Canada Research Chair in

Ethical Complexity in Primary Care

What is Ethical Complexity?

“Ethical complexity” occurs in medical encounters which provoke uncertainty, dilemma, or distress in the patient, clinician, or both. Dr. Vanstone studies several different kinds of ethical complexity in healthcare.

Moral complexity occurs when a person is required to make a healthcare decision that affects others beyond themselves, and potentially impacts society.

Decisional complexity occurs when patients need to make decisions for which evidence is unavailable, equivocal, or conflicting.

Emotional complexity occurs in clinical events that provoke strong emotions, where iatrogenic harm can occur when care is delivered without the time or resources to attend to the accompanying emotions that can arise for patients, family members, and clinicians.

 

 

Social complexity occurs in clinical interactions related to patient actions and decisions outside of the clinic, where there is discord between healthcare recommendations and a patient’s social or cultural circumstances and practices.

System complexity occurs when clinicians and patients must work to navigate interlocking, overlapping, and incomplete systems of health and social care.

 

 

Why study ethical complexity in primary care?

Primary care is a key site of daily ethical complexity, because the longitudinal and holistic work of a primary care provider requires aptitude in navigating complex relationships, systems, medical decisions. Primary care providers are the first point of contact for patients, who bring their undifferentiated symptoms for identification, diagnosis, and management. When a diagnosis is uncertain or when no effective cure is possible, primary care providers are there to assist patients in the community manage their symptoms and circumstances, and to help them cope with the impacts of health challenges on other aspects of their life. Accordingly, one of the hallmarks of high quality primary care is the provider’s ability to manage uncertainty and complexity. Primary care provides therefore end up addressing many health issues for which there is no clear evidence, or for which evidence is not the main decision determinant. These are the ethically complex areas of practice that Dr. Vanstone studies, where a focus on patient context and values is the north star of healthcare decision-making.

Meredith Vanstone,

Associate Professor, Department of Family Medicine

DBHSC 5001F, McMaster University

100 Main St. W., Hamilton, ON L8P 1H6

Meredith.Vanstone@mcmaster.ca

Moral complexity occurs when a person is required to make a healthcare decision that affects others beyond themselves, and potentially impacts society.

Decisional complexity occurs when patients need to make decisions for which evidence is unavailable, equivocal, or conflicting.

Emotional complexity occurs in clinical events that provoke strong emotions, where iatrogenic harm can occur when care is delivered without the time or resources to attend to the accompanying emotions that can arise for patients, family members, and clinicians.

Social complexity occurs in clinical interactions related to patient actions and decisions outside of the clinic, where there is discord between healthcare recommendations and a patient’s social or cultural circumstances and practices.

System complexity occurs when clinicians and patients must work to navigate interlocking, overlapping, and incomplete systems of health and social care.