothesis (comprehensive view)

bull amp

bull And a particular fact that will not fitrdquo

Hans Jonas cited by Richard Zaner Conversations on the Edge (2004) 8)

NEED to find a way out or through

Important in ethics

17 COPYRIGHT TC-CCAC Christopher De Bono

In health carehellip getting to know the other

That collision has to do with illness

Storiestalking are the way into these relationships

Conversation is the way into what matters to a person about the effects of that illness

This can be a challenge hellip It can also be lonely

It just doesnrsquot fit hellip

18

FIT ndash PROM STORY

COPYRIGHT TC-CCAC Christopher De Bono

What never works

Stressing Autonomy abstractlyhellip ldquoitrsquos your decision to makehelliprdquo

BUT

Talking askinghellip listeninghellip (features of dialogue) hellip is a working start

Building trusthellip (which again is a relationship)hellip

What does this have to do with ldquobeing in this togetherrdquo

19 COPYRIGHT TC-CCAC Christopher De Bono

A case which taught me something about ldquobeing in it

togetherrdquo

For me hellip something about ethicshellip AHA MOMENT

20 COPYRIGHT TC-CCAC Christopher De Bono

These are ldquoahardquo moments (akahellip ldquoThreshold Concept TCsrdquo)

Several qualities including

bull Transformative

bull Irreversible

bull Troublesome

helliphellip TC helps us link thingshellip

(Cousins 2006) 21 COPYRIGHT TC-CCAC Christopher De Bono

The ldquoworthwhile conversationrdquo experience of ethics in health care

PART ONE

WHAT IS CLINICAL ETHICS

ldquoClinical ethics is a disciplined way of helping people understand their conditions situations and prospects by helping them (at times insisting that they) grapple with their own moral beliefs what they really truly want and believe is worthwhile

(Richard Zaner 1993 adapted)

Transformative Irreversible Troublesome

22 COPYRIGHT TC-CCAC Christopher De Bono

Signs of an Ethical Issue

My gut tells me

somethingrsquos wrong

I start questioning my own or othersrsquo basic beliefs like

religion culture or lsquoup-bringingrsquo

I canrsquot sleep at night or I take my anxiety at work home with me

Things donrsquot fit - a

conflict

There are no easy or right answers to the

problem

23 COPYRIGHT TC-CCAC Christopher De Bono

PART ONE

WHAT IS CLINICAL ETHICS

ldquoClinical ethics is a disciplined way of helping people understand their conditions situations and prospects

by helping them (at times insisting that they) grapple

with their own moral beliefs what they really truly want and

believe is worthwhile

(Richard Zaner 1993 adapted)

Transformative Irreversible Troublesome

24

REVIEW

COPYRIGHT TC-CCAC Christopher De Bono

start with a thought experiment

1 Think of an unsettling time a powerful moment (experience)

that resulted in a profound shift in your understanding of ldquobeing with other peoplerdquo in home and community health care Please use something from your experiencehellip

2 Briefly on a piece of paper (if you need) hellip Identify a time hellip when you came to see something differentlyhellip

bull Identify what happened as a result

bull What did it provoke in you

bull What did you do with it

Thought experiment designed by Barbara Harrison used with permission 25

THINK PAIR SHARE

COPYRIGHT TC-CCAC Christopher De Bono

Our storiesaha moments

26 COPYRIGHT TC-CCAC Christopher De Bono

Some ethics cases to try

Whatrsquos the ethics grapple (FIT issue)

27

conditions situations and prospects grapple (with)

own moral beliefs what they really truly want and believe is worthwhile

COPYRIGHT TC-CCAC Christopher De Bono

Ethics Case

Conflict of interest case

What should you do How might you justify your position

28 COPYRIGHT TC-CCAC Christopher De Bono

Start with Experience hellipa case

29

Cultural duty to disclose case

What should you do as CCCSS person

How might you justify your position

What about you COPYRIGHT TC-CCAC Christopher De Bono

Todayrsquos key point Ethics is (in part) about ldquoright relationshiprdquo or ldquojusticerdquo

For us that relationship is within the health care relationship

o What is sometimes called the ldquofiduciary relationshiprdquo and the duties which flow from ithellip

I am going to argue that the better wersquore at it (justice) the better we are as personshellip and perhaps the easier it is to sleep at night

I am going to argue we get there by having ldquoworthwhile conversationsrdquo

30 COPYRIGHT TC-CCAC Christopher De Bono

Nothing about me without me

Itrsquos from Valerie Billingham from a session at the Salzburg Global Seminar (session 356) in 1998 ldquoThrough the Patientrsquos Eyesrdquo

Nothing about me without me 31

Ethics begins with self-awareness

COPYRIGHT TC-CCAC Christopher De Bono

In health carehellip getting to know the other

That collision has to do with illness

Storiestalking are the way into these relationships

Conversation is the way into what matters to a person about the effects of that illness

This can be a challenge hellip It can also be lonely

It just doesnrsquot fit hellip

18

FIT ndash PROM STORY

COPYRIGHT TC-CCAC Christopher De Bono

What never works

Stressing Autonomy abstractlyhellip ldquoitrsquos your decision to makehelliprdquo

BUT

Talking askinghellip listeninghellip (features of dialogue) hellip is a working start

Building trusthellip (which again is a relationship)hellip

What does this have to do with ldquobeing in this togetherrdquo

19 COPYRIGHT TC-CCAC Christopher De Bono

A case which taught me something about ldquobeing in it

togetherrdquo

For me hellip something about ethicshellip AHA MOMENT

20 COPYRIGHT TC-CCAC Christopher De Bono

These are ldquoahardquo moments (akahellip ldquoThreshold Concept TCsrdquo)

Several qualities including

bull Transformative

bull Irreversible

bull Troublesome

helliphellip TC helps us link thingshellip

(Cousins 2006) 21 COPYRIGHT TC-CCAC Christopher De Bono

The ldquoworthwhile conversationrdquo experience of ethics in health care

PART ONE

WHAT IS CLINICAL ETHICS

ldquoClinical ethics is a disciplined way of helping people understand their conditions situations and prospects by helping them (at times insisting that they) grapple with their own moral beliefs what they really truly want and believe is worthwhile

(Richard Zaner 1993 adapted)

Transformative Irreversible Troublesome

22 COPYRIGHT TC-CCAC Christopher De Bono

Signs of an Ethical Issue

My gut tells me

somethingrsquos wrong

I start questioning my own or othersrsquo basic beliefs like

religion culture or lsquoup-bringingrsquo

I canrsquot sleep at night or I take my anxiety at work home with me

Things donrsquot fit - a

conflict

There are no easy or right answers to the

problem

23 COPYRIGHT TC-CCAC Christopher De Bono

PART ONE

WHAT IS CLINICAL ETHICS

ldquoClinical ethics is a disciplined way of helping people understand their conditions situations and prospects

by helping them (at times insisting that they) grapple

with their own moral beliefs what they really truly want and

believe is worthwhile

(Richard Zaner 1993 adapted)

Transformative Irreversible Troublesome

24

REVIEW

COPYRIGHT TC-CCAC Christopher De Bono

start with a thought experiment

1 Think of an unsettling time a powerful moment (experience)

that resulted in a profound shift in your understanding of ldquobeing with other peoplerdquo in home and community health care Please use something from your experiencehellip

2 Briefly on a piece of paper (if you need) hellip Identify a time hellip when you came to see something differentlyhellip

bull Identify what happened as a result

bull What did it provoke in you

bull What did you do with it

Thought experiment designed by Barbara Harrison used with permission 25

THINK PAIR SHARE

COPYRIGHT TC-CCAC Christopher De Bono

Our storiesaha moments

26 COPYRIGHT TC-CCAC Christopher De Bono

Some ethics cases to try

Whatrsquos the ethics grapple (FIT issue)

27

conditions situations and prospects grapple (with)

own moral beliefs what they really truly want and believe is worthwhile

COPYRIGHT TC-CCAC Christopher De Bono

Ethics Case

Conflict of interest case

What should you do How might you justify your position

28 COPYRIGHT TC-CCAC Christopher De Bono

Start with Experience hellipa case

29

Cultural duty to disclose case

What should you do as CCCSS person

How might you justify your position

What about you COPYRIGHT TC-CCAC Christopher De Bono

Todayrsquos key point Ethics is (in part) about ldquoright relationshiprdquo or ldquojusticerdquo

For us that relationship is within the health care relationship

o What is sometimes called the ldquofiduciary relationshiprdquo and the duties which flow from ithellip

I am going to argue that the better wersquore at it (justice) the better we are as personshellip and perhaps the easier it is to sleep at night

I am going to argue we get there by having ldquoworthwhile conversationsrdquo

30 COPYRIGHT TC-CCAC Christopher De Bono

Nothing about me without me

Itrsquos from Valerie Billingham from a session at the Salzburg Global Seminar (session 356) in 1998 ldquoThrough the Patientrsquos Eyesrdquo

Nothing about me without me 31

Ethics begins with self-awareness

COPYRIGHT TC-CCAC Christopher De Bono

What never works

Stressing Autonomy abstractlyhellip ldquoitrsquos your decision to makehelliprdquo

BUT

Talking askinghellip listeninghellip (features of dialogue) hellip is a working start

Building trusthellip (which again is a relationship)hellip

What does this have to do with ldquobeing in this togetherrdquo

19 COPYRIGHT TC-CCAC Christopher De Bono

A case which taught me something about ldquobeing in it

togetherrdquo

For me hellip something about ethicshellip AHA MOMENT

20 COPYRIGHT TC-CCAC Christopher De Bono

These are ldquoahardquo moments (akahellip ldquoThreshold Concept TCsrdquo)

Several qualities including

bull Transformative

bull Irreversible

bull Troublesome

helliphellip TC helps us link thingshellip

(Cousins 2006) 21 COPYRIGHT TC-CCAC Christopher De Bono

The ldquoworthwhile conversationrdquo experience of ethics in health care

PART ONE

WHAT IS CLINICAL ETHICS

ldquoClinical ethics is a disciplined way of helping people understand their conditions situations and prospects by helping them (at times insisting that they) grapple with their own moral beliefs what they really truly want and believe is worthwhile

(Richard Zaner 1993 adapted)

Transformative Irreversible Troublesome

22 COPYRIGHT TC-CCAC Christopher De Bono

Signs of an Ethical Issue

My gut tells me

somethingrsquos wrong

I start questioning my own or othersrsquo basic beliefs like

religion culture or lsquoup-bringingrsquo

I canrsquot sleep at night or I take my anxiety at work home with me

Things donrsquot fit - a

conflict

There are no easy or right answers to the

problem

23 COPYRIGHT TC-CCAC Christopher De Bono

PART ONE

WHAT IS CLINICAL ETHICS

ldquoClinical ethics is a disciplined way of helping people understand their conditions situations and prospects

by helping them (at times insisting that they) grapple

with their own moral beliefs what they really truly want and

believe is worthwhile

(Richard Zaner 1993 adapted)

Transformative Irreversible Troublesome

24

REVIEW

COPYRIGHT TC-CCAC Christopher De Bono

start with a thought experiment

1 Think of an unsettling time a powerful moment (experience)

that resulted in a profound shift in your understanding of ldquobeing with other peoplerdquo in home and community health care Please use something from your experiencehellip

2 Briefly on a piece of paper (if you need) hellip Identify a time hellip when you came to see something differentlyhellip

bull Identify what happened as a result

bull What did it provoke in you

bull What did you do with it

Thought experiment designed by Barbara Harrison used with permission 25

THINK PAIR SHARE

COPYRIGHT TC-CCAC Christopher De Bono

Our storiesaha moments

26 COPYRIGHT TC-CCAC Christopher De Bono

Some ethics cases to try

Whatrsquos the ethics grapple (FIT issue)

27

conditions situations and prospects grapple (with)

own moral beliefs what they really truly want and believe is worthwhile

COPYRIGHT TC-CCAC Christopher De Bono

Ethics Case

Conflict of interest case

What should you do How might you justify your position

28 COPYRIGHT TC-CCAC Christopher De Bono

Start with Experience hellipa case

29

Cultural duty to disclose case

What should you do as CCCSS person

How might you justify your position

What about you COPYRIGHT TC-CCAC Christopher De Bono

Todayrsquos key point Ethics is (in part) about ldquoright relationshiprdquo or ldquojusticerdquo

For us that relationship is within the health care relationship

o What is sometimes called the ldquofiduciary relationshiprdquo and the duties which flow from ithellip

I am going to argue that the better wersquore at it (justice) the better we are as personshellip and perhaps the easier it is to sleep at night

I am going to argue we get there by having ldquoworthwhile conversationsrdquo

30 COPYRIGHT TC-CCAC Christopher De Bono

Nothing about me without me

Itrsquos from Valerie Billingham from a session at the Salzburg Global Seminar (session 356) in 1998 ldquoThrough the Patientrsquos Eyesrdquo

Nothing about me without me 31

Ethics begins with self-awareness

COPYRIGHT TC-CCAC Christopher De Bono

A case which taught me something about ldquobeing in it

togetherrdquo

For me hellip something about ethicshellip AHA MOMENT

20 COPYRIGHT TC-CCAC Christopher De Bono

These are ldquoahardquo moments (akahellip ldquoThreshold Concept TCsrdquo)

Several qualities including

bull Transformative

bull Irreversible

bull Troublesome

helliphellip TC helps us link thingshellip

(Cousins 2006) 21 COPYRIGHT TC-CCAC Christopher De Bono

The ldquoworthwhile conversationrdquo experience of ethics in health care

PART ONE

WHAT IS CLINICAL ETHICS

ldquoClinical ethics is a disciplined way of helping people understand their conditions situations and prospects by helping them (at times insisting that they) grapple with their own moral beliefs what they really truly want and believe is worthwhile

(Richard Zaner 1993 adapted)

Transformative Irreversible Troublesome

22 COPYRIGHT TC-CCAC Christopher De Bono

Signs of an Ethical Issue

My gut tells me

somethingrsquos wrong

I start questioning my own or othersrsquo basic beliefs like

religion culture or lsquoup-bringingrsquo

I canrsquot sleep at night or I take my anxiety at work home with me

Things donrsquot fit - a

conflict

There are no easy or right answers to the

problem

23 COPYRIGHT TC-CCAC Christopher De Bono

PART ONE

WHAT IS CLINICAL ETHICS

ldquoClinical ethics is a disciplined way of helping people understand their conditions situations and prospects

by helping them (at times insisting that they) grapple

with their own moral beliefs what they really truly want and

believe is worthwhile

(Richard Zaner 1993 adapted)

Transformative Irreversible Troublesome

24

REVIEW

COPYRIGHT TC-CCAC Christopher De Bono

start with a thought experiment

1 Think of an unsettling time a powerful moment (experience)

that resulted in a profound shift in your understanding of ldquobeing with other peoplerdquo in home and community health care Please use something from your experiencehellip

2 Briefly on a piece of paper (if you need) hellip Identify a time hellip when you came to see something differentlyhellip

bull Identify what happened as a result

bull What did it provoke in you

bull What did you do with it

Thought experiment designed by Barbara Harrison used with permission 25

THINK PAIR SHARE

COPYRIGHT TC-CCAC Christopher De Bono

Our storiesaha moments

26 COPYRIGHT TC-CCAC Christopher De Bono

Some ethics cases to try

Whatrsquos the ethics grapple (FIT issue)

27

conditions situations and prospects grapple (with)

own moral beliefs what they really truly want and believe is worthwhile

COPYRIGHT TC-CCAC Christopher De Bono

Ethics Case

Conflict of interest case

What should you do How might you justify your position

28 COPYRIGHT TC-CCAC Christopher De Bono

Start with Experience hellipa case

29

Cultural duty to disclose case

What should you do as CCCSS person

How might you justify your position

What about you COPYRIGHT TC-CCAC Christopher De Bono

Todayrsquos key point Ethics is (in part) about ldquoright relationshiprdquo or ldquojusticerdquo

For us that relationship is within the health care relationship

o What is sometimes called the ldquofiduciary relationshiprdquo and the duties which flow from ithellip

I am going to argue that the better wersquore at it (justice) the better we are as personshellip and perhaps the easier it is to sleep at night

I am going to argue we get there by having ldquoworthwhile conversationsrdquo

30 COPYRIGHT TC-CCAC Christopher De Bono

Nothing about me without me

Itrsquos from Valerie Billingham from a session at the Salzburg Global Seminar (session 356) in 1998 ldquoThrough the Patientrsquos Eyesrdquo

Nothing about me without me 31

Ethics begins with self-awareness

COPYRIGHT TC-CCAC Christopher De Bono

These are ldquoahardquo moments (akahellip ldquoThreshold Concept TCsrdquo)

Several qualities including

bull Transformative

bull Irreversible

bull Troublesome

helliphellip TC helps us link thingshellip

(Cousins 2006) 21 COPYRIGHT TC-CCAC Christopher De Bono

The ldquoworthwhile conversationrdquo experience of ethics in health care

PART ONE

WHAT IS CLINICAL ETHICS

ldquoClinical ethics is a disciplined way of helping people understand their conditions situations and prospects by helping them (at times insisting that they) grapple with their own moral beliefs what they really truly want and believe is worthwhile

(Richard Zaner 1993 adapted)

Transformative Irreversible Troublesome

22 COPYRIGHT TC-CCAC Christopher De Bono

Signs of an Ethical Issue

My gut tells me

somethingrsquos wrong

I start questioning my own or othersrsquo basic beliefs like

religion culture or lsquoup-bringingrsquo

I canrsquot sleep at night or I take my anxiety at work home with me

Things donrsquot fit - a

conflict

There are no easy or right answers to the

problem

23 COPYRIGHT TC-CCAC Christopher De Bono

PART ONE

WHAT IS CLINICAL ETHICS

ldquoClinical ethics is a disciplined way of helping people understand their conditions situations and prospects

by helping them (at times insisting that they) grapple

with their own moral beliefs what they really truly want and

believe is worthwhile

(Richard Zaner 1993 adapted)

Transformative Irreversible Troublesome

24

REVIEW

COPYRIGHT TC-CCAC Christopher De Bono

start with a thought experiment

1 Think of an unsettling time a powerful moment (experience)

that resulted in a profound shift in your understanding of ldquobeing with other peoplerdquo in home and community health care Please use something from your experiencehellip

2 Briefly on a piece of paper (if you need) hellip Identify a time hellip when you came to see something differentlyhellip

bull Identify what happened as a result

bull What did it provoke in you

bull What did you do with it

Thought experiment designed by Barbara Harrison used with permission 25

THINK PAIR SHARE

COPYRIGHT TC-CCAC Christopher De Bono

Our storiesaha moments

26 COPYRIGHT TC-CCAC Christopher De Bono

Some ethics cases to try

Whatrsquos the ethics grapple (FIT issue)

27

conditions situations and prospects grapple (with)

own moral beliefs what they really truly want and believe is worthwhile

COPYRIGHT TC-CCAC Christopher De Bono

Ethics Case

Conflict of interest case

What should you do How might you justify your position

28 COPYRIGHT TC-CCAC Christopher De Bono

Start with Experience hellipa case

29

Cultural duty to disclose case

What should you do as CCCSS person

How might you justify your position

What about you COPYRIGHT TC-CCAC Christopher De Bono

Todayrsquos key point Ethics is (in part) about ldquoright relationshiprdquo or ldquojusticerdquo

For us that relationship is within the health care relationship

o What is sometimes called the ldquofiduciary relationshiprdquo and the duties which flow from ithellip

I am going to argue that the better wersquore at it (justice) the better we are as personshellip and perhaps the easier it is to sleep at night

I am going to argue we get there by having ldquoworthwhile conversationsrdquo

30 COPYRIGHT TC-CCAC Christopher De Bono

Nothing about me without me

Itrsquos from Valerie Billingham from a session at the Salzburg Global Seminar (session 356) in 1998 ldquoThrough the Patientrsquos Eyesrdquo

Nothing about me without me 31

Ethics begins with self-awareness

COPYRIGHT TC-CCAC Christopher De Bono

The ldquoworthwhile conversationrdquo experience of ethics in health care

PART ONE

WHAT IS CLINICAL ETHICS

ldquoClinical ethics is a disciplined way of helping people understand their conditions situations and prospects by helping them (at times insisting that they) grapple with their own moral beliefs what they really truly want and believe is worthwhile

(Richard Zaner 1993 adapted)

Transformative Irreversible Troublesome

22 COPYRIGHT TC-CCAC Christopher De Bono

Signs of an Ethical Issue

My gut tells me

somethingrsquos wrong

I start questioning my own or othersrsquo basic beliefs like

religion culture or lsquoup-bringingrsquo

I canrsquot sleep at night or I take my anxiety at work home with me

Things donrsquot fit - a

conflict

There are no easy or right answers to the

problem

23 COPYRIGHT TC-CCAC Christopher De Bono

PART ONE

WHAT IS CLINICAL ETHICS

ldquoClinical ethics is a disciplined way of helping people understand their conditions situations and prospects

by helping them (at times insisting that they) grapple

with their own moral beliefs what they really truly want and

believe is worthwhile

(Richard Zaner 1993 adapted)

Transformative Irreversible Troublesome

24

REVIEW

COPYRIGHT TC-CCAC Christopher De Bono

start with a thought experiment

1 Think of an unsettling time a powerful moment (experience)

that resulted in a profound shift in your understanding of ldquobeing with other peoplerdquo in home and community health care Please use something from your experiencehellip

2 Briefly on a piece of paper (if you need) hellip Identify a time hellip when you came to see something differentlyhellip

bull Identify what happened as a result

bull What did it provoke in you

bull What did you do with it

Thought experiment designed by Barbara Harrison used with permission 25

THINK PAIR SHARE

COPYRIGHT TC-CCAC Christopher De Bono

Our storiesaha moments

26 COPYRIGHT TC-CCAC Christopher De Bono

Some ethics cases to try

Whatrsquos the ethics grapple (FIT issue)

27

conditions situations and prospects grapple (with)

own moral beliefs what they really truly want and believe is worthwhile

COPYRIGHT TC-CCAC Christopher De Bono

Ethics Case

Conflict of interest case

What should you do How might you justify your position

28 COPYRIGHT TC-CCAC Christopher De Bono

Start with Experience hellipa case

29

Cultural duty to disclose case

What should you do as CCCSS person

How might you justify your position

What about you COPYRIGHT TC-CCAC Christopher De Bono

Todayrsquos key point Ethics is (in part) about ldquoright relationshiprdquo or ldquojusticerdquo

For us that relationship is within the health care relationship

o What is sometimes called the ldquofiduciary relationshiprdquo and the duties which flow from ithellip

I am going to argue that the better wersquore at it (justice) the better we are as personshellip and perhaps the easier it is to sleep at night

I am going to argue we get there by having ldquoworthwhile conversationsrdquo

30 COPYRIGHT TC-CCAC Christopher De Bono

Nothing about me without me

Itrsquos from Valerie Billingham from a session at the Salzburg Global Seminar (session 356) in 1998 ldquoThrough the Patientrsquos Eyesrdquo

Nothing about me without me 31

Ethics begins with self-awareness

COPYRIGHT TC-CCAC Christopher De Bono

Signs of an Ethical Issue

My gut tells me

somethingrsquos wrong

I start questioning my own or othersrsquo basic beliefs like

religion culture or lsquoup-bringingrsquo

I canrsquot sleep at night or I take my anxiety at work home with me

Things donrsquot fit - a

conflict

There are no easy or right answers to the

problem

23 COPYRIGHT TC-CCAC Christopher De Bono

PART ONE

WHAT IS CLINICAL ETHICS

ldquoClinical ethics is a disciplined way of helping people understand their conditions situations and prospects

by helping them (at times insisting that they) grapple

with their own moral beliefs what they really truly want and

believe is worthwhile

(Richard Zaner 1993 adapted)

Transformative Irreversible Troublesome

24

REVIEW

COPYRIGHT TC-CCAC Christopher De Bono

start with a thought experiment

1 Think of an unsettling time a powerful moment (experience)

that resulted in a profound shift in your understanding of ldquobeing with other peoplerdquo in home and community health care Please use something from your experiencehellip

2 Briefly on a piece of paper (if you need) hellip Identify a time hellip when you came to see something differentlyhellip

bull Identify what happened as a result

bull What did it provoke in you

bull What did you do with it

Thought experiment designed by Barbara Harrison used with permission 25

THINK PAIR SHARE

COPYRIGHT TC-CCAC Christopher De Bono

Our storiesaha moments

26 COPYRIGHT TC-CCAC Christopher De Bono

Some ethics cases to try

Whatrsquos the ethics grapple (FIT issue)

27

conditions situations and prospects grapple (with)

own moral beliefs what they really truly want and believe is worthwhile

COPYRIGHT TC-CCAC Christopher De Bono

Ethics Case

Conflict of interest case

What should you do How might you justify your position

28 COPYRIGHT TC-CCAC Christopher De Bono

Start with Experience hellipa case

29

Cultural duty to disclose case

What should you do as CCCSS person

How might you justify your position

What about you COPYRIGHT TC-CCAC Christopher De Bono

Todayrsquos key point Ethics is (in part) about ldquoright relationshiprdquo or ldquojusticerdquo

For us that relationship is within the health care relationship

o What is sometimes called the ldquofiduciary relationshiprdquo and the duties which flow from ithellip

I am going to argue that the better wersquore at it (justice) the better we are as personshellip and perhaps the easier it is to sleep at night

I am going to argue we get there by having ldquoworthwhile conversationsrdquo

30 COPYRIGHT TC-CCAC Christopher De Bono

Nothing about me without me

Itrsquos from Valerie Billingham from a session at the Salzburg Global Seminar (session 356) in 1998 ldquoThrough the Patientrsquos Eyesrdquo

Nothing about me without me 31

Ethics begins with self-awareness

COPYRIGHT TC-CCAC Christopher De Bono

PART ONE

WHAT IS CLINICAL ETHICS

ldquoClinical ethics is a disciplined way of helping people understand their conditions situations and prospects

by helping them (at times insisting that they) grapple

with their own moral beliefs what they really truly want and

believe is worthwhile

(Richard Zaner 1993 adapted)

Transformative Irreversible Troublesome

24

REVIEW

COPYRIGHT TC-CCAC Christopher De Bono

start with a thought experiment

1 Think of an unsettling time a powerful moment (experience)

that resulted in a profound shift in your understanding of ldquobeing with other peoplerdquo in home and community health care Please use something from your experiencehellip

2 Briefly on a piece of paper (if you need) hellip Identify a time hellip when you came to see something differentlyhellip

bull Identify what happened as a result

bull What did it provoke in you

bull What did you do with it

Thought experiment designed by Barbara Harrison used with permission 25

THINK PAIR SHARE

COPYRIGHT TC-CCAC Christopher De Bono

Our storiesaha moments

26 COPYRIGHT TC-CCAC Christopher De Bono

Some ethics cases to try

Whatrsquos the ethics grapple (FIT issue)

27

conditions situations and prospects grapple (with)

own moral beliefs what they really truly want and believe is worthwhile

COPYRIGHT TC-CCAC Christopher De Bono

Ethics Case

Conflict of interest case

What should you do How might you justify your position

28 COPYRIGHT TC-CCAC Christopher De Bono

Start with Experience hellipa case

29

Cultural duty to disclose case

What should you do as CCCSS person

How might you justify your position

What about you COPYRIGHT TC-CCAC Christopher De Bono

Todayrsquos key point Ethics is (in part) about ldquoright relationshiprdquo or ldquojusticerdquo

For us that relationship is within the health care relationship

o What is sometimes called the ldquofiduciary relationshiprdquo and the duties which flow from ithellip

I am going to argue that the better wersquore at it (justice) the better we are as personshellip and perhaps the easier it is to sleep at night

I am going to argue we get there by having ldquoworthwhile conversationsrdquo

30 COPYRIGHT TC-CCAC Christopher De Bono

Nothing about me without me

Itrsquos from Valerie Billingham from a session at the Salzburg Global Seminar (session 356) in 1998 ldquoThrough the Patientrsquos Eyesrdquo

Nothing about me without me 31

Ethics begins with self-awareness

COPYRIGHT TC-CCAC Christopher De Bono

start with a thought experiment

1 Think of an unsettling time a powerful moment (experience)

that resulted in a profound shift in your understanding of ldquobeing with other peoplerdquo in home and community health care Please use something from your experiencehellip

2 Briefly on a piece of paper (if you need) hellip Identify a time hellip when you came to see something differentlyhellip

bull Identify what happened as a result

bull What did it provoke in you

bull What did you do with it

Thought experiment designed by Barbara Harrison used with permission 25

THINK PAIR SHARE

COPYRIGHT TC-CCAC Christopher De Bono

Our storiesaha moments

26 COPYRIGHT TC-CCAC Christopher De Bono

Some ethics cases to try

Whatrsquos the ethics grapple (FIT issue)

27

conditions situations and prospects grapple (with)

own moral beliefs what they really truly want and believe is worthwhile

COPYRIGHT TC-CCAC Christopher De Bono

Ethics Case

Conflict of interest case

What should you do How might you justify your position

28 COPYRIGHT TC-CCAC Christopher De Bono

Start with Experience hellipa case

29

Cultural duty to disclose case

What should you do as CCCSS person

How might you justify your position

What about you COPYRIGHT TC-CCAC Christopher De Bono

Todayrsquos key point Ethics is (in part) about ldquoright relationshiprdquo or ldquojusticerdquo

For us that relationship is within the health care relationship

o What is sometimes called the ldquofiduciary relationshiprdquo and the duties which flow from ithellip

I am going to argue that the better wersquore at it (justice) the better we are as personshellip and perhaps the easier it is to sleep at night

I am going to argue we get there by having ldquoworthwhile conversationsrdquo

30 COPYRIGHT TC-CCAC Christopher De Bono

Nothing about me without me

Itrsquos from Valerie Billingham from a session at the Salzburg Global Seminar (session 356) in 1998 ldquoThrough the Patientrsquos Eyesrdquo

Nothing about me without me 31

Ethics begins with self-awareness

COPYRIGHT TC-CCAC Christopher De Bono

Our storiesaha moments

26 COPYRIGHT TC-CCAC Christopher De Bono

Some ethics cases to try

Whatrsquos the ethics grapple (FIT issue)

27

conditions situations and prospects grapple (with)

own moral beliefs what they really truly want and believe is worthwhile

COPYRIGHT TC-CCAC Christopher De Bono

Ethics Case

Conflict of interest case

What should you do How might you justify your position

28 COPYRIGHT TC-CCAC Christopher De Bono

Start with Experience hellipa case

29

Cultural duty to disclose case

What should you do as CCCSS person

How might you justify your position

What about you COPYRIGHT TC-CCAC Christopher De Bono

Todayrsquos key point Ethics is (in part) about ldquoright relationshiprdquo or ldquojusticerdquo

For us that relationship is within the health care relationship

o What is sometimes called the ldquofiduciary relationshiprdquo and the duties which flow from ithellip

I am going to argue that the better wersquore at it (justice) the better we are as personshellip and perhaps the easier it is to sleep at night

I am going to argue we get there by having ldquoworthwhile conversationsrdquo

30 COPYRIGHT TC-CCAC Christopher De Bono

Nothing about me without me

Itrsquos from Valerie Billingham from a session at the Salzburg Global Seminar (session 356) in 1998 ldquoThrough the Patientrsquos Eyesrdquo

Nothing about me without me 31

Ethics begins with self-awareness

COPYRIGHT TC-CCAC Christopher De Bono

Some ethics cases to try

Whatrsquos the ethics grapple (FIT issue)

27

conditions situations and prospects grapple (with)

own moral beliefs what they really truly want and believe is worthwhile

COPYRIGHT TC-CCAC Christopher De Bono

Ethics Case

Conflict of interest case

What should you do How might you justify your position

28 COPYRIGHT TC-CCAC Christopher De Bono

Start with Experience hellipa case

29

Cultural duty to disclose case

What should you do as CCCSS person

How might you justify your position

What about you COPYRIGHT TC-CCAC Christopher De Bono

Todayrsquos key point Ethics is (in part) about ldquoright relationshiprdquo or ldquojusticerdquo

For us that relationship is within the health care relationship

o What is sometimes called the ldquofiduciary relationshiprdquo and the duties which flow from ithellip

I am going to argue that the better wersquore at it (justice) the better we are as personshellip and perhaps the easier it is to sleep at night

I am going to argue we get there by having ldquoworthwhile conversationsrdquo

30 COPYRIGHT TC-CCAC Christopher De Bono

Nothing about me without me

Itrsquos from Valerie Billingham from a session at the Salzburg Global Seminar (session 356) in 1998 ldquoThrough the Patientrsquos Eyesrdquo

Nothing about me without me 31

Ethics begins with self-awareness

COPYRIGHT TC-CCAC Christopher De Bono

Ethics Case

Conflict of interest case

What should you do How might you justify your position

28 COPYRIGHT TC-CCAC Christopher De Bono

Start with Experience hellipa case

29

Cultural duty to disclose case

What should you do as CCCSS person

How might you justify your position

What about you COPYRIGHT TC-CCAC Christopher De Bono

Todayrsquos key point Ethics is (in part) about ldquoright relationshiprdquo or ldquojusticerdquo

For us that relationship is within the health care relationship

o What is sometimes called the ldquofiduciary relationshiprdquo and the duties which flow from ithellip

I am going to argue that the better wersquore at it (justice) the better we are as personshellip and perhaps the easier it is to sleep at night

I am going to argue we get there by having ldquoworthwhile conversationsrdquo

30 COPYRIGHT TC-CCAC Christopher De Bono

Nothing about me without me

Itrsquos from Valerie Billingham from a session at the Salzburg Global Seminar (session 356) in 1998 ldquoThrough the Patientrsquos Eyesrdquo

Nothing about me without me 31

Ethics begins with self-awareness

COPYRIGHT TC-CCAC Christopher De Bono

Start with Experience hellipa case

29

Cultural duty to disclose case

What should you do as CCCSS person

How might you justify your position

What about you COPYRIGHT TC-CCAC Christopher De Bono

Todayrsquos key point Ethics is (in part) about ldquoright relationshiprdquo or ldquojusticerdquo

For us that relationship is within the health care relationship

o What is sometimes called the ldquofiduciary relationshiprdquo and the duties which flow from ithellip

I am going to argue that the better wersquore at it (justice) the better we are as personshellip and perhaps the easier it is to sleep at night

I am going to argue we get there by having ldquoworthwhile conversationsrdquo

30 COPYRIGHT TC-CCAC Christopher De Bono

Nothing about me without me

Itrsquos from Valerie Billingham from a session at the Salzburg Global Seminar (session 356) in 1998 ldquoThrough the Patientrsquos Eyesrdquo

Nothing about me without me 31

Ethics begins with self-awareness

COPYRIGHT TC-CCAC Christopher De Bono

Todayrsquos key point Ethics is (in part) about ldquoright relationshiprdquo or ldquojusticerdquo

For us that relationship is within the health care relationship

o What is sometimes called the ldquofiduciary relationshiprdquo and the duties which flow from ithellip

I am going to argue that the better wersquore at it (justice) the better we are as personshellip and perhaps the easier it is to sleep at night

I am going to argue we get there by having ldquoworthwhile conversationsrdquo

30 COPYRIGHT TC-CCAC Christopher De Bono

Nothing about me without me

Itrsquos from Valerie Billingham from a session at the Salzburg Global Seminar (session 356) in 1998 ldquoThrough the Patientrsquos Eyesrdquo

Nothing about me without me 31

Ethics begins with self-awareness

COPYRIGHT TC-CCAC Christopher De Bono

Nothing about me without me

Itrsquos from Valerie Billingham from a session at the Salzburg Global Seminar (session 356) in 1998 ldquoThrough the Patientrsquos Eyesrdquo

Nothing about me without me 31

Ethics begins with self-awareness

COPYRIGHT TC-CCAC Christopher De Bono

Review so farhellip

bull In this together

bull Hell is other people (really) or Not

bull It pays to be curious

bull Wersquore really all strangers (especially in health care)

bull Collisions happen

bull Ethics is grappling (examples of worthwhile conversations)

HELP TO GRAPPLE hellip Whatrsquos out there 32 COPYRIGHT TC-CCAC Christopher De Bono

Ethics canshould start with Policy

Making difficult decisions is an inherent part of interaction with clients and colleagues in the Community Health Care and Support Service sector These decisions however sometimes involve

ethical issues and require special attention They may be decisions around service delivery education research or organizational practices

Policy PMA-401

33 COPYRIGHT TC-CCAC Christopher De Bono

Ethics canshould start with Policy

Making difficult decisions is an inherent part of interaction with clients and colleagues in the Community Health Care and Support Service sector These decisions however sometimes involve

ethical issues and require special attention They may be decisions around service delivery education research or organizational practices

Policy PMA-401

33 COPYRIGHT TC-CCAC Christopher De Bono

The policy how to practice ethicsethical decision making

bull Through a safe blame-free organizational culture

bull Supported by the Directors Management and Ethics Department

bull With partners (includes SPOs) toohellip

PMA-PO-401 34 COPYRIGHT TC-CCAC Christopher De Bono

Ethical decision-making is deciding what we should do explaining why we should do it and

describing how we should do it

Barbara Secker PhD Director of Education University of Toronto Joint Centre for Bioethics

IT IS A PROCESS amp IS DOCUMENTABLE amp it is COACHABLE

35

What is Ethical Decision-Making

COPYRIGHT TC-CCAC Christopher De Bono

CCAC proposes TOOLSRESOURCES

Ethics IDEA framework (picked up nationallyinternationally)

PeersManagers

Ethicist

Senior Leaders

More to comehellip

37 COPYRIGHT TC-CCAC Christopher De Bono

Algorithm on TCNet

hellip gt Capacity at Service level

38 COPYRIGHT TC-CCAC Christopher De Bono

CCAC proposes TOOLSRESOURCES

Ethics IDEA framework (picked up nationallyinternationally)

PeersManagers

Ethicist

Senior Leaders

More to comehellip

37 COPYRIGHT TC-CCAC Christopher De Bono

Algorithm on TCNet

hellip gt Capacity at Service level

38 COPYRIGHT TC-CCAC Christopher De Bono

Algorithm on TCNet

hellip gt Capacity at Service level

38 COPYRIGHT TC-CCAC Christopher De Bono

Any one ever used an ethics framework If sohellip Which onehellip

39 COPYRIGHT TC-CCAC Christopher De Bono

Ethical frameworks are like ldquoFiltersrdquo

They serve to ldquofilterrdquo how ldquowe selectively attend to the all of the potential information available to us as we tryrdquo

bull To understand the world around us amp

bull How best to live our lives

These filters shape [and reflect] our personalinstitutional moral system^

40 COPYRIGHT TC-CCAC Christopher De Bono

Ethics IDEA framework

bull Step-by-step tool

bull Considers 4 things facts (amp emotions) ethical principles options amp outcome evaluation

bull Forum for open amp non-threatening discussion

CAN ENGAGE

RISK

41 COPYRIGHT TC-CCAC Christopher De Bono

Ethics IDEA framework

bull Think about it as a ldquoworthwhile conversationrdquo

bull Engages Client CCCSS worker manager SPOshellip

42 COPYRIGHT TC-CCAC Christopher De Bono

Ethics IDEA framework

Think about it as part of complex Clinical Assessment

bull Identify

bull the underlying diagnosis

bull Treatment options amp recommendations amp

bull identifying and mobilizing the appropriate supports

IMPORTANT GAP

43 COPYRIGHT TC-CCAC Christopher De Bono

bull4 BOXES

1 What are the relevant medical

indications

2 What are the patient(s) preferences 1 RISK

3 What is the QoLevidence

4 What are the contextual features

bullWhat is the ethical issue (defined)

Step 1 Identify the Facts and the Ethical Issue

44 COPYRIGHT TC-CCAC Christopher De Bono

bullWhat is the ethical issue (defined)

Step 1B Identify the Facts and the Ethical Issue

Given the devastating facts about our childrsquos health and our love as parents which we understand to be about giving life how can we opt for palliative care Is this ethical

45 COPYRIGHT TC-CCAC Christopher De Bono

bull Advocacy bull Client and Employee Safety bull Commitment to Quality Services bull Confidentiality bull Conflict of Interest bull Dignity bull Fair and Equitable Access bull Health and Well-Being bull Informed Choice and

Empowerment bull Relationships Among Community

Agencies

SEE the community ethics Network webpage

This page is on the back of your

handout

46 COPYRIGHT TC-CCAC Christopher De Bono

bull Who are the stakeholders (relevant parties)

bull What valuesprinciples does each (stakeholder) believe are relevant to the issue

bull Which valuesprinciples do stakeholders agree are most important in the current context

bull Are there any other factors that need to be considered

Step 2 Determine the Ethical Principles in Conflict

47 COPYRIGHT TC-CCAC Christopher De Bono

Step 3 Explore the Options

bull Identify ALL options bull even options that might have

limitations or seem unfeasible

bull What are the strengthsbenefits of each option

bull What are the limitationsharm of each option

bull What is the most ethically justifiable option

48 COPYRIGHT TC-CCAC Christopher De Bono

bull Develop an action plan bull Include Safety plan

bullEvaluate the Planyour decision bull Are we (am I) comfortable with this

decision

Step 4 Act on your decision and evaluate

49 COPYRIGHT TC-CCAC Christopher De Bono

Putting this into practice

Learn the Acronym IDEA

50 COPYRIGHT TC-CCAC Christopher De Bono

Review ndash I D E A

I D E A

51 COPYRIGHT TC-CCAC Christopher De Bono

Review ndash I D E A

52 COPYRIGHT TC-CCAC Christopher De Bono

A casehellip a real one from last week

53 COPYRIGHT TC-CCAC Christopher De Bono

Supreme court case LTC placement questions

54

Building Ethics Capacity (a bit of Hx)

When all staffhellip

Recognize an ethical issue when they face it

Are equipped with tools resources and education to address ethical issues

Know where to get help

- Camille Orridge CEO Toronto Central LHIN (formerly of Toronto Central CCAC)

COPYRIGHT TC-CCAC Christopher De Bono

Any final thoughts about ldquobeing in this togetherrdquo

55 COPYRIGHT TC-CCAC Christopher De Bono

56 COPYRIGHT TC-CCAC Christopher De Bono

THANKShellip

Christopher E De Bono PhD Ethicist - Toronto Central CCAC

Member - Joint Centre for Bioethics(UofT) Adjunct Faculty Course Instructor (UofT)

Christopherdebonotorontoccac-ontca

57 COPYRIGHT TC-CCAC Christopher De Bono

Ethical frameworks are like ldquoFiltersrdquo

They serve to ldquofilterrdquo how ldquowe selectively attend to the all of the potential information available to us as we tryrdquo

bull To understand the world around us amp

bull How best to live our lives

These filters shape [and reflect] our personalinstitutional moral system^

40 COPYRIGHT TC-CCAC Christopher De Bono

Ethics IDEA framework

bull Step-by-step tool

bull Considers 4 things facts (amp emotions) ethical principles options amp outcome evaluation

bull Forum for open amp non-threatening discussion

CAN ENGAGE

RISK

41 COPYRIGHT TC-CCAC Christopher De Bono

Ethics IDEA framework

bull Think about it as a ldquoworthwhile conversationrdquo

bull Engages Client CCCSS worker manager SPOshellip

42 COPYRIGHT TC-CCAC Christopher De Bono

Ethics IDEA framework

Think about it as part of complex Clinical Assessment

bull Identify

bull the underlying diagnosis

bull Treatment options amp recommendations amp

bull identifying and mobilizing the appropriate supports

IMPORTANT GAP

43 COPYRIGHT TC-CCAC Christopher De Bono

bull4 BOXES

1 What are the relevant medical

indications

2 What are the patient(s) preferences 1 RISK

3 What is the QoLevidence

4 What are the contextual features

bullWhat is the ethical issue (defined)

Step 1 Identify the Facts and the Ethical Issue

44 COPYRIGHT TC-CCAC Christopher De Bono

bullWhat is the ethical issue (defined)

Step 1B Identify the Facts and the Ethical Issue

Given the devastating facts about our childrsquos health and our love as parents which we understand to be about giving life how can we opt for palliative care Is this ethical

45 COPYRIGHT TC-CCAC Christopher De Bono

bull Advocacy bull Client and Employee Safety bull Commitment to Quality Services bull Confidentiality bull Conflict of Interest bull Dignity bull Fair and Equitable Access bull Health and Well-Being bull Informed Choice and

Empowerment bull Relationships Among Community

Agencies

SEE the community ethics Network webpage

This page is on the back of your

handout

46 COPYRIGHT TC-CCAC Christopher De Bono

bull Who are the stakeholders (relevant parties)

bull What valuesprinciples does each (stakeholder) believe are relevant to the issue

bull Which valuesprinciples do stakeholders agree are most important in the current context

bull Are there any other factors that need to be considered

Step 2 Determine the Ethical Principles in Conflict

47 COPYRIGHT TC-CCAC Christopher De Bono

Step 3 Explore the Options

bull Identify ALL options bull even options that might have

limitations or seem unfeasible

bull What are the strengthsbenefits of each option

bull What are the limitationsharm of each option

bull What is the most ethically justifiable option

48 COPYRIGHT TC-CCAC Christopher De Bono

bull Develop an action plan bull Include Safety plan

bullEvaluate the Planyour decision bull Are we (am I) comfortable with this

decision

Step 4 Act on your decision and evaluate

49 COPYRIGHT TC-CCAC Christopher De Bono

Putting this into practice

Learn the Acronym IDEA

50 COPYRIGHT TC-CCAC Christopher De Bono

Review ndash I D E A

I D E A

51 COPYRIGHT TC-CCAC Christopher De Bono

Review ndash I D E A

52 COPYRIGHT TC-CCAC Christopher De Bono

A casehellip a real one from last week

53 COPYRIGHT TC-CCAC Christopher De Bono

Supreme court case LTC placement questions

54

Building Ethics Capacity (a bit of Hx)

When all staffhellip

Recognize an ethical issue when they face it

Are equipped with tools resources and education to address ethical issues

Know where to get help

- Camille Orridge CEO Toronto Central LHIN (formerly of Toronto Central CCAC)

COPYRIGHT TC-CCAC Christopher De Bono

Any final thoughts about ldquobeing in this togetherrdquo

55 COPYRIGHT TC-CCAC Christopher De Bono

56 COPYRIGHT TC-CCAC Christopher De Bono

THANKShellip

Christopher E De Bono PhD Ethicist - Toronto Central CCAC

Member - Joint Centre for Bioethics(UofT) Adjunct Faculty Course Instructor (UofT)

Christopherdebonotorontoccac-ontca

57 COPYRIGHT TC-CCAC Christopher De Bono

Ethics IDEA framework

bull Step-by-step tool

bull Considers 4 things facts (amp emotions) ethical principles options amp outcome evaluation

bull Forum for open amp non-threatening discussion

CAN ENGAGE

RISK

41 COPYRIGHT TC-CCAC Christopher De Bono

Ethics IDEA framework

bull Think about it as a ldquoworthwhile conversationrdquo

bull Engages Client CCCSS worker manager SPOshellip

42 COPYRIGHT TC-CCAC Christopher De Bono

Ethics IDEA framework

Think about it as part of complex Clinical Assessment

bull Identify

bull the underlying diagnosis

bull Treatment options amp recommendations amp

bull identifying and mobilizing the appropriate supports

IMPORTANT GAP

43 COPYRIGHT TC-CCAC Christopher De Bono

bull4 BOXES

1 What are the relevant medical

indications

2 What are the patient(s) preferences 1 RISK

3 What is the QoLevidence

4 What are the contextual features

bullWhat is the ethical issue (defined)

Step 1 Identify the Facts and the Ethical Issue

44 COPYRIGHT TC-CCAC Christopher De Bono

bullWhat is the ethical issue (defined)

Step 1B Identify the Facts and the Ethical Issue

Given the devastating facts about our childrsquos health and our love as parents which we understand to be about giving life how can we opt for palliative care Is this ethical

45 COPYRIGHT TC-CCAC Christopher De Bono

bull Advocacy bull Client and Employee Safety bull Commitment to Quality Services bull Confidentiality bull Conflict of Interest bull Dignity bull Fair and Equitable Access bull Health and Well-Being bull Informed Choice and

Empowerment bull Relationships Among Community

Agencies

SEE the community ethics Network webpage

This page is on the back of your

handout

46 COPYRIGHT TC-CCAC Christopher De Bono

bull Who are the stakeholders (relevant parties)

bull What valuesprinciples does each (stakeholder) believe are relevant to the issue

bull Which valuesprinciples do stakeholders agree are most important in the current context

bull Are there any other factors that need to be considered

Step 2 Determine the Ethical Principles in Conflict

47 COPYRIGHT TC-CCAC Christopher De Bono

Step 3 Explore the Options

bull Identify ALL options bull even options that might have

limitations or seem unfeasible

bull What are the strengthsbenefits of each option

bull What are the limitationsharm of each option

bull What is the most ethically justifiable option

48 COPYRIGHT TC-CCAC Christopher De Bono

bull Develop an action plan bull Include Safety plan

bullEvaluate the Planyour decision bull Are we (am I) comfortable with this

decision

Step 4 Act on your decision and evaluate

49 COPYRIGHT TC-CCAC Christopher De Bono

Putting this into practice

Learn the Acronym IDEA

50 COPYRIGHT TC-CCAC Christopher De Bono

Review ndash I D E A

I D E A

51 COPYRIGHT TC-CCAC Christopher De Bono

Review ndash I D E A

52 COPYRIGHT TC-CCAC Christopher De Bono

A casehellip a real one from last week

53 COPYRIGHT TC-CCAC Christopher De Bono

Supreme court case LTC placement questions

54

Building Ethics Capacity (a bit of Hx)

When all staffhellip

Recognize an ethical issue when they face it

Are equipped with tools resources and education to address ethical issues

Know where to get help

- Camille Orridge CEO Toronto Central LHIN (formerly of Toronto Central CCAC)

COPYRIGHT TC-CCAC Christopher De Bono

Any final thoughts about ldquobeing in this togetherrdquo

55 COPYRIGHT TC-CCAC Christopher De Bono

56 COPYRIGHT TC-CCAC Christopher De Bono

THANKShellip

Christopher E De Bono PhD Ethicist - Toronto Central CCAC

Member - Joint Centre for Bioethics(UofT) Adjunct Faculty Course Instructor (UofT)

Christopherdebonotorontoccac-ontca

57 COPYRIGHT TC-CCAC Christopher De Bono

Ethics IDEA framework

bull Think about it as a ldquoworthwhile conversationrdquo

bull Engages Client CCCSS worker manager SPOshellip

42 COPYRIGHT TC-CCAC Christopher De Bono

Ethics IDEA framework

Think about it as part of complex Clinical Assessment

bull Identify

bull the underlying diagnosis

bull Treatment options amp recommendations amp

bull identifying and mobilizing the appropriate supports

IMPORTANT GAP

43 COPYRIGHT TC-CCAC Christopher De Bono

bull4 BOXES

1 What are the relevant medical

indications

2 What are the patient(s) preferences 1 RISK

3 What is the QoLevidence

4 What are the contextual features

bullWhat is the ethical issue (defined)

Step 1 Identify the Facts and the Ethical Issue

44 COPYRIGHT TC-CCAC Christopher De Bono

bullWhat is the ethical issue (defined)

Step 1B Identify the Facts and the Ethical Issue

Given the devastating facts about our childrsquos health and our love as parents which we understand to be about giving life how can we opt for palliative care Is this ethical

45 COPYRIGHT TC-CCAC Christopher De Bono

bull Advocacy bull Client and Employee Safety bull Commitment to Quality Services bull Confidentiality bull Conflict of Interest bull Dignity bull Fair and Equitable Access bull Health and Well-Being bull Informed Choice and

Empowerment bull Relationships Among Community

Agencies

SEE the community ethics Network webpage

This page is on the back of your

handout

46 COPYRIGHT TC-CCAC Christopher De Bono

bull Who are the stakeholders (relevant parties)

bull What valuesprinciples does each (stakeholder) believe are relevant to the issue

bull Which valuesprinciples do stakeholders agree are most important in the current context

bull Are there any other factors that need to be considered

Step 2 Determine the Ethical Principles in Conflict

47 COPYRIGHT TC-CCAC Christopher De Bono

Step 3 Explore the Options

bull Identify ALL options bull even options that might have

limitations or seem unfeasible

bull What are the strengthsbenefits of each option

bull What are the limitationsharm of each option

bull What is the most ethically justifiable option

48 COPYRIGHT TC-CCAC Christopher De Bono

bull Develop an action plan bull Include Safety plan

bullEvaluate the Planyour decision bull Are we (am I) comfortable with this

decision

Step 4 Act on your decision and evaluate

49 COPYRIGHT TC-CCAC Christopher De Bono

Putting this into practice

Learn the Acronym IDEA

50 COPYRIGHT TC-CCAC Christopher De Bono

Review ndash I D E A

I D E A

51 COPYRIGHT TC-CCAC Christopher De Bono

Review ndash I D E A

52 COPYRIGHT TC-CCAC Christopher De Bono

A casehellip a real one from last week

53 COPYRIGHT TC-CCAC Christopher De Bono

Supreme court case LTC placement questions

54

Building Ethics Capacity (a bit of Hx)

When all staffhellip

Recognize an ethical issue when they face it

Are equipped with tools resources and education to address ethical issues

Know where to get help

- Camille Orridge CEO Toronto Central LHIN (formerly of Toronto Central CCAC)

COPYRIGHT TC-CCAC Christopher De Bono

Any final thoughts about ldquobeing in this togetherrdquo

55 COPYRIGHT TC-CCAC Christopher De Bono

56 COPYRIGHT TC-CCAC Christopher De Bono

THANKShellip

Christopher E De Bono PhD Ethicist - Toronto Central CCAC

Member - Joint Centre for Bioethics(UofT) Adjunct Faculty Course Instructor (UofT)

Christopherdebonotorontoccac-ontca

57 COPYRIGHT TC-CCAC Christopher De Bono

Ethics IDEA framework

Think about it as part of complex Clinical Assessment

bull Identify

bull the underlying diagnosis

bull Treatment options amp recommendations amp

bull identifying and mobilizing the appropriate supports

IMPORTANT GAP

43 COPYRIGHT TC-CCAC Christopher De Bono

bull4 BOXES

1 What are the relevant medical

indications

2 What are the patient(s) preferences 1 RISK

3 What is the QoLevidence

4 What are the contextual features

bullWhat is the ethical issue (defined)

Step 1 Identify the Facts and the Ethical Issue

44 COPYRIGHT TC-CCAC Christopher De Bono

bullWhat is the ethical issue (defined)

Step 1B Identify the Facts and the Ethical Issue

Given the devastating facts about our childrsquos health and our love as parents which we understand to be about giving life how can we opt for palliative care Is this ethical

45 COPYRIGHT TC-CCAC Christopher De Bono

bull Advocacy bull Client and Employee Safety bull Commitment to Quality Services bull Confidentiality bull Conflict of Interest bull Dignity bull Fair and Equitable Access bull Health and Well-Being bull Informed Choice and

Empowerment bull Relationships Among Community

Agencies

SEE the community ethics Network webpage

This page is on the back of your

handout

46 COPYRIGHT TC-CCAC Christopher De Bono

bull Who are the stakeholders (relevant parties)

bull What valuesprinciples does each (stakeholder) believe are relevant to the issue

bull Which valuesprinciples do stakeholders agree are most important in the current context

bull Are there any other factors that need to be considered

Step 2 Determine the Ethical Principles in Conflict

47 COPYRIGHT TC-CCAC Christopher De Bono

Step 3 Explore the Options

bull Identify ALL options bull even options that might have

limitations or seem unfeasible

bull What are the strengthsbenefits of each option

bull What are the limitationsharm of each option

bull What is the most ethically justifiable option

48 COPYRIGHT TC-CCAC Christopher De Bono

bull Develop an action plan bull Include Safety plan

bullEvaluate the Planyour decision bull Are we (am I) comfortable with this

decision

Step 4 Act on your decision and evaluate

49 COPYRIGHT TC-CCAC Christopher De Bono

Putting this into practice

Learn the Acronym IDEA

50 COPYRIGHT TC-CCAC Christopher De Bono

Review ndash I D E A

I D E A

51 COPYRIGHT TC-CCAC Christopher De Bono

Review ndash I D E A

52 COPYRIGHT TC-CCAC Christopher De Bono

A casehellip a real one from last week

53 COPYRIGHT TC-CCAC Christopher De Bono

Supreme court case LTC placement questions

54

Building Ethics Capacity (a bit of Hx)

When all staffhellip

Recognize an ethical issue when they face it

Are equipped with tools resources and education to address ethical issues

Know where to get help

- Camille Orridge CEO Toronto Central LHIN (formerly of Toronto Central CCAC)

COPYRIGHT TC-CCAC Christopher De Bono

Any final thoughts about ldquobeing in this togetherrdquo

55 COPYRIGHT TC-CCAC Christopher De Bono

56 COPYRIGHT TC-CCAC Christopher De Bono

THANKShellip

Christopher E De Bono PhD Ethicist - Toronto Central CCAC

Member - Joint Centre for Bioethics(UofT) Adjunct Faculty Course Instructor (UofT)

Christopherdebonotorontoccac-ontca

57 COPYRIGHT TC-CCAC Christopher De Bono

bull4 BOXES

1 What are the relevant medical

indications

2 What are the patient(s) preferences 1 RISK

3 What is the QoLevidence

4 What are the contextual features

bullWhat is the ethical issue (defined)

Step 1 Identify the Facts and the Ethical Issue

44 COPYRIGHT TC-CCAC Christopher De Bono

bullWhat is the ethical issue (defined)

Step 1B Identify the Facts and the Ethical Issue

Given the devastating facts about our childrsquos health and our love as parents which we understand to be about giving life how can we opt for palliative care Is this ethical

45 COPYRIGHT TC-CCAC Christopher De Bono

bull Advocacy bull Client and Employee Safety bull Commitment to Quality Services bull Confidentiality bull Conflict of Interest bull Dignity bull Fair and Equitable Access bull Health and Well-Being bull Informed Choice and

Empowerment bull Relationships Among Community

Agencies

SEE the community ethics Network webpage

This page is on the back of your

handout

46 COPYRIGHT TC-CCAC Christopher De Bono

bull Who are the stakeholders (relevant parties)

bull What valuesprinciples does each (stakeholder) believe are relevant to the issue

bull Which valuesprinciples do stakeholders agree are most important in the current context

bull Are there any other factors that need to be considered

Step 2 Determine the Ethical Principles in Conflict

47 COPYRIGHT TC-CCAC Christopher De Bono

Step 3 Explore the Options

bull Identify ALL options bull even options that might have

limitations or seem unfeasible

bull What are the strengthsbenefits of each option

bull What are the limitationsharm of each option

bull What is the most ethically justifiable option

48 COPYRIGHT TC-CCAC Christopher De Bono

bull Develop an action plan bull Include Safety plan

bullEvaluate the Planyour decision bull Are we (am I) comfortable with this

decision

Step 4 Act on your decision and evaluate

49 COPYRIGHT TC-CCAC Christopher De Bono

Putting this into practice

Learn the Acronym IDEA

50 COPYRIGHT TC-CCAC Christopher De Bono

Review ndash I D E A

I D E A

51 COPYRIGHT TC-CCAC Christopher De Bono

Review ndash I D E A

52 COPYRIGHT TC-CCAC Christopher De Bono

A casehellip a real one from last week

53 COPYRIGHT TC-CCAC Christopher De Bono

Supreme court case LTC placement questions

54

Building Ethics Capacity (a bit of Hx)

When all staffhellip

Recognize an ethical issue when they face it

Are equipped with tools resources and education to address ethical issues

Know where to get help

- Camille Orridge CEO Toronto Central LHIN (formerly of Toronto Central CCAC)

COPYRIGHT TC-CCAC Christopher De Bono

Any final thoughts about ldquobeing in this togetherrdquo

55 COPYRIGHT TC-CCAC Christopher De Bono

56 COPYRIGHT TC-CCAC Christopher De Bono

THANKShellip

Christopher E De Bono PhD Ethicist - Toronto Central CCAC

Member - Joint Centre for Bioethics(UofT) Adjunct Faculty Course Instructor (UofT)

Christopherdebonotorontoccac-ontca

57 COPYRIGHT TC-CCAC Christopher De Bono

bullWhat is the ethical issue (defined)

Step 1B Identify the Facts and the Ethical Issue

Given the devastating facts about our childrsquos health and our love as parents which we understand to be about giving life how can we opt for palliative care Is this ethical

45 COPYRIGHT TC-CCAC Christopher De Bono

bull Advocacy bull Client and Employee Safety bull Commitment to Quality Services bull Confidentiality bull Conflict of Interest bull Dignity bull Fair and Equitable Access bull Health and Well-Being bull Informed Choice and

Empowerment bull Relationships Among Community

Agencies

SEE the community ethics Network webpage

This page is on the back of your

handout

46 COPYRIGHT TC-CCAC Christopher De Bono

bull Who are the stakeholders (relevant parties)

bull What valuesprinciples does each (stakeholder) believe are relevant to the issue

bull Which valuesprinciples do stakeholders agree are most important in the current context

bull Are there any other factors that need to be considered

Step 2 Determine the Ethical Principles in Conflict

47 COPYRIGHT TC-CCAC Christopher De Bono

Step 3 Explore the Options

bull Identify ALL options bull even options that might have

limitations or seem unfeasible

bull What are the strengthsbenefits of each option

bull What are the limitationsharm of each option

bull What is the most ethically justifiable option

48 COPYRIGHT TC-CCAC Christopher De Bono

bull Develop an action plan bull Include Safety plan

bullEvaluate the Planyour decision bull Are we (am I) comfortable with this

decision

Step 4 Act on your decision and evaluate

49 COPYRIGHT TC-CCAC Christopher De Bono

Putting this into practice

Learn the Acronym IDEA

50 COPYRIGHT TC-CCAC Christopher De Bono

Review ndash I D E A

I D E A

51 COPYRIGHT TC-CCAC Christopher De Bono

Review ndash I D E A

52 COPYRIGHT TC-CCAC Christopher De Bono

A casehellip a real one from last week

53 COPYRIGHT TC-CCAC Christopher De Bono

Supreme court case LTC placement questions

54

Building Ethics Capacity (a bit of Hx)

When all staffhellip

Recognize an ethical issue when they face it

Are equipped with tools resources and education to address ethical issues

Know where to get help

- Camille Orridge CEO Toronto Central LHIN (formerly of Toronto Central CCAC)

COPYRIGHT TC-CCAC Christopher De Bono

Any final thoughts about ldquobeing in this togetherrdquo

55 COPYRIGHT TC-CCAC Christopher De Bono

56 COPYRIGHT TC-CCAC Christopher De Bono

THANKShellip

Christopher E De Bono PhD Ethicist - Toronto Central CCAC

Member - Joint Centre for Bioethics(UofT) Adjunct Faculty Course Instructor (UofT)

Christopherdebonotorontoccac-ontca

57 COPYRIGHT TC-CCAC Christopher De Bono

bull Advocacy bull Client and Employee Safety bull Commitment to Quality Services bull Confidentiality bull Conflict of Interest bull Dignity bull Fair and Equitable Access bull Health and Well-Being bull Informed Choice and

Empowerment bull Relationships Among Community

Agencies

SEE the community ethics Network webpage

This page is on the back of your

handout

46 COPYRIGHT TC-CCAC Christopher De Bono

bull Who are the stakeholders (relevant parties)

bull What valuesprinciples does each (stakeholder) believe are relevant to the issue

bull Which valuesprinciples do stakeholders agree are most important in the current context

bull Are there any other factors that need to be considered

Step 2 Determine the Ethical Principles in Conflict

47 COPYRIGHT TC-CCAC Christopher De Bono

Step 3 Explore the Options

bull Identify ALL options bull even options that might have

limitations or seem unfeasible

bull What are the strengthsbenefits of each option

bull What are the limitationsharm of each option

bull What is the most ethically justifiable option

48 COPYRIGHT TC-CCAC Christopher De Bono

bull Develop an action plan bull Include Safety plan

bullEvaluate the Planyour decision bull Are we (am I) comfortable with this

decision

Step 4 Act on your decision and evaluate

49 COPYRIGHT TC-CCAC Christopher De Bono

Putting this into practice

Learn the Acronym IDEA

50 COPYRIGHT TC-CCAC Christopher De Bono

Review ndash I D E A

I D E A

51 COPYRIGHT TC-CCAC Christopher De Bono

Review ndash I D E A

52 COPYRIGHT TC-CCAC Christopher De Bono

A casehellip a real one from last week

53 COPYRIGHT TC-CCAC Christopher De Bono

Supreme court case LTC placement questions

54

Building Ethics Capacity (a bit of Hx)

When all staffhellip

Recognize an ethical issue when they face it

Are equipped with tools resources and education to address ethical issues

Know where to get help

- Camille Orridge CEO Toronto Central LHIN (formerly of Toronto Central CCAC)

COPYRIGHT TC-CCAC Christopher De Bono

Any final thoughts about ldquobeing in this togetherrdquo

55 COPYRIGHT TC-CCAC Christopher De Bono

56 COPYRIGHT TC-CCAC Christopher De Bono

THANKShellip

Christopher E De Bono PhD Ethicist - Toronto Central CCAC

Member - Joint Centre for Bioethics(UofT) Adjunct Faculty Course Instructor (UofT)

Christopherdebonotorontoccac-ontca

57 COPYRIGHT TC-CCAC Christopher De Bono

bull Who are the stakeholders (relevant parties)

bull What valuesprinciples does each (stakeholder) believe are relevant to the issue

bull Which valuesprinciples do stakeholders agree are most important in the current context

bull Are there any other factors that need to be considered

Step 2 Determine the Ethical Principles in Conflict

47 COPYRIGHT TC-CCAC Christopher De Bono

Step 3 Explore the Options

bull Identify ALL options bull even options that might have

limitations or seem unfeasible

bull What are the strengthsbenefits of each option

bull What are the limitationsharm of each option

bull What is the most ethically justifiable option

48 COPYRIGHT TC-CCAC Christopher De Bono

bull Develop an action plan bull Include Safety plan

bullEvaluate the Planyour decision bull Are we (am I) comfortable with this

decision

Step 4 Act on your decision and evaluate

49 COPYRIGHT TC-CCAC Christopher De Bono

Putting this into practice

Learn the Acronym IDEA

50 COPYRIGHT TC-CCAC Christopher De Bono

Review ndash I D E A

I D E A

51 COPYRIGHT TC-CCAC Christopher De Bono

Review ndash I D E A

52 COPYRIGHT TC-CCAC Christopher De Bono

A casehellip a real one from last week

53 COPYRIGHT TC-CCAC Christopher De Bono

Supreme court case LTC placement questions

54

Building Ethics Capacity (a bit of Hx)

When all staffhellip

Recognize an ethical issue when they face it

Are equipped with tools resources and education to address ethical issues

Know where to get help

- Camille Orridge CEO Toronto Central LHIN (formerly of Toronto Central CCAC)

COPYRIGHT TC-CCAC Christopher De Bono

Any final thoughts about ldquobeing in this togetherrdquo

55 COPYRIGHT TC-CCAC Christopher De Bono

56 COPYRIGHT TC-CCAC Christopher De Bono

THANKShellip

Christopher E De Bono PhD Ethicist - Toronto Central CCAC

Member - Joint Centre for Bioethics(UofT) Adjunct Faculty Course Instructor (UofT)

Christopherdebonotorontoccac-ontca

57 COPYRIGHT TC-CCAC Christopher De Bono

Step 3 Explore the Options

bull Identify ALL options bull even options that might have

limitations or seem unfeasible

bull What are the strengthsbenefits of each option

bull What are the limitationsharm of each option

bull What is the most ethically justifiable option

48 COPYRIGHT TC-CCAC Christopher De Bono

bull Develop an action plan bull Include Safety plan

bullEvaluate the Planyour decision bull Are we (am I) comfortable with this

decision

Step 4 Act on your decision and evaluate

49 COPYRIGHT TC-CCAC Christopher De Bono

Putting this into practice

Learn the Acronym IDEA

50 COPYRIGHT TC-CCAC Christopher De Bono

Review ndash I D E A

I D E A

51 COPYRIGHT TC-CCAC Christopher De Bono

Review ndash I D E A

52 COPYRIGHT TC-CCAC Christopher De Bono

A casehellip a real one from last week

53 COPYRIGHT TC-CCAC Christopher De Bono

Supreme court case LTC placement questions

54

Building Ethics Capacity (a bit of Hx)

When all staffhellip

Recognize an ethical issue when they face it

Are equipped with tools resources and education to address ethical issues

Know where to get help

- Camille Orridge CEO Toronto Central LHIN (formerly of Toronto Central CCAC)

COPYRIGHT TC-CCAC Christopher De Bono

Any final thoughts about ldquobeing in this togetherrdquo

55 COPYRIGHT TC-CCAC Christopher De Bono

56 COPYRIGHT TC-CCAC Christopher De Bono

THANKShellip

Christopher E De Bono PhD Ethicist - Toronto Central CCAC

Member - Joint Centre for Bioethics(UofT) Adjunct Faculty Course Instructor (UofT)

Christopherdebonotorontoccac-ontca

57 COPYRIGHT TC-CCAC Christopher De Bono

bull Develop an action plan bull Include Safety plan

bullEvaluate the Planyour decision bull Are we (am I) comfortable with this

decision

Step 4 Act on your decision and evaluate

49 COPYRIGHT TC-CCAC Christopher De Bono

Putting this into practice

Learn the Acronym IDEA

50 COPYRIGHT TC-CCAC Christopher De Bono

Review ndash I D E A

I D E A

51 COPYRIGHT TC-CCAC Christopher De Bono

Review ndash I D E A

52 COPYRIGHT TC-CCAC Christopher De Bono

A casehellip a real one from last week

53 COPYRIGHT TC-CCAC Christopher De Bono

Supreme court case LTC placement questions

54

Building Ethics Capacity (a bit of Hx)

When all staffhellip

Recognize an ethical issue when they face it

Are equipped with tools resources and education to address ethical issues

Know where to get help

- Camille Orridge CEO Toronto Central LHIN (formerly of Toronto Central CCAC)

COPYRIGHT TC-CCAC Christopher De Bono

Any final thoughts about ldquobeing in this togetherrdquo

55 COPYRIGHT TC-CCAC Christopher De Bono

56 COPYRIGHT TC-CCAC Christopher De Bono

THANKShellip

Christopher E De Bono PhD Ethicist - Toronto Central CCAC

Member - Joint Centre for Bioethics(UofT) Adjunct Faculty Course Instructor (UofT)

Christopherdebonotorontoccac-ontca

57 COPYRIGHT TC-CCAC Christopher De Bono

Putting this into practice

Learn the Acronym IDEA

50 COPYRIGHT TC-CCAC Christopher De Bono

Review ndash I D E A

I D E A

51 COPYRIGHT TC-CCAC Christopher De Bono

Review ndash I D E A

52 COPYRIGHT TC-CCAC Christopher De Bono

A casehellip a real one from last week

53 COPYRIGHT TC-CCAC Christopher De Bono

Supreme court case LTC placement questions

54

Building Ethics Capacity (a bit of Hx)

When all staffhellip

Recognize an ethical issue when they face it

Are equipped with tools resources and education to address ethical issues

Know where to get help

- Camille Orridge CEO Toronto Central LHIN (formerly of Toronto Central CCAC)

COPYRIGHT TC-CCAC Christopher De Bono

Any final thoughts about ldquobeing in this togetherrdquo

55 COPYRIGHT TC-CCAC Christopher De Bono

56 COPYRIGHT TC-CCAC Christopher De Bono

THANKShellip

Christopher E De Bono PhD Ethicist - Toronto Central CCAC

Member - Joint Centre for Bioethics(UofT) Adjunct Faculty Course Instructor (UofT)

Christopherdebonotorontoccac-ontca

57 COPYRIGHT TC-CCAC Christopher De Bono

Review ndash I D E A

I D E A

51 COPYRIGHT TC-CCAC Christopher De Bono

Review ndash I D E A

52 COPYRIGHT TC-CCAC Christopher De Bono

A casehellip a real one from last week

53 COPYRIGHT TC-CCAC Christopher De Bono

Supreme court case LTC placement questions

54

Building Ethics Capacity (a bit of Hx)

When all staffhellip

Recognize an ethical issue when they face it

Are equipped with tools resources and education to address ethical issues

Know where to get help

- Camille Orridge CEO Toronto Central LHIN (formerly of Toronto Central CCAC)

COPYRIGHT TC-CCAC Christopher De Bono

Any final thoughts about ldquobeing in this togetherrdquo

55 COPYRIGHT TC-CCAC Christopher De Bono

56 COPYRIGHT TC-CCAC Christopher De Bono

THANKShellip

Christopher E De Bono PhD Ethicist - Toronto Central CCAC

Member - Joint Centre for Bioethics(UofT) Adjunct Faculty Course Instructor (UofT)

Christopherdebonotorontoccac-ontca

57 COPYRIGHT TC-CCAC Christopher De Bono

Review ndash I D E A

52 COPYRIGHT TC-CCAC Christopher De Bono

A casehellip a real one from last week

53 COPYRIGHT TC-CCAC Christopher De Bono

Supreme court case LTC placement questions

54

Building Ethics Capacity (a bit of Hx)

When all staffhellip

Recognize an ethical issue when they face it

Are equipped with tools resources and education to address ethical issues

Know where to get help

- Camille Orridge CEO Toronto Central LHIN (formerly of Toronto Central CCAC)

COPYRIGHT TC-CCAC Christopher De Bono

Any final thoughts about ldquobeing in this togetherrdquo

55 COPYRIGHT TC-CCAC Christopher De Bono

56 COPYRIGHT TC-CCAC Christopher De Bono

THANKShellip

Christopher E De Bono PhD Ethicist - Toronto Central CCAC

Member - Joint Centre for Bioethics(UofT) Adjunct Faculty Course Instructor (UofT)

Christopherdebonotorontoccac-ontca

57 COPYRIGHT TC-CCAC Christopher De Bono

A casehellip a real one from last week

53 COPYRIGHT TC-CCAC Christopher De Bono

Supreme court case LTC placement questions

54

Building Ethics Capacity (a bit of Hx)

When all staffhellip

Recognize an ethical issue when they face it

Are equipped with tools resources and education to address ethical issues

Know where to get help

- Camille Orridge CEO Toronto Central LHIN (formerly of Toronto Central CCAC)

COPYRIGHT TC-CCAC Christopher De Bono

Any final thoughts about ldquobeing in this togetherrdquo

55 COPYRIGHT TC-CCAC Christopher De Bono

56 COPYRIGHT TC-CCAC Christopher De Bono

THANKShellip

Christopher E De Bono PhD Ethicist - Toronto Central CCAC

Member - Joint Centre for Bioethics(UofT) Adjunct Faculty Course Instructor (UofT)

Christopherdebonotorontoccac-ontca

57 COPYRIGHT TC-CCAC Christopher De Bono

54

Building Ethics Capacity (a bit of Hx)

When all staffhellip

Recognize an ethical issue when they face it

Are equipped with tools resources and education to address ethical issues

Know where to get help

- Camille Orridge CEO Toronto Central LHIN (formerly of Toronto Central CCAC)

COPYRIGHT TC-CCAC Christopher De Bono

Any final thoughts about ldquobeing in this togetherrdquo

55 COPYRIGHT TC-CCAC Christopher De Bono

56 COPYRIGHT TC-CCAC Christopher De Bono

THANKShellip

Christopher E De Bono PhD Ethicist - Toronto Central CCAC

Member - Joint Centre for Bioethics(UofT) Adjunct Faculty Course Instructor (UofT)

Christopherdebonotorontoccac-ontca

57 COPYRIGHT TC-CCAC Christopher De Bono

Any final thoughts about ldquobeing in this togetherrdquo

55 COPYRIGHT TC-CCAC Christopher De Bono

56 COPYRIGHT TC-CCAC Christopher De Bono

THANKShellip

Christopher E De Bono PhD Ethicist - Toronto Central CCAC

Member - Joint Centre for Bioethics(UofT) Adjunct Faculty Course Instructor (UofT)

Christopherdebonotorontoccac-ontca

57 COPYRIGHT TC-CCAC Christopher De Bono

56 COPYRIGHT TC-CCAC Christopher De Bono

THANKShellip

Christopher E De Bono PhD Ethicist - Toronto Central CCAC

Member - Joint Centre for Bioethics(UofT) Adjunct Faculty Course Instructor (UofT)

Christopherdebonotorontoccac-ontca

57 COPYRIGHT TC-CCAC Christopher De Bono

THANKShellip

Christopher E De Bono PhD Ethicist - Toronto Central CCAC

Member - Joint Centre for Bioethics(UofT) Adjunct Faculty Course Instructor (UofT)

Christopherdebonotorontoccac-ontca

57 COPYRIGHT TC-CCAC Christopher De Bono