Shared Health Ethics Service

Shared Health Ethics Service provides ethics decision support and education across Manitoba’s Health Care Systems. We provide assistance in navigating complex decision making, support to ethics committees, education through workshops and presentations, and policy development and review.

What is Ethics?

Ethics is the process of balancing principles and values to guide difficult decisions by determining what we should do, why we should do it, and how we should do it.

Ethics can assist us in healthcare by providing guidance navigating complex decision making and fostering a reflective practice. It can assist us in understanding the reasoning behind our decision and actions.

Ethical Dilemmas

An ethical dilemma is a situation where competing moral principles, values, or obligations create a difficult choice. These dilemmas often require careful reflection and thoughtful decision-making.

An ethical issue can also present as:

• Needing to determine the best course of action.
• Asking a “should” question. Balancing conflicting values or beliefs.
• Feeling uncomfortable with a course of action.

In a health-care setting, decisions must prioritize the wellbeing of the individuals involved, respect autonomy, minimize harm, promote the greater good, and adhere to legislation and professional codes of ethics.

Ethical Frameworks and Practical Steps

Ethical decision-making is a shared responsibility across all roles in health care. Every staff member, whether in a clinical setting or non-clinical setting, must strive to act in a way that upholds respect, minimizes harm, and maintains boundaries and privacy. Ethical frameworks provide structured approaches to guide decisions in complex scenarios. To navigate such dilemmas, tools like Shared Health Ethical Decision Making Framework can help clarify the decision-making process. This guide supports individuals in exploring options, identifying decision-making needs, and planning actionable steps. By breaking down complex situations, it enables individuals to make more informed and confident choices.

The Shared Health Ethical Decision Making Framework offers a systematic process to support health-care workers in ethical decision-making. Please note that going through these guides may evoke strong emotional feelings or Post-Traumatic Stress (PTS).

Understanding Moral Distress in Health Care

Moral distress occurs when health-care workers know the ethically appropriate action to take but feel unable to act due to institutional constraints, power imbalances, or external pressures. It is a physical and psychological response that can occur when an individual’s values are being compromised by being prevented by taking what they believe is the right course of action.

Moral distress is a unique form of distress experienced within the health-care system, affecting individuals in all roles and at all levels. This internal conflict can lead to frustration, guilt, and a sense of powerlessness, affecting both personal wellbeing and professional satisfaction.

Examples of when moral distress can occur is during public health emergencies, such as a pandemic, where decisions often involve competing priorities and limited resources affecting patient care and the safety of health-care workers. But it can also occur from bedside to boardroom in any ethically complex situation where there are conflicting values.

Over time, unresolved moral distress can lead to moral residue, emotional exhaustion, reduced job satisfaction, burnout, and moral injury.

Identifying Moral Distress

Moral distress can feel like being “trapped” in a situation where every option seems wrong or misaligned with one’s values. Health-care workers may feel isolated, as moral distress is not openly discussed. Over time, if unresolved, moral distress can lead to moral injury – a deeper psychological impact resulting in burnout or the staff member leaving the profession entirely. Health-care workers may experience moral distress in situations such as:

• feeling forced to provide care that contradicts their ethical values,
• observing colleagues engaging in practices they perceive as unethical, but feeling unable to intervene, or
• facing systemic issues that prevent delivering equitable care to all patients.

Common symptoms of Moral Distress include:

• Emotional responses – anger, sadness, guilt, or frustration.
• Physical symptoms – headaches, fatigue, or insomnia.
• Behavioural changes – withdrawal, decreased motivation, or questioning one’s professional role.

Addressing Moral Distress

1. Recognize it – naming and understanding the emotions and ethical conflicts involved is step one.
2. Seek Support – use organizational ethics resources, or consult with peers and mentors, to process the situation.
3. Advocate for Change – engage in conversations about systemic issues contributing to your moral distress and propose improvements.

Reach out for Support

Ethics services and ethics committees can provide valuable guidance and consultation. Here are the key contacts in your region if you need support:

• Shared Health Provincial Ethics Services:
  • Cara Corvino, Provincial Ethics Lead at Shared Health, at [email protected]
  • Dr. Tyler Peikes, Clinical Ethicist at Health Sciences Centre (HSC), is available through the HSC switchboard for consultation
• CancerCare Manitoba Ethics Committee:
  • Contact the co-Chairs of the Ethics Committee through the office of CCMB’s President and CEO by calling 204-787-2241 or 204-787-2186 and leaving a message.
• Winnipeg Regional Health Authority Ethics Services:
  •  Tools and resources available at Ethics Services | Winnipeg Regional Health Authority
  • St. Boniface Hospital Ethics Services: Home | Health Care Ethics or Call 204-235-3619 or email: [email protected]
• Prairie Mountain Health Ethics Services:
  • For additional support, you may contact member of the Ethics Committee or complete a Request Form through the PMH Intranet.
• Interlake-Eastern Regional Health Authority Ethics Services:
  • IERHA Ethics webpage
  • To request an ethics consultation, complete the Ethics Consultation Request Form. The Ethics Council can be contacted at [email protected].
• Southern Health-Santé Sud:
  • Follow the appropriate pathway in this Ethics Resource Algorithm.
• Northern Health Region Ethics Services:
  • Contact the Ethics Committee at [email protected].

Resources