Helping patients chart a course
through a sea of ethical dilemmas
Marine biology was my first passion. It’s an ocean away from my current role as the Jewish General Hospital’s Clinical Ethicist, but it’s where my interest in ethics truly began. As a child, I decided to spend my life researching whales and dolphins, and looking after the environment. This was an odd choice, as I had grown up land-locked in a village in the Ottawa Valley. Marine biology certainly wasn’t a career that our guidance counselor would normally suggest. Determined, I pursued the sciences and looked into attending universities where I might see a whale on the horizon.
I was also an avid reader, but I hadn’t had an opportunity to study philosophy or critical theory in a small town. So when the opportunity arose, I moved to Halifax to attend University of King’s College, where I completed a combined Honours degree in Marine Biology and Contemporary Studies. At last, I was living the dream in the Whitehead Lab, which specialized in studying cetaceans, especially sperm whales (think Moby-Dick). Aboard a 40-foot Valiant sailboat, five of us spent weeks at sea, with no running water, electricity or phone. We sailed to Bermuda, the Sea of Cortez and Sable Island, always following the whales. It was a great adventure.
Only when I began my Master’s degree (collecting fecal samples for hormone analysis) did I realize how much of my intellectual interest stemmed from a deeper fascination with bioethics. I had completed my Honours work on conflict of interest in marine mammal noise research, and now that I was focusing purely on the biological side of the marine world, my mind began to wander. I missed the sort of critical thinking that I had encountered the previous summer during an internship in bioethics at Yale University. So, with great difficulty—I still miss the smell of the ocean and the sound of whales breathing next to the boat—I transferred from Dalhousie University to McGill University to complete my Master’s in experimental medicine, with a specialization in bioethics.
I quickly became passionate about clinical ethics after a practicum at the McGill University Health Centre. In the hospital setting, my academic interests were balanced by a need for pragmatism and clinical skill. It was, and continues to be, incredibly rewarding to apply my knowledge of ethics to complex clinical situations in a way that helps people move forward, while respecting the moral values of patients, their families, the involved clinicians and the organization.
Next came specialized clinical training through an academic fellowship in clinical and organizational ethics at the University of Toronto’s Joint Centre for Bioethics, with work in such diverse clinical environments as Holland-Bloorview Kids Rehab and the Baycrest Centre for Geriatrics. From a senior fellowship at the Joint Centre, I arrived at the JGH in late 2012 as the hospital’s first full-time clinical ethicist.
As I lead and manage the day-to-day activities of the Ethics Program, I work with patients, families, healthcare teams and an administration dedicated to improving the patient and staff experience. Together, we identify areas of moral distress or conflict, and work to find a solution that addresses the clinical needs of patients, while respecting fundamental ethical obligations.
In the course of a day, I might support a substitute decision-maker (acting on the patient’s behalf) and a healthcare team in considering whether prolonged active treatment is in a patient’s best interest; analyze the relative risks and benefits of respecting a patient’s wishes by sending her home from the hospital, despite the significant physical risk; provide multidisciplinary education; and, meet with members of the hospital’s administration to consider ways of mitigating the potential—and unintended—negative impact on clinical care when difficult financial decisions must be made.
This diverse range of ethical questions and inquiry is what makes each day so interesting and meaningful. Through contact with my clinical partners across the JGH and at all levels of administration, I am continually challenged to bring the best ethics knowledge and clinical and organizational skill to the table. There may not be whales involved, but it remains an adventure every day!