A Canadian Perspective

The recent survey by the American Society of Bioethics and the Humanities (ASBH 2001) provides important information regarding the education and training of bioethicists in North America.¹ The collected data and the thoughtful commentary by the survey's authors inspire us to take stock of where we are as a field, how we can and should shape and support students, and how we envision the future of bioethics. The Canadian Bioethics Society appreciates the opportunity to have participated in the ASBH survey, and we are looking forward to the first joint annual meeting of our societies, to be held in Montreal in October 2003.

The dramatic growth in the number of graduate programs in the 1990's (182% according to the survey) reflects an increase in the need for ethics capability in the education of health professionals, more research opportunities for academically- oriented bioethicists, and the value of clinical bioethicists as members of healthcare teams. It also follows upon the realization by government and nongovernment organizations that bioethicists might be able to help meet the increased public demand for accountability and ethical behavior in these organizations. Above all, it indicates optimism that there will be positions available for these graduates to move into.

In Canada there have been several developments over the past decade that have affected demand for bioethicists. One has been the increased attention of the Canadian Council on Health Services Accreditation (http://www.cchsa.ca) to ethical matters in its accreditation of Canadian hospitals. Hospitals must show that they have systems in place to provide means of addressing patients' rights (for example to information), end-of-life decision making, and ethics at the organizational level, including the education of staff and volunteers and the harmonization of policies with organizational mission and values. While many healthcare organizations have ethics committees (clinical and sometimes organizational) to fulfill these needs, large teaching hospitals are increasingly hiring bioethicists as well. These individuals come from a variety of backgrounds and participate in the hospital community as consultants, educators, and administrators.

A second development has been the requirement of the Royal College of Physicians and Surgeons of Canada ( http://rcpsc.medical.org/english/ethics/) that all postgraduate residency training programs include bioethics in their curricula. This means that all specialty and subspecialty doctors-in-training in Canada must have the opportunity to learn bioethics; as a result, all 16 medical schools and affiliated teaching hospitals have been developing learning opportunities. This has increased the need for capable faculty, who may be hospital bioethicists, university medical faculty, or teams of bioethicists and clinicians.

Thirdly, in 1998 the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans ( http://www.nserc.ca/programs/ethics/english/policy.htm) was introduced. This policy applies to all publicly funded research in Canada. Research Ethics Boards (REBs, the Canadian equivalent of institutional review boards) need assistance with learning and teaching about the policy and implementing it in their organizations. Review of research protocols has increased in number and complexity, and the Policy requires that at least one REB member be knowledgeable in ethics.

Finally, another significant factor in the increased need for bioethicists was the recent creation of the Canadian Institutes for Health Research (CIHR; http://www.cihr-irsc.gc.ca), Can- ada's major federal funding agency for health research. Ethics is an integral part of the agency; a bioethicist sits on the Governing Council, ethics designates sit on each of the 13 Institutes' advisory boards, there is a Standing Committee on Ethics, an Ethics Office, and a Health Ethics and Law Peer Review Committee. Funding opportunities are increasingly available through the CIHR for both research in bioethics and healthcare research with ethics components.

The need for bioethicists in Canada is continuing to grow. We need faculty to teach and mentor the enthusiastic and committed young folks who are entering our programs. Canadians are participating in countrywide consultations preceding healthcare reform and some sort of governance of health research. Canadian...