Keri Ferguson

Western has established a new Centre for Bioethics, bringing top experts together to examine the critical ethical issues plaguing health-care providers, policy-makers and health systems. The inaugural chair of the centre is School of Health Studies professor Maxwell Smith, a bioethicist and Canadian Institutes of Health Research Applied Public Health Chair in Ethics and Health Emergencies. Hosted by the Faculty of Health Sciences, the centre already boasts 35 members representing faculty, staff and students, across five faculties, 11 departments and programs, as well as Western’s Office of Research Ethics, London Health Sciences Centre, St. Joseph’s Health Care London and the Middlesex-London Health Unit. The centre officially launched Dec. 4, with a nod to Western’s history in bioethics, which began in 1978 with the creation of the Westminster Institute for Ethics and Human Values. Guest speaker Françoise Baylis, MA’84, PhD’89, an internationally renowned bioethicist, worked in the institute as a Western student and following her graduation. During her talk, Baylis, a member of the Order of Canada, the Order of Nova Scotia and President of the Royal Society of Canada, reflected on her time at Western and her pioneering work at the intersection of health-care ethics, practice and policy. Western News spoke with Smith to learn more about the centre and its mission.  

What is bioethics?

Maxwell Smith: Bioethics is the study of questions concerning right and wrong, good and bad, as they relate to health. It provides a framework to help make decisions about health and health care – either as a clinician, researcher, patient, health authority or the government. Bioethics as a field wants to ensure we’re interrogating not only the evidence informing the decisions people make, but also how their values and moral reasoning affect those decisions. That gives us an opportunity to make compelling arguments and help shape policy.  

What are some examples of bioethical issues?

MS: Very common issues in bioethics include termination of pregnancy, medical assistance and dying and vaccine mandates. People can have very strong views about these issues and about certain health-care services or the lack thereof, but those observations aren’t strictly scientific; they involve value judgments. Bioethics is an attempt to systematically study those sorts of questions and judgments and to make sure issues around our health and our health care are as ethically justifiable and morally right as they can be.  

A lot of the issues you mentioned can be ‘hot topics.’

MS: That can make it fun, especially when teaching undergraduate students, because it deals with all the issues in our health system that make front page news. These are the most controversial issues, societal debates that get people talking. Bioethics is the space where we systematically study and think about those issues, and it can be quite compelling.  

What is the purpose of Western’s Centre for Bioethics?

MS: It is a research centre with a primary aim to foster and grow research in bioethics, by consolidating Western’s bench strength in this area. Bioethics is an interdisciplinary field. We have ‘card-carrying’ bioethicists like me all around campus – in health sciences, medicine, philosophy, law, and social science, but until now, we haven’t been under the same umbrella. There’s a need to bring us together so we can collaborate, promote and advance research in these areas. There are other people on campus who may not be bioethicists, but look at ethical issues in their research or need help doing so. We want to make sure we’re bringing that community together as well, along with students and postdocs and partners within our hospital systems and health unit, to make sure we’re engaging with people who are interested in or impacted by the different issues. Conversing and connecting with one another stimulates new research questions and more opportunities to address them.  

How will the new centre benefit students?

MS: There will be more opportunities for undergraduate and graduate students to get involved with our hospitals to see how ethics are raised in a clinical setting and how consultation on ethical issues in health-care settings works. We want to bring interested students from different departments together to learn about bioethics and bioethics research, which might give them ideas about pathways for further training or careers.

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What is the history of bioethics research – and why do we need it now?

MS: It wasn’t until the 1960s and 1970s, when we started to think about civil rights, that we also started to think seriously about patient rights. Since then, with huge technological advances in health care, including the first mapping of the human genome (and the key ethics panel resulting from it), the field of bioethics really took off. This is still accelerating; there are always new technological advances when it comes to health – artificial intelligence is one example. The pandemic raised a host of issues we hadn’t previously thought carefully about. We’re at a point where it’s become crucial to be thinking about these issues and having a dedicated group on campus will allow that. For anyone doing health research, there’s always going to be ethical dimensions. I think it’s becoming increasingly important that we have people focusing on ethics alongside the scientific side of our research.  

What do you wish people knew or understood more about bioethics?

MS: While it is the controversial issues that get people interested in bioethics, they don’t necessarily appreciate there are really thorny and important bioethical questions that emerge in the most mundane of places. These might not make the front page, but they’re incredibly complicated and require sustained systematic analysis. I have students who may only want to look at the huge issues, but the people who practice bioethics in hospitals will tell you their day-to-day looks very different than that.  

What’s an example of a bioethical issue health-care workers face daily?

MS: We have a health system that is overcapacity, with people showing up to the emergency department waiting hours to be seen. That’s often because there are people in the ER who can’t be admitted to the hospital units because there are no available beds. Sometimes, that’s because people receiving care could be discharged to a home, community or long-term care setting, but aren’t because those are overcapacity as well. We’re doing everything we can in our health system to think about how we can open up more space so people can get the care they need. There’s the hopeful solution, just throw money at the problem, but we don’t have unlimited resources. This requires us to make really tough calls about when it is ethically appropriate to discharge a patient who might require some level of care, but perhaps not the acute care provided in a hospital. But if we have a whole health system operating that way, it might mean many people don’t get any care at all. This raises difficult questions about our ethical obligations to patients within a universal health system that promises people will receive a certain level of care.  

That is tough for the people making those decisions, day in and day out.

MS: The ethical questions are leading to a lot of moral distress amongst health-care providers, who are already overworked. Experienced physicians, nurses and social workers want to do better by their patients, but the system is so constrained they have to make these tough choices. If, day-to-day, you’re facing issues you feel morally troubled by, you don’t want to work there anymore. That’s going to harm all of us. I believe we have an imperative to make sure we’re trying to think through and prevent some of those issues from occurring, so our health workforce doesn’t have to shoulder those decisions alone.  

How does the study of bioethics help?

MS: Part of what we try to offer is an approach to make the best right choice in those terrible circumstances. That requires a very careful way of thinking about what we owe each of these patients and what sort of trade-offs we can accept. *Responses edited for brevity and clarity.