PoPulationand Public HealtH etHics

Case discussion in response to
use oF eviDence For PrograM Decision Making
Bashir Jiwani, Ph.D.
Ethics Services & Diversity Services, Fraser Health
Surrey BC
BasHIR@BjetHICsInCoRPoRateD.Ca
Introduction
The ethically significant dimensions of any system-level decision extend far
beyond the decision itself.* The process of ethics analysis should be thought
of as a collaborative endeavour with the decision-making body from the beginning
of the decision process through to its completion.**
* In my opinion, there are at least five ethically salient dimensions to system-level decisions:
1. The mandate and relationships of the decision team (those charged with making the
decisions, and the terms by which they will engage each other throughout the process).
2. The distinct and systematic analysis of facts and values (separating the description of the
context from the ideals that the solution should live up to).
3. Consultation with system experts, those affected and the public (provision of information
about the facts of the decision and other education as appropriate, an invitation to critically
review the operating understanding of the context as well as what should matter in the
solution, all through a process of respectful dialogue).
4. Decision rationale and justification (explanation of why a particular solution is chosen, as
well as why it is seen as the most appropriate response).
5. Decision follow-up plans (how the decision is to be communicated, implemented and
evaluated; what education and downstream ethics support is to be provided to those affected;
and how those affected will be able to provide ongoing feedback).
** Based on the five dimensions, my approach to ethics analysis involves stepwise attention to:
· Establishment of the decision team.
· Clarification of the key philosophical problem(s) to be resolved.
· Review of the context, including the evidence for the various factual claims made in the story.
· Critical reflection on the values at stake in the situation, defining what these mean and
prioritizing them; and distinguishing what implicitly emerges as important within the story
from other considerations that ought to guide the response.
· Brainstorming possible solutions to the problem.
Use of evidence for program decision making
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