Lab

The Everyday Ethics Lab

About the lab

The Everyday Ethics lab is dedicated to the study of healthcare ethics as it interfaces with mental health, substance use, and chronic pain. Our research seeks to promote human flourishing through generating empirically grounded and philosophically rigorous knowledge to inform knowledge mobilization, translation, and exchange within healthcare. We apply a variety of conceptual and empirical methods including qualitative interviews and focus groups, surveys, mixed-methods designs, media analyses, and knowledge syntheses. We take seriously the idea that we cannot understand how people’s values are realized or undermined in daily life without being attuned to intersecting contextual factors, including relationships, historical, cultural meanings, social processes, and political factors.

Featured projects (2)

Project
Funder: University of Toronto Dalla Lana School of Public Health Interdisciplinary Data Science Cluster. The primary aim of this project is to examine how datasets are created, interpreted, and used within a specific context: the Emergency Department at the Centre for Addiction and Mental Health (CAMH ED). Our project will integrate unstructured and structured risk assessment data from CAMH electronic health records (EHRs), identify various biases, and combine ethnographic and ML-tools to redress these biases, build fair models and provide the critical context for future applications of ML-based risk assessment tools.
Project
The aim of this study is to document evidence of sponsorship from Big Cannabis related to healthcare, scientific research, and policy processes in order to understand the extent to which such activities contribute to risks to individual and community mental health. Funder: Mental Health Commission of Canada and Canadian Institutes of Health Research.

Featured research (9)

Introduction Communicable disease epidemics and pandemics magnify the health inequities experienced by marginalised populations. People who use substances suffer from high rates of morbidity and mortality and should be a priority to receive palliative care, yet they encounter many barriers to palliative care access. Given the pre-existing inequities to palliative care access for people with life-limiting illnesses who use substances, it is important to understand the impact of communicable disease epidemics and pandemics such as COVID-19 on this population. Methods and analysis We will conduct a scoping review and report according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews reporting guidelines. We conducted a comprehensive literature search in seven bibliographical databases from the inception of each database to August 2020. We also performed a grey literature search to identify the publications not indexed in the bibliographical databases. All the searches will be rerun in April 2021 to retrieve recently published information because the COVID-19 pandemic is ongoing at the time of this writing. We will extract the quantitative data using a standardised data extraction form and summarise it using descriptive statistics. Additionally, we will conduct thematic qualitative analyses and present our findings as narrative summaries. Ethics and dissemination Ethics approval is not required for a scoping review. We will disseminate our findings to healthcare providers and policymakers through professional networks, digital communications through social media platforms, conference presentations and publication in a scientific journal.
Researchers and advocates have argued that people living with severe mental illnesses are a vulnerable group and should be prioritized for COVID-19 vaccines. People living with severe mental illnesses, including substance use disorders, bear an elevated burden of intersecting risk factors related to the social determinants of health and medical comorbidities leading to greater COVID-19 morbidity and mortality. This increased risk is based on several intersecting factors, including the likelihood of living in unstable and crowded living conditions such as shelters, group homes, or institutions; unsafe working conditions; high rate of comorbidities; and marginalization and stigmatization. Nonetheless, many of the initial iterations of vaccine allocation frameworks internationally did not prioritize people living with severe mental illnesses. Moreover, people with severe mental illness who are long-stay inpatients in psychiatric institutions were left off of vaccine priority setting lists that included long-term care facilities and other congregate settings. In this commentary, we question why people living with severe mental illnesses – particularly those who are institutionalized – were not initially considered a priority for vaccine access given the supposed vulnerability. We describe how people are made vulnerable by intersecting aspects of systematic disadvantage such as stigma, poverty, and racism. We suggest that the lack of attention given to intersectional factors in vaccine prioritization compromises health equity for people living with mental health and substance use disorders. We end the commentary by suggesting how vaccine distribution and allocation could be more equitable by including people with lived experience of mental illness in designing and implementing vaccination strategies. Understanding how people with mental illnesses have experienced structural vulnerability and intersecting risk factors throughout the pandemic can help inform the creation of effective and ethical vaccine-related responses to the COVID-19 pandemic.
Since its introduction in the 1980s, futility as a concept has held contested meaning and applications throughout medicine. There has been little discussion within the psychiatric literature about the use of futility in the care of individuals experiencing severe and persistent mental illness (SPMI), despite some tacit acceptance that futility may apply in certain cases of psychiatric illness. In this paper, we explore the literature surrounding futility and argue that its connotation within medicine is to describe situations where patients (or their substitute decision-makers) believe that interventions will almost certainly provide no meaningful benefit. We then provide two arguments in support of the use of futility within the care of individuals experiencing SPMI: that some SPMI can be considered a terminal illness, and that the risk-benefit ratio is a dynamic entity such that futility can help describe what Gillett calls the ‘risk of unacceptable badness’ when it comes to considering how an intervention might impact a patient’s quality of life. We posit that capacity should not pose an obstacle to declaring futility when caring for individuals experiencing SPMI and explain how futility is not antithetical to recovery in mental health. Finally, we describe how using futility within psychiatric practice can allow for a reorientation of care by signalling the need to shift to a palliative approach.
Alcohol-related liver disease (ARLD) is a common indication for liver transplantation yet it is considered ethically controversial in academic, clinical and public discourses. Various social groups consider people with ARLD as personally responsible for their condition and question whether they should have access to a scarce resource. How the news media constructs responsibility for ARLD may influence public opinions toward those who are ill as well as related healthcare policies. Since the organ transplantation system relies on the willingness of individuals to donate organs, understanding how the media portrays controversial issues is a matter of vital importance for public health and health policy. We investigated how responsibility for ARLD requiring liver transplantation is presented for public consumption in the news media. Using a keyword search of two online news databases, we selected 81 articles from the United Kingdom, Canada and the United States. We analyzed the articles using a discursive psychological approach. We found that the news media ascribed responsibility for ARLD to three main actors: individuals with ARLD, biological predisposition, and policy and industry representatives. How responsibility for ARLD requiring liver transplantation is presented in the news media may have implications for people diagnosed with other substance-related disorders who present for transplant candidacy or are on the transplant waiting list. Investigating how responsibility for ARLD is constructed in news media may provide insights into how responsibility is understood in other stigmatized health conditions and its potential implications for population health equity.

Lab head

Daniel Z Buchman

Members

Alumni (5)

Denitsa Vasileva
  • University of British Columbia - Vancouver
Sapna Wadhawan
  • Mental Health Commission of Canada
Shreya Mahajan
  • University of Waterloo
Rajita Sharma
  • University of Toronto