In our work and in our lives, we set out to do right by others. However, what happens when the best course of action is not obvious? Questions that require ethical decision-making come up naturally in palliative care, and each new situation requires critical thought and communication. The 2025 edition of Palliative Care 海角精品黑料鈥檚 Continuing Professional Development (CPD) Day will feature an ethics panel with Gabrielle Lemieux, M.A.P., David Wright, PhD, and Silvana Barone, MD. To identify key issues and tackle them step by step, the panelists will present cases based on real life events for discussion. As we wait for CPD Day to arrive, ethicist Gabrielle Lemieux enlightens us on a key resource available at the 海角精品黑料 Health Centre (MUHC)鈥�.
Lexa Frail (LF): Could you tell me about your role as an ethicist and how you came into that position?
Gabrielle Lemieux (GL): I am a senior advisor at the MUHC, responsible for both clinical and organizational ethics. My background differs from a lot of clinical ethicists, although nobody has the same exact profile. I studied public management and the ethics of public management鈥攖he ethics of government, administration, and public services鈥攁nd I鈥檝e been working in the health network for about 15 years now. About seven or eight years ago, I was approached to act as an ethics advisor for the organizational ethics program at the MUHC. From that point on, my interest in clinical ethics grew, and now I serve both roles.
As a senior advisor, I provide different types of services for both programs. The clinical ethics program offers a consultation service where physicians, nurses, patients, patient family members or managers at the MUHC call us to serve as a consultant for bedside questions and ethical dilemmas. We have a capacity building plan as well, where we offer a variety of training and educational activities. Through those, we propose tools for recognizing ethical dilemmas and knowing how to go about analyzing ethical situations.
Between the clinical and organizational programs, there鈥檚 a continuum. Whereas clinical ethics pertains to questions raised at the bedside for one patient, 鈥渃linical-organizational鈥� ethics applies to situations where a department might have an ethical question pertaining to multiple patients.聽Though they don't have one single patient in mind, they might have ongoing issues or questions about the group of patients that they provide treatment to. So, they鈥檇 ask questions like, 鈥渋s our policy or procedure ethically sound? Are there things we haven't thought about? Would you review this procedure?鈥� Sometimes, we manage transversal issues as well, which are typically referred to as organizational ethics.
We have an organizational ethics advisory council, chaired by our PDGA鈥攐ur second in command at the MUHC鈥攁nd that council meets to look at trends in ethics throughout the institution. We try to reflect on trends and topics like what lessons there are to learn, required quality improvement initiatives, or recommendations that we should make. There鈥檚 also an organizational ethics consult service. It鈥檚 similar to the clinical ethics consult service in that managers鈥攖ypically senior leadership鈥攃all us with significant ethical dilemmas pertaining to either administrative questions or questions that are transversal throughout the institution, which bring risks that would significantly impact the institution. We also do some organizational ethics training. That covers most of our programs and services.
LF: Are healthcare practitioners generally aware that they have ethicists available as a resource?
GL: Not all of them. We have to continuously advertise our services. Even when we do, sometimes people still think only physicians can access this resource, perhaps it's because it used to be that the medical ethicist was also a physician. But we insist that anybody can reach us directly to request or initiate a consult. Typically, if it's a clinical ethics question, we might suggest involving other parties, such as the physician, relevant professionals, or the whole multidisciplinary team, if needed.
We advertise through regularly updated intranet content, outreach, and promotion鈥攇enerally through avenues like e-mails and MUHC newsletters. Then, there's knowing that you have access and then there's actually recognizing the dilemma and knowing when to call and feeling like you should and can call. That's another question, of course.
LF: How can healthcare workers make use of ethicists as a resource?
GL: What we say is to consult ethicists in any situation where you feel like there's uncertainty or a question regarding different values and how they apply to the situation. Sometimes, it's a very complex, heavy, muggy situation. Then, sometimes, you've identified a clear dilemma. Suppose you're torn between your role in terms of beneficence versus non-malfeasance. Even though you have a clearly identified ethical dilemma, typically, it's difficult to recognize and articulate said dilemma. That is usually the first step we take when people call us.
In those complex situations with a feeling of impasse鈥攜ou've tried everything, nothing's working, or there鈥檚 signs of disagreement amongst team members or with patients or families鈥攖here's a lack of consensus regarding the best thing to do. Generally speaking, in situations where values might be competing, the best thing to do鈥攐r sometimes the least worst thing to do鈥攊s not obvious. The parties involved need help to identify not only what that course of action might be, but also how to go about following it. Sometimes, it's easy to decide what the right thing is to do, but then it's very complex to think of how to implement decisions in a way that protects the balance between the most important values in this situation. Ethicists aim to help you figure out the best course of action under your circumstances.
LF: What insight will you bring to your upcoming CPD Day panel?
GL: Of the panelists, I am the only clinical ethicist. My plan is to offer insight into how we analyze ethical dilemmas in our work and our methods for ethics analysis. Currently, our method is pretty clear in how we integrate different ethical concepts and frameworks to provide support to teams and patients when they ask for it. I will also share what I've learned from my experiences and what we've learned in terms of best practice. We'll be looking at the questions that come up most often rather than the once-in-a-lifetime-type cases. In doing that, we will also reflect on the outcomes and potential consequences of a range of acceptable options when we consider a complex case.
LF: Before we go, is there anything else you'd like to add that I haven't mentioned?
GL: I would describe myself as someone who constantly loves to learn about new things, new approaches, new treatments, new people, new patient cases. As an ethicist, I'm really only an expert on ethics analysis. I'm not at all an expert in a lot of situations and cases that we see, but I love to learn about them. Getting the chance to participate in an educational panel like this one is as much of a learning activity for myself as it is for the attendees.
CPD Day is November 21, 2025. Make sure you so you don鈥檛 miss out on the chance to learn about ethical decision-making from experts like Gabrielle Lemieux.