It's Complicated: A Podcast about Healthcare Ethics in Practice

NSHEN
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A podcast discussion on the latest healthcare ethics issues in practice with guest speakers.

  1. Trust between Health Care Providers

    Jun 3

    Trust between Health Care Providers

    Host Marika Warren Guest Francis Bakewell DISCUSSION QUESTIONS How may trust or distrust manifest in the health care setting?In the patient-provider interaction? In the interaction between providers? What are some of the systemic factors that may impact trust relationships between heath care providers? How might silo’s in health care impact patient care and patient trust in health care? RESOURCES Varga AI, Spehar I, Veggeland F, Skirbekk H. Factors influencing trust among colleagues in hospital settings: a systematic review. BMC Health Serv Res. 2025 Jan 3;25(1):16. doi: 10.1186/s12913-024-12159-6. PMID: 39754115; PMCID: PMC11697850. Sutherland BL, Pecanac K, LaBorde TM, Bartels CM, Brennan MB. Good working relationships: how healthcare system proximity influences trust between healthcare workers. J Interprof Care. 2022 May-Jun;36(3):331-339. doi: 10.1080/13561820.2021.1920897. Epub 2021 Jun 14. PMID: 34126853; PMCID: PMC8669032. Corbaz-Kurth S, Weissbrodt R, Juvet TM, Hannart S, Krsmanovic B, Salamin Plaschy I, Terrier P. How does trust emerge in interprofessional collaboration? A qualitative study of the significance, importance, and dynamics of trust in healthcare teams and networks. J Interprof Care. 2025 May 15:1-10. doi: 10.1080/13561820.2025.2495013. Epub ahead of print. PMID: 40370201. Discussion and Resource PageDownload

    25 min

  2. Mar 4

    Goals of Care Simulation

    Host Marika Warren, NSHEN Ethicist Guests David Henderson and Sarah Manley Simulated Patient Theofani Pitsiavas DISCUSSION QUESTIONS Which part of the simulated conversation stood out to you? why? Were there any aspects of the conversation where you would have liked more information from the patient about their values and preferences? How might you help patients identify their values and preferences? How can a conversation like this benefit the patient and his family? Edward finds it difficult to talk with his wife and kids about his illness and what happens when he dies. Do you think this is common? Discuss different ways to make people (health care providers, patients and families) more comfortable talking about their values and preferences to help determine Goals of Care and Levels of Interventions. How do we ‘normalize’ these conversations? Discussion Questions and Resources PDFDownload

    53 min

  3. Jan 27

    Ethics and Goals of Care

    Host Marika Warren, NSHEN Ethicist Guests Lisa Weatherbee, Professional Practice Lead, Palliative Care, NS Health and Sarah Manley, Manager of Planning and Development with Palliative Care Network, NS Health Discussion Questions DISCUSSION QUESTIONS How can health care providers prevent their own biases from influencing the patient’s decisions around goals of care? How might you help patients identify their values and preferences? In the podcast they talk about the importance of identifying and documenting Goals of Care and Level of Interventions in many different situations and that it should not be limited to end-of-life. In your opinion, when should conversations about Goals of Care take place? Discuss different ways to make people (health care providers, patients and families) more comfortable talking about their values and preferences to help determine Goals of Care and Levels of Interventions. How do we ‘normalize’ these conversations? RESOURCES The resources shared in this podcast were developed collaboratively by the Nova Scotia Health Palliative Care Network, the Integrated Acute and Episodic Care Network, and the Interprofessional Practice and Learning Team. This partnership ensured a comprehensive and inclusive approach to supporting care across settings. Goals of Care (Clinical Practice Support/ Library Guide) https://library.nshealth.ca/GoalsofCare [note: this website includes links to resources developed for health care providers and resources developed for patients and families, including the patient education pamphlets individually linked below] Talking about your Goals of Care and Levels of Intervention: https://www.nshealth.ca/patient-education-resources/2208 Nova Scotia Green Sleeve Information for Patients, Families, and Substitute Decision-Makers https://www.nshealth.ca/patient-education-resources/1833 Conversations about Serious Illness (Clinical Practice Support/ Library Guide) https://library.nshealth.ca/SeriousIllness Palliative Care (Clinical Practice Support/ Library Guide) https://library.nshealth.ca/PalliativeCare Goals of Care Discussion Qs and ResourcesDownload

    25 min

  4. 12/09/2025

    Ethics and Psychedelics Research and Regulations

    with Host, Andrea Frolic and special guest James Downar, MDCM, MHSc, FRCPC DISCUSSION QUESTIONS What surprised you about psychedelics research and its potentials in treating end-of-life patients’ psychological distress? Dr. Downar describes several challenges associated with conducting research with psychedelics for treatment of psychological distress in end-of-life patients.  Do you think that the regulatory barriers to research on psychedelics are ethically justifiable? Do you think it is morally imperative to be more risk tolerant when it comes to making psychedelics accessible to end-of -life patients as a way of treating psychological distress? RESOURCES Kratina S, Lo C, Strike C, Schwartz R, Rush B. Psychedelics to Relieve Psychological Suffering Associated with a Life-Threatening Diagnosis: Time for a Canadian Policy Discussion. Health Policy. 2023;18(4):134-142. doi:10.12927/hcpol.2023.27048   Watt CL, Downar J. Whither palliative care. Curr Oncol. 2019;26(3):164-165. doi:10.3747/co.26.4803 Podcasts: Psychedelics: Is it time to change your mind… The Critical Care Commute Podcast. https://podcasts.apple.com/ca/podcast/psychedelics-is-it-time-to-change-your-mind-with-dr/id1651920943?i=1000715746659 Ethics and Psychedelics Research Discussion Qs and ResourcesDownload

    27 min

  5. 10/24/2025

    Working with Patients and Substitute Decisions-Makers (SDMs)

    An Education Guide for Nova Scotia Health Team Members with Marika Warren, NSHEN Ethicist and Amanda Porter, Ethics Collaboration Team Education guide for staff: Working with Patients and Substitute Decision-makers: Home – Working with Patients and Substitute Decisions-Makers (SDMs) – LibGuides at Nova Scotia Health Patient and family guide: Making Health Care Decisions for Someone Else: Acting as a Substitute Decision-Maker (SDM) | Nova Scotia Health Ethics Nova Scotia Health’s Library Subject Guide: Accessing Ethics Support – Ethics Nova Scotia Health – LibGuides at Nova Scotia Health

    14 min

  6. 09/05/2025

    The Context of MAiD in Quebec and Ethical Issues Arising

    With Host, Andrea Frolic And special guests Marie-Eve Bouthillier and Delphine Roigt DISCUSSION QUESTIONS In 2024, Quebec introduced legislation that allow for advance request for MAiD. The legislation is narrow in scope. You can only enact an advance request for MAiD if you are diagnosed with an illness that is known to lead to incapacity. Moreover, the request is only eligible for the condition it was intended for.   It is mentioned in the podcast that a quarter of Quebec’s population are currently without a family physician and that there are ongoing issues with access to care in general. How would you approach the issue of prioritization with regards to people’s access to care for treatment of illness and access to MAiD? Ethical concerns associated with advance requests for MAiD include issues around decisions to activate a person’s advance request, issues around resource allocation, and issues around conscientious objection. What do you see as the most pressing ethical issues with advance request for MAiD? Why? In your opinion, how should situations be managed when a patient’s advance request for MAiD is activated and the patient (who no longer has capacity for health care decision-making) manifests refusal? RESOURCES Canadian Medical Protection Association (CMPA). Updated Québec MAID legislation. October 30, 2024. https://www.cmpa-acpm.ca/en/news/2024/updated-quebec-maid-legislation [website accessed May 13, 2025] Government of Quebec. Advance request for medical aid in dying. https://www.quebec.ca/en/health/health-system-and-services/end-of-life-care/medical-aid-in-dying/advance-request-medical-aid-dying [website accessed May 13, 2025] Variath, C., Peter. E., Cranley, L., Godkin, D. Health care providers’ ethical perspectives on waiver of final consent for Medical Assistance in Dying (MAiD): a qualitative study. BMC Medical Ethics, 23,8 (2022). https://doi.org/10.1186/s12910-022-00745-4 Discussion Guide – PDF

    26 min
  7. Ethics and Harm Reduction – Addiction Medicine and Case Discussion

    08/27/2025

    Ethics and Harm Reduction – Addiction Medicine and Case Discussion

    with Host, Amanda Porter Special Guest, Dr. Thomas Brothers DISCUSSION QUESTIONS  Dr. Brothers mentions that harm reduction approaches have not historically been incorporated in medical education. What might be some of the reasons for this?  Why do you think there is a difference in the standard of care in the community setting compared to in the acute hospital setting with regards to harm reduction for people who use drugs?  Why do you think that stigma persists in healthcare?  RESOURCES  Brothers, T., Mosseler, K., Kirkland, S., Melanson, P., Barret, L., Webster, D. (2022) Unequal access to opioid agonist treatment and sterile injecting equipment among hospitalized patients with injection drug use-associated infective endocarditis. PLOS ONE, 17(1): e0263156. https://doi.org/10.1371/journal.pone.0263156   Knaak, S., Romie, C., Mercer, S., Stuart, H.: Harm Reduction, Stigma and the Problem of Low Compassion Satisfaction: Tensions on the front-lines of Canada’s opioid crisis. Journal of Mental Health and Addition Nursing. Vol 3 (1) , May 2019. https://utppublishing.com/doi/abs/10.22374/jmhan.v3i1.37   McKay M., Coldwell, M., Graham, S., Upham, K.: Harm Reduction Position Paper. Doctors Nova Scotia (2023) harm-reduction-position-paper2023.pdf  Websites:  Addictions Medicine Consult Service : https://mha.nshealth.ca/en/clients-and-providers/resources-providers/addictions-medicine-consult-service  [accessed May 12, 2025]  Canadian Centre for Substance Use and Addiction: Lived and Living Experience | Canadian Centre on Substance Use and Addiction [accessed March 17, 2025]  Nova Scotia Health: What is Harm Reduction. Harm reduction | Nova Scotia Mental Health and Addictions [accessed March 17, 2025] Harm Reduction-Case Discussion Resource PageDownload

    26 min
  8. Ethics and Harm Reduction – A providers perspective.

    06/18/2025

    Ethics and Harm Reduction – A providers perspective.

    with Amanda Porter, Host and Dr. Tiffany O’Donnell, Family Physician, Wije’winen Health Centre DISCUSSION QUESTIONS Do you think there is a moral difference between providing people who use drug with a safe supply of drugs and providing them with clean needles and a safe space to inject drugs? Why/why not? A lot of effort has gone into addressing stigma associated with substance use disorder, including efforts to make people look at it as a health condition and not a moral failure. Yet, stigma towards people who use drugs persist. Why do you think that is the case? Can you think of different ways to address stigma associated with substance use disorder? RESOURCES Canadian Centre for Substance Use and Addiction:Lived and Living Experience | Canadian Centre on Substance Use and Addiction [accessed March 17, 2025] Jonson, B. Changing Her Tune. DoctorsNS Magazine, Vol 3 (2), June 2023, p16-17. https://doctorsns.com/news-events/doctorsns/archive/2023-06-01 Jonson, B. Dr. Tiffany O’Donnell takes a new approach to addiction medicine. DoctorsNS, Blogpost, August 2023. https://yourdoctors.ca/blog/health-care/dr-tiffany-odonnell/ Knaak, S., Romie, C., Mercer, S., Stuart, H.: Harm Reduction, Stigma and the Problem of Low Compassion Satisfaction: Tensions on the front-lines of Canada’s opioid crisis. Journal of Mental Health and Addition Nursing. Vol 3 (1) , May 2019. https://utppublishing.com/doi/abs/10.22374/jmhan.v3i1.37 McKay M., Coldwell, M., Graham, S., Upham, K.: Harm Reduction Position Paper. Doctors Nova Scotia (2023) harm-reduction-position-paper2023.pdf Nova Scotia Health: What is Harm Reduction. Harm reduction | Nova Scotia Mental Health and Addictions [accessed March 17, 2025]

    27 min
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A podcast discussion on the latest healthcare ethics issues in practice with guest speakers.

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