University of Toronto Joint Centre for Bioethics

The University of Toronto Joint Centre for Bioethics, or JCB, is an academic research centre located on the downtown campus of the University of Toronto in Toronto, Ontario, Canada. The Joint Centre for Bioethics is a partnership between the University and 15 affiliated health care organizations in the Greater Toronto Area. The centre studies ethical, health-related topics through research, educational and clinical activities that aim to improve the standard of health care at national and international levels. The centre consists of a network of over 180 multidisciplinary professionals, approximately 30 of whom work full-time in bioethics, representing the largest multi-disciplinary group of in-hospital bioethicists in Canada.

In 2002, the centre was designated the first World Health Organization collaborating centre in bioethics in 15 years.

Originally founded as the Centre for Bioethics in the 1980's by Dr. Frederick Lowy, then Dean of the Faculty of Medicine at the University of Toronto, who also served as the centre's first Director. In partnership with four Toronto hospitals, the Joint Centre for Bioethics was created in 1995, headed by Dr. Peter A. Singer, who served as Director until 2006. Currently, the Director of the centre is Dr. Ross Upshur.

Mission, Vision, Values and Goals
The mission of the Joint Centre for Bioethics is to provide leadership in bioethics research, education and clinical activities.

The centre's vision is to be a model of interdisciplinary collaboration in order to create new knowledge and improve practices with respect to bioethics.

The centre's values include academic and clinical excellence, intellectual freedom, integrity, respect, inclusiveness and justice. However, the centre itself does not advocate positions on specific issues, although its individual members may do so.

The goals of the centre are:
 * To foster interdisciplinary research and scholarship, link education to research, and disseminate research findings to improve policies and practices.
 * To support undergraduate, graduate and postgraduate educational programs in bioethics.
 * To support clinical ethics activities including continuing education for health care providers, ethics committees, ethics consultation, and projects to address specific issues arising in partner institutions.
 * To foster collegial discussion of bioethics issues throughout the network of participating institutions, and to serve as a resource for the media, policymakers and community groups.

Research
The Joint Centre for Bioethics aims to put "theory into practice" through interdisciplinary research. The value of research projects is to address ethical issues encountered in the partner hospitals, and to then disseminate research findings to improve policies and practices.

To date, the members of the centre have published more than 500 articles and obtained more than $20 million in research grants.

Clinical Ethics
Good practices in clinical ethics have not yet been systematically studied, evaluated, or shared. Clinical ethics practice has been described as a “black box” because of the lack of evidence for effectiveness and for good practice in the discipline. The JCB’s Clinical Ethics Group conceived PEECE - an innovative study designed to address the pressing need to identify good practices for clinical ethics. PEECE involved a series of nine case studies at JCB partner hospitals across Toronto. The specific objective was to examine perceptions of effectiveness and good practice in clinical ethics through the eyes of the bioethicists, clinical staff, hospital senior management, and patients and families. By including the views of all key stakeholders, the project aimed to provide a solid basis for further research and development in clinical ethics.

Consent, Trust & Error
Understanding a patient's level of capacity (competency) is necessary for health care workers in determining whether to follow the patient's treatment wishes or those of a substitute decision-maker. The Aid for Capacity Evaluation was created by JCB members as a method of overcoming the difficulty of measuring capacity in practice.

Other JCB members study ethical issues related to surgical care, teaching and research. Themes include the influence of trust on the surgeon-patient relationship, the ethical obligations of surgical teams, innovations in surgical care-such as artificial lungs and hearts, and the management of conflicts of interest in surgical research.

Error is not uncommon in health care and can have adverse outcomes. The response to error can be in the terms of disclosure and reporting, which leads to prevention, and improve future patient safety. JCB members developed a policy for disclosure and reporting of error to aid institutions in making their response.

Disability, Rehabilitation & Continuing Care
Disability, rehabilitation and continuing care ethics research involves critical reflection on ethical issues arising in the special areas of physical medicine, rehabilitation, and complex continuing care. Ethics research in this area is a relatively new and rather underdeveloped sub-field of bioethics, particularly in Canada. At the JCB, current projects in this area include: defining the ethical issues present in rehab and continuing care, the right to refuse life-sustaining treatment, issues of capacity and consent in the rehab setting, relationships between rehab patients and workers, understanding of social aspects of disabilities in parents and their children, and exercise among people with HIV/AIDS.

End-of-Life
JCB contributions to end-of-life care research include: developing a new, patient-centered model of quality end-of-life care, developing a new model of advance care planning, including living wills, and developing a new model for addressing the issues of euthanasia and assisted suicide. The Ian Anderson Continuing Education Program in End-of-Life Care is a joint initiative of the JCB, University of Toronto, and Temmy Latner Centre for Palliative Care, to educate physicians on issues surrounding death and dying. The goal of this program is to create a national network of health care providers trained to care for terminally ill patients.

Ethics Education
Bioethics education is a required component for accreditation in Canada, and is considered an equally important part of the medical curriculum as clinical training. A recent survey found that residents felt that the issues being taught did not adequately reflect ethical issues in clinical practice. Research being conducted at the JCB identifies strengths and challenges in bioethics education and assesses delivery methods. The goal is to reconcile the teaching curriculum with needs of residents to ensure graduate physicians acquire the necessary skills to deal with ethical issues.

Genomics & Global Health
The 2002 WHO report on Genomics and World Health states global health inequity as one of the most urgent ethical challenges facing the world today. The Joint Centre for Bioethics is involved in projects aimed at preventing the formation of a “genomic divide”, in terms of concern over the health priorities, between the developed and developing world. Among other projects the centre is involved with include: convergence genomics, ethical, environmental, legal and social research across health, nutrition, agriculture and environmental applications of genomics and biotechnology.

Organizational Ethics
Organizational ethics at the JCB has been about the exploration of issues health care organizations face, the strategies used to address the issues, and the perceived effectiveness of these strategies. A study of Toronto health care leaders revealed eight key issues facing their organizations: resource allocation, business development, charitable fundraising, disagreement over treatment decisions, access to care for the uninsured, disclosure of risk, workplace ethics, and conflict of interest. Publications will focus on addressing the ethical obligations of health care managers and implementable solutions.

Priority Setting
Priority setting, or resource allocation, is an important health policy issue that occurs at all levels of health care. The Joint Centre for Bioethics shares its research platform on priority setting with the Canadian Priority Setting Research Network, which aims to improve the politics and processes of health care priority setting and enhance the research capacity for priority setting. The centre takes an innovative approach to priority setting research in that the focus is placed on enhancing the priority setting processes, capturing and sharing actual priority setting experiences, and taking a bottom-up approach to improve priority setting.

Public Health Ethics
At the JCB, public health ethics is a key research area in light of the SARS incident of 2003. SARS led the JCB to investigate ethical implications within the health care system and shed light on ethical issues in dealing with infectious disease. Expanding on the ethics of infectious disease, pandemic influenza planning is an important topic under research at the JCB. Stand on Guard for Thee is a report published by the Influenza Pandemic Working Group recommending a 15-point ethical guide for pandemic planning that illustrates the need for a basis on commonly held ethical values and advance support of the public. Issues of duty to care, restrictive measures (i.e. quarantine), priority setting, and global governance continue to be topic studied by JCB members. One of the centre’s aims is to engage the public in the debate about ethical pandemic planning.

Degree Programs
The University of Toronto (through the Joint Centre for Bioethics) offers undergraduate, graduate, postgraduate, professional and continuing education in bioethics. The centre itself coordinates all programs it offers.

Courses include a wide range of disciplines incorporating many aspects of bioethics. Graduate-level degrees offered level include a Master of Health Science (MHSc) in Bioethics and masters and doctoral stream Collaborative Program in Bioethics (CPB).

Continuing Education Programs
The Ian Anderson Continuing Education Program in End-of-Life Care is a joint project of the University of Toronto (Joint Centre for Bioethics and Continuing Education, Faculty of Medicine) and Mount Sinai Hospital (Temmy Latner Centre for Palliative Care) that aims to train 10,000 physicians in end-of-life care.

Seminars
The Joint Centre for Bioethics holds weekly public seminars by members of the local, national and international bioethics community on a wide variety of bioethics topics.

Governance
The University of Toronto Joint Centre for Bioethics is governed by an Advisory Council consisting of representatives from all its member organizations, both from the University of Toronto and partner health care organizations.

University of Toronto is be represented by the Vice-Provost, Relations with Health Care Institutions chairs the Advisory Council, as well as the Deans of Arts and Science, Law, Nursing, and the School of Graduate Studies or their designates. Partner organizations are represented by the CEO of each organization or a designate from the executive team of that organization. The Advisory Council's mandate is to provide advice to the Executive Committee and the Director of the centre.

Membership
Members ordinarily hold an appointment at the University of Toronto or one of the participating healthcare organizations. Members assist the centre to fulfill its mission through participation in research, education or clinical ethics activities.

Appointments are reviewed annually by an advisory committee. The criteria for membership include participation in the centre's research activities, bioethics education, or clinical ethics committees or other clinical ethics activities or are "opinion leaders" as identified by the hospital bioethicist. Potential members are offered membership by the Director on the advice of the leader of the centre's relevant research area. Members and Associate Members of the Centre for Bioethics have automatically been considered members. Centre membership normally will cease when individuals leave their University of Toronto or hospital appointment.

Members are expected to state their affiliation with the centre on bioethics-related publications and presentations, and to provide on request information about their bioethics-related activities for inclusion in the centre's reports.

The benefits of membership include priority notification of the centre's seminars, lectures and workshops, opportunities to join in the centre's research activities, and opportunities to meet colleagues in member institutions who share interests in bioethics.

Selected Publications

 * Pandemic influenza preparedness: an ethical framework to guide decision-making (2006) at BMC Medical Ethics
 * Just regionalisation: rehabilitating care for people with disabilities and chronic illnesses (2006) at BMC Medical Ethics
 * Project Examining Effectiveness in Clinical Ethics (PEECE): phase 1—descriptive analysis of nine clinical ethics services (2005) at Journal of Medical Ethics
 * Ethics and SARS: lessons from Toronto (2003) at British Medical Journal

More of the centre's publications are available on PubMed, click here.