Development of an ethical resolution process and education resources: supporting equity-focused public health ethics education through community-engaged research

Healthcare ethics education is essential for supporting trainees and health professionals to build ethical reasoning skills necessary to resolve complex ethical issues, support equitable health outcomes, and promote just healthcare systems. Traditional ethical decision-making frameworks, grounded in principles-based approaches, may be insufficient in supporting a process of resolving clinical and public health ethical dilemmas that is attentive to both sociopolitical context and inclusion of parties most impacted by ethical issues. While many approaches to ethics education show promise, healthcare system resource constraints result in challenges in delivering ethics education.

The aim of this project was to develop an equity-focused process for resolving ethical dilemmas in healthcare and to produce evidence-informed public health ethics education resources in British Columbia, Canada. A consultation process was undertaken to develop and refine an ethical resolution process to support healthcare ethics practice. An empirical qualitative study was conducted with members of equity-denied communities to inform educational resource development. An online course was collaboratively developed, based on the ethical resolution process and empirical data, that used universal design principles, scaffolded learning activities, and original artwork.

The ethical resolution process supports iterative and flexible analysis of clinical and public health ethics issues, consisting of five components: ethical dilemma, impacted parties, information, options, resolution. Public health ethics values and principles prioritized by participants included accessibility, transparency, and wholistic wellbeing. Other points of emphasis were acknowledgement of upstream causes, focus on current ethical issues, application of intersectionality, and incorporation of Indigenous Ways of Knowing. Participants made several recommendations to support development of education resources. The end products included a public health ethics guide and an accompanying openly accessible asynchronous online course in which fictional scenarios based on findings from the qualitative study were analyzed through the ethical resolution process.

This project incorporated theoretical understandings of ethics and instructional design with qualitative data and the realities of providing ethics education in resource-constrained environments. A collaborative, interdisciplinary approach brought together those most impacted by public health ethics dilemmas, public health professionals, ethicists, and instructional designers to develop evidence-informed, context-specific, openly accessible online resources to support healthcare ethics education.