The goal of ethics-informed decision making frameworks is to facilitate the balanced application of various relevant ‘lenses’ (e.g., clinical practice, legal, business, communications, ethics, etc.) to decision making at multiple organizational levels. From the perspective of a health care organization’s internal stakeholders and the public, the use of such frameworks enhances accountability for the decisions made, as compared to more traditional, ‘top-down’ approaches.

Ethics-informed decision making frameworks developed by NSHEN and the Ethics Collaborations Team (Drs. Kirby, Warren, and Simpson), Department of Bioethics, Dalhousie University are characterized by the following key elements:

  • Designation of the ‘right’ decision makers, including the primary stakeholders and relevant resource persons
  • Identification of, and reflection on, the process values that are to inform decision making
  • Identification of an inclusive list of decisional options
  • Development of criteria (e.g., substantive values and principles) to guide selection among the identified options
  • Analysis of the benefits and burdens of the options, and ‘to whom’
  • Consensus-type decision making, insofar as possible
  • Development of a comprehensive communication strategy regarding the decision making process and its outcomes
  • Development of education and implementation plans, as appropriate
  • Establishment of processes to: 1) ensure accountability for decision making, and 2) evaluate short and long term outcomes

Within health organizations, decision making frameworks are used to collectively address complex organizational ethics issues and to assist in the fair allocation of limited health resources. Examples of decision making frameworks that have been developed by NSHEN and the Ethics Collaborations Team (Drs. Kirby, Warren, and Simpson) include:

‘Health’ Priority Setting PDF

Disclosure of Significant Adverse Events PDF

Responsible Health Partnering PDF

The ‘3E’ Framework (informed by evidence, economics and ethics; addresses the public funding of expensive drugs; adopted for use by the Nova Scotia Cancer Systemic Therapy Committee) PDF