1. Christy Simpson NSHEN Conference 2013
Professional Boundaries
in Ethics Work
Christy Simpson NSHEN Conference 2013

2. Opening questions…
Do you believe “boundary” issues in ethics work are similar or different from other types of professional boundary issues in healthcare?
Can you think of any examples of “boundary” issues in ethics work?

3. Consider…
During an ethics consultation, you begin to wonder whether the patient might be at risk as she is taking medications which are contra-indicated.
While you are a pharmacist, you are here as an ethics consultant. Is it appropriate to raise this issue?

4. Consider…
A very controversial change in how care is provided in outpatient clinics has come to the ethics committee for discussion. You are neighbours with one of the key proponents of the proposed change.
Should you share this with the committee? Participate in the meeting? How will you address your neighbour later?

5. Consider…
One of the new VPs to your health organization wants to join the ethics committee. In fact, the current chair is thinking of stepping down…and poses the question as to whether this person should be invited to act as chair.
What would your response be? Why?
Would it be different if this was someone with training in healthcare ethics?

6. Overview Background context Similar and different boundary issues?
Historical
Current
Similar and different boundary issues?
Values, process
Revisiting the cases

7. Some (historical) concerns about “boundaries” in ethics work…

8. Notice…
Key questions about where and how we do ethics work in health organizations
Brings our attention to who draws these boundaries and at what levels (e.g., in individual cases versus the ethics committee versus the larger organization)

9. Current work on “boundary” issues…
Practicing Healthcare Ethicists Exploring Professionalization (PHEEP)
Conceptual Working Group
Presentation at Canadian Bioethics Society conference (2012), “Playing with and at the Margins? Questions about Boundaries for Health Care Ethicists”

10. Starting point...
Much of our work as ethicists and in ethics work is precisely about boundaries, about negotiating and understanding the margins
We can learn about the practice of ethics by identifying, describing, and examining our boundaries and boundary issues

11. Focus...
Group is examining whether, in ethics work, there are some boundary issues that are “just like” other boundary issues for all health professionals…and whether there are some that are unique or take on a unique “flavour” because of the nature of the work we do in ethics

12. Consider, for example:
When doing ethics work, the possibilities related to being an:
Insider/Outsider

13. Doing ethics work as: Insider/Outsider
As “insiders” – we may sacrifice neutrality, and perspective on the issues that arise with a particular team
May gain trust because you know what the context is and the challenges that arise
Suggest we are “in” enough to experience some of the same boundary issues as other health care professionals - e.g., dual roles, conflicts of interest

14. Doing ethics works as: Insider/Outsider
Yet, we are “out” enough that we often see things in a different way (not of the team) or have a different perspective
We sometimes intentionally use this “outsider” position to, e.g., gain access to some ethics issues or decision-making tables, encourage requests
Gain trust by being separate

15. Doing ethics work as: Insider/Outsider
We need to be attentive to the benefits and risks of occupying these “positions”…and the related boundary issues that may arise

16. “Just like”? May include: Confidentiality Negotiating dual roles
Several possibilities for these
Power and trust in relationships

17. “Different”? May include: Subject matter – values
Perception of being a “moral expert” or claiming “moral authority”
Limits of taking only one theoretical position
Power and trust in relationships

18. So? New(er) boundary issues with respect to what we do
Includes triaging of requests, conflict of roles and responsibilities, accountability
Importance of process – the “how”
Importance of clarity re: values, expectations

19. So? Revisiting the cases…
What values are relevant?
What processes/resources may be helpful for addressing these issues?

20. We’re not taking this journey alone….
We’re not taking this journey alone….

21. For more information about PHEEP
Chair, PHEEP Steering Committee
Dianne Godkin, PhD

22. Related readings
Heesters, A Hats: Exploring the Challenges of Boundary and Community – Reflections on Professionalization. HEC Forum 24(3): Simpson, C Mapping Our Practice? Some Conceptual “Bumps” for Us to Consider. HEC Forum 24(3):