The Innovation

What’s Different About This Approach

Traditionally, when people think of ethics in the context of policy, what comes to mind is identification of key principles relevant to the work. Ethics analysis of the policy then explores what these principles mean and how they are balanced in the policy.

The conventional approach only considers formal policies as worthy of ethics analysis, and the method of analysis leaves a number of key ethically significant dimensions of the system-level decision process unaddressed.

The process offered here includes a number of innovations to the conventional method of analysis, including:


Mandate and Relationships of Decision Team

  • WHAT MATTERS -Who is involved? How will disagreement be resolved? How open are we to different perspectives? The way a team has dialogues has a direct relationship to the values that the solution will reflect. These process decisions should be made thoughtfully and intentionally.
  • CURRENT PRACTICE -A team is struck and immediately begins developing a solution. This usually begins by surveying literature and practice at other organizations. Little or no attention is paid to group mandate or dynamics.
  • THE INNOVATION -The approach outlined in this document begins with explicit discussion of what the group’s mandate is, who should be involved, and how the team will work.

Distinction and Systematic Analysis of Facts and Values

  • WHAT MATTERS -Facts and values are different types of concepts. Some facts can be defended by evidence and information. Values are defended by reasons and appeals to what should matter most. These different types of beliefs should be distinguished and analyzed separately.
  • CURRENT PRACTICE -Teams rarely separate the facts and values implicit in preferred positions. These are usually muddled together in defense of a preferred solution making it hard to assess the quality of an argument or solution.
  • THE INNOVATION -Facts and values are explicitly treated as distinct categories. Each is addressed in a separate step and discussed in an organized and careful way.

Consultation with System Experts

  • WHAT MATTERS -Good decisions depend on good information. Relevant information includes not only technical facts, but also facts about the intended purpose or ends the activity is being pursued to achieve. To get this, the most knowledgeable sources should be consulted.
  • CURRENT PRACTICE -Technical information and practices at other places are often compiled well, but in an unsystematic way. Information about what matters to the experts involved and the values implicit in preferred solutions are often left unexplored.
  • THE INNOVATION -A separate worksheet is provided to help think through which physicians, staff and other experts should be consulted and how this can be done.

Consultation With Those Affected

  • WHAT MATTERS -Patients and family members often have the most at stake in system-level decisions. They also have important knowledge about the impact of clinical system-decisions. Their views should inform decisions.
  • CURRENT PRACTICE -Patients and families are rarely consulted in system-level decisions.
  • THE INNOVATION -A separate worksheet is provided to help think through which patients and loved ones should be consulted and how this can be done.

Consultation With the Public

  • WHAT MATTERS -We share a commitment to ideals of democracy in Canada. This means that the values of those impacted by decisions should influence the decisions.
  • CURRENT PRACTICE -This is simply not considered in most system-level decision approaches.
  • THE INNOVATION -Separate tools are provided to help think through what sub-groups of the public should be consulted and how this can be done.

Decision Rationale and Justification

  • WHAT MATTERS -For people to be convinced that a decision or solution is the best course of action it would help for them to know the issue has been carefully thought through, and for them to be able to assess the evidence and the reasons for the value balancing on which the decision is based. They should be provided decision rationale and justification.
  • CURRENT PRACTICE -Decisions tend to be written with incomplete descriptions of the context against which they are made. Often justifications incompletely articulate the values that the decisions live up to, and remain silent on values the decision sacrifices and why this is seen as on balance acceptable.
  • THE INNOVATION -The process supports the careful articulation of a preliminary decision before consultation and then again after a final decision is reached. This articulation includes a summary of important factual assumptions, important value trade-offs being made, and an explanation of why these are seen as defensible.

Decision Follow-Up Plans

  • WHAT MATTERS – A decision by itself likely won’t solve the problem that led to the decision team’s creation. The decision has to be implemented and supported. Implementation and follow up should be treated with care and be part of the decision process.
  • CURRENT PRACTICE -Decisions are made and then unevenly followed up. Practice standards are often supported by a short-term educational push, while policy decisions are often not followed up.
  • THE INNOVATION -Separate steps in the process create space to discuss communication, education, sustainability, downstream ethics support, and evaluation plans.