Andrea Frolic

Exploring a model role description for ethicists

This paper provides a description of the role of the clinical ethicist as it is generally experienced in Canada. It examines the activities of Canadian ethicists working in healthcare institutions and the way in which their work incorporates more than ethics case consultation. The Canadian Bioethics Society established a “Taskforce on Working Conditions for Bioethics” (hereafter referred to as the Taskforce), to make recommendations on a number of issues affecting ethicists and to develop a model role description. This essay carefully assesses this model role description.

A Pilot Qualitative Study of “Conflicts of Interests and/or Conflicting Interests” Among Canadian Bioethicists. Part 2: Defining and Managing Conflicts

This paper examines one aspect of professional practice for bioethicists: managing conflicts of interest. Drawing from our qualitative study and descriptive analysis of the experiences of conflicts of interest and/or conflicting interests (COI) of 13 Canadian clinical bioethicists (Frolic and Chidwick 2010), this paper examines how bioethicists define their roles, the nature of COIs in their roles, how their COIs relate to conventional definitions of conflicts of interest, and how COIs can be most effectively managed.

A Pilot Qualitative Study of “Conflicts of Interests and/or Conflicting Interests” Among Canadian Bioethicists. Part 1: Five Cases, Experiences and Lessons Learned

In this pilot qualitative study 13 clinical bioethicists from across Canada were interviewed about their experiences of conflicts of interest and/or conflicting interests in their professional roles. The interviews generated five composite cases. Participants reported being significantly impacted by these experiences both personally and professionally.

Who are We When We are Doing What We are Doing? The Case for Mindful Embodiment in Ethics Case Consultation

This paper explores the theory and practice of embodied epistemology or mindful embodiment in ethics case consultation. I argue that not only is this epistemology an ethical imperative to safeguard the integrity of this emerging profession, but that it has the potential to improve the quality of ethics consultation (EC). It also has implications for how ethics consultants are trained and how consultation services are organized. My viewpoint is informed by ethnographic research and by my experimental application of mindful embodiment to the development of an ethics consultation service. My argument proceeds in four phases. First I explore the notion of situatedness in the bioethics literature, identifying gaps in the fields theories as they apply to EC. I then describe my theoretical approach to embodiment grounded in critical-interpretive medical anthropology and autoethnography. I use embodiment to refer to a moral epistemology grounded in the body, comprised of the interplay of physical, symbolic, intersubjective and political elements. Third, I describe how mindful embodiment can inform the role of the ethics consultant and the development of effective training techniques, vocabularies and processes for EC. I also discuss the benefits of this orientation, and the potential harms of ignoring the embodied dimensions of EC. My goals are to expose the fallacy of the theory-practice gap, to demonstrate how my own EC practice is deeply informed by this theoretical orientation, and to argue for a wider definition of what counts as relevant theory for ethics consultation.

Beyond trail blazing: a roadmap for new healthcare ethics leaders (and the people who hire them).

This article is intended to serve as a roadmap to help new healthcare ethics leaders establish or renew an ethics program in a healthcare organization. The authors share a systemic step-by-step process for navigating this early career passage. In this paper, we describe five critical success strategies and provide explanations and concrete tools to help get you on the road to success as quickly and painlessly as possible. We will discuss how to define your role; diagnose your organization’s needs; build important relationships; and develop a strategic plan for starting or revitalizing an ethics program. We also review some of the more personal challenges that may be encountered along the way, and identify social supports and self-care strategies. The advice we provide grows out of reflections on our collective experience as new ethics leaders in three Ontario healthcare organizations.

The art of medicine: arts-based training in observation and mindfulness for fostering the empathic response in medical residents

Empathy is an essential attribute for medical professionals. Yet, evidence indicates that medical learners empathy levels decline dramatically during medical school. Training in evidence-based observation and mindfulness has the potential to bolster the acquisition and demonstration of empathic behaviours for medical learners. In this prospective cohort study, we explore the impact of a course in arts-based visual literacy and mindfulness practice (Art of Seeing) on the empathic response of medical residents engaged in obstetrics and gynaecology and family medicine training. Following this multifaceted arts-based programme that integrates the facilitated viewing of art and dance, art-making, and mindfulness-based practices into a practitioner-patient context, 15 resident trainees completed the previously validated Interpersonal Reactivity Index, Compassion, and Mindfulness Scales. Fourteen participants also participated in semistructured interviews that probed their perceived impacts of the programme on their empathic clinical practice. The results indicated that programme participants improved in the Mindfulness Scale domains related to self-confidence and communication relative to a group of control participants following the arts-based programme. However, the majority of the psychometric measures did not reveal differences between groups over the duration of the programme. Importantly, thematic qualitative analysis of the interview data revealed that the programme had a positive impact on the participants perceived empathy towards colleagues and patients and on the perception of personal and professional well-being. The study concludes that a multifaceted arts-based curriculum focusing on evidence-based observation and mindfulness is a useful tool in bolstering the empathic response, improving communication, and fostering professional well-being among medical residents.

Critical Self-Reflection as Moral Practice: A Collaborative Meditation on Peer Review in Ethics Consultation

With “The Zadeh Scenario,” Finder offers us a gift…a rich and thoughtful first-person account of the gradual unfolding of a specific ethics consultation conducted by a specific ethics consultant in a specific context. This is not your average case report, stripped to the bare facts and devoid of the ambiguity of real-time human interactions. It’s also not simply an example of thick description, offering the reader a detailed account of the context out of which an abstract ethical dilemma has emerged, with the ethics consultant describing all from a distance, above the fray. What Finder offers and models for us instead is something entirely new and different. He offers us a case narrative into which he has chosen to place himself squarely and explicitly. And in the spirit of “peer review” he has generously revealed his own inner dialogue in response to twists and turns in the case, sharing his personal reflections as events unfolded, and his musings about various actions he took and choices he made in his role. By inviting us to ponder his story about the story of the case, he generously extends a gift to us: the opportunity to reflect on his—and therefore our own—consultation practice, and the opportunity to try a new kind of peer review.

Minding Baby Abigail

This chapter depicts a composite case study of several neonatal cases I have facilitated as an ethicist working for over 10 years in a children’s hospital. This narrative is structured as a play in order to capture the immediacy and embodied dimensions of my clinical practice. Through this genre, I attempt to demonstrate how I weave mindfulness practice into everyday encounters with patients, families, and professional colleagues. Mindfulness brings awareness to one’s internal environment—sensations, emotions, thoughts—as well as one’s external environment—the sights, smells, sounds, and contexts that shape sensory experience. The genre of a play facilitates expression of this embodied dimension of clinical practice through the setting of the scene, the words spoken by the characters, the stage directions, and indications of the characters’ gestures and expressions.