Ethical Issues

Last Updated: Second Wave- Feb 2021

This page is designed to help understand the current ethical decisions this hospital has made, in addition to resources for navigating difficult conversations with patients.

See All Files In Ethics Folder

Goals of Care/CPR Policy:

New: Dec 15: changes to CPR/ Life Sustaining Policy: new policy and direction for Code Status designations in the hospital: largely directed at admitted patients and orders, but principles identical to be followed in ER for written orders and approach to patients. In summary - 4 new levels of care. Full code, Modified Respiritory, DNR (medical mangement), and DNR (comfort care).

Revised Code Status Poster (nice overview infographic) - 1 page (Dec 15)

Revised Code Status Practice Policy Notice - 1 page (Jan 19/21)

Revised Code Status FAQ document - 2 pages (Dec 15)

Advanced Directives (e.g. Level of Care from nursing home) have no legal standing in Ontario. Goals of care/Advanced directives are part of the process to help the patient/SDM communicate their wishes to the Health team.

The below recorded session (56 min) covers:

the relevant legal aspects of the GOC, code status documents and level of care forms.
Introduces a model for GOC conversations with role modeling
Discusses specific ED scenarios

Recorded Session by Dr. Incardona regarding Goals of Care and the ED physician

Session Chat Transcript

New: Jan 21: Goals of Care (GOC) Powernote: Although intended for inpatient care admissions, this powernote can be used to capture the full GOC discussion with patient/SDM to be easily found for all clinical teams members in a standard location in powerchart.

Goals of Care Powernote Instructions - 2 pages (Jan 11/21)

Standards of Care

Current Standards of Care. Unchanged from before COVID

MGH Standards of Care Pre- COVID Surge

Difficult Conversations

Resources for Navigating Difficult Conversations

Examples of Difficult Conversation Phrases in Challenging COVID situations

Palliative care

general guidance (old - April 3, 2020) regarding an approach to palliative care for COVID. includes general recommendations, but also examples of conversations for goals of care as well as sample medications for symptom management. see more recent and specific guidance by our MGH team and our palliative care set for ordering meds in ER

Toronto Region COVID-19 Recommendations for Palliative Care Services 11 pages (April 3, 2020)

Use of Restraints to Enforce Isolation

Guidelines in the use of seclusion or mechanical restraints in Suspected/COVID patients who will not maintain isolation (not psychiatric patients). These patients can be legally restrained if they have a medical need/desire to stay in hospital, otherwise, they should be escorted out of the ER. Full process still to be established with security

Algorithm for Management of Inpatients at Risk for Non-adherence with Self Isolation Practices

MGH Policy document on the use of restraint or seclusion in suspected COVID patients

Resource Decisions (Surge Planning)

March 2023: This Area is no longer being maintained or applicable but can be of value when reviewing general ethical considerations in a pandemic/resource limited crisis.

This are is designed to help understand the current ethical and resource planning decisions this hospital has made, in addition to resources for navigating difficult conversations with patients.

due to the sensitive nature of the material, this information can only be accessed from the private Ethics page.

Go To the Private Ethics Page Here.

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