Department of Bioethics
The Department of Bioethics at SickKids is an academically grounded and clinically and organizationally-focused ethics service. As leaders in paediatric bioethics, we collaborate locally, nationally, and internationally to improve the health and care of children through consultation, education, policy, and research. We provide bioethics analysis grounded in ethics literature, policy, law and stakeholder engagement. Our SickKids Ethical Decision-Making Framework (PDF) guides our practice.
Our vision: healthier children, better care through principled decision-making.
To achieve our vision, the Department of Bioethics will:
- Engage with and support our colleagues, patients, and families through clinical and organizational consultation
- Extend the scope and quality of ethics education initiatives for health professionals, trainees, and staff
- Initiate and enhance policy work through ethical analysis
- Generate and collaborate on research and scholarship that inform and improve healthcare delivery for children
We engage with SickKids staff, patients, families, trainees, and volunteers to discuss ethical issues they face. Bioethics consultation involves identifying values and viewpoints, exploring fair decision-making processes, and examining the ethics of different options.
We conduct research to systematically explore many ethical issues in health care. We publish our work for academic and public audiences, prepare grants, and collaborate with other institutions on research projects. We participate in international research collaborations on topics of paediatric bioethics, research ethics and artificial intelligence/machine learning.
We provide training and capacity-building for staff and trainees to recognize and analyze ethical issues across the organization. We are affiliated with and teach at the University of Toronto (U of T) .
We are actively involved with or lead hospital policies that have ethics-related content.
Patients, families, staff, volunteers, and researchers at SickKids may reach out to our team of bioethicists for any matters relating to the department’s pillars or for consultation about ethical issues. SickKids patients and families may request a consultation by email. The team is available to consult online, by phone and in-person. This information does not need to reach your clinical team if you wish, subject to legal limitations. External consultation may be available upon request.
Randi Zlotnik Shaul, Director
Randi Zlotnik Shaul JD, LLM, PhD is the Director of the Department of Bioethics and Senior Associate Scientist with Child Health Evaluative Sciences. In her role, Zlotnik Shaul provides bioethics clinical and organizational consultation services and policy support, teaches health care professionals and bioethics students, and conducts bioethics research. Zlotnik Shaul is an Associate Professor in the Department of Paediatrics at U of T and is a member of the Joint Centre for Bioethics. Her current research focuses on paediatric healthcare challenges at the intersection of ethics and law.
President’s Award for outstanding service Ensuring quality and accountability in everything we do
Notini L and Zlotnik Shaul R.Innovation Poster Showcase, Student Competition Award, 7th Annual Joint Centre for Bioethics Research and Awards Day Celebration, Toronto ON. “Ethical Issues Associated with Healthcare Professionals’ Attendance at Paediatric Patients’ Funerals.”
James Anderson, Bioethicist
James Anderson MHA, MA, PhD is a Bioethicist in the Department of Bioethics, an Assistant Professor (status only) in the Institute for Health Policy, Management and Evaluation at U of T and a member of the Joint Centre for Bioethics. In his role, Anderson provides bioethics consultation, policy analysis, bioethics education and conducts research. Since 2013, Anderson has directed a course in ethical theory in the MHSc in Bioethics program at U of T. His research explores the intersection of ethics and epistemology in clinical research and practice. Recent work has focused on machine learning applications in health care, whole genome sequencing, and clinical decision making in paediatrics.
Recipient, Ross Upshur Course Director Award. Joint Centre for Bioethics, University of Toronto
Nomination for the Christine Harrison Award for Excellence in Teaching. Joint Centre for Bioethics, University of Toronto.
Melissa McCradden, Bioethicist
Melissa McCradden PhD, MHSc is a Bioethicist with the Department of Bioethics and an Assistant Professor (status only) with the Dalla Lana School of Public Health and a member of the Joint Centre for Bioethics. She was the inaugural postdoctoral fellow in Ethics of AI and Healthcare with SickKids and the Vector Institute. McCradden’s research explores the research and translation of clinical machine learning tools in health care focusing on foundational research ethics issues, patient-centred implementation, clinical decision-making, and ‘explainability’ in machine learning. Her scholarly work explores paediatric bioethics, neuroethics, and bias in health care.
Judges’ Choice Poster Presentation Award - Canadian Bioethics Society Annual Meeting
Best Poster Award - Joint Centre for Bioethics Research & Awards Day
Clinical Bioethics Associates are clinicians who have completed graduate training in bioethics and are committed to engagement with the Department of Bioethics.
Mary Campbell is a staff nurse in the Cardiac Critical Care Unit at SickKids. She completed her nursing degree at Ryerson University and a Masters of Health Science in Bioethics at U of T. Her practicum and capstone work has focused on beside ethics dialogue for nurses working in cardiac critical care, reflecting her interest in the challenges bedside nurses experience working in this clinical area.
Lauren Chad is a Staff Physician in the Division of Clinical and Metabolic Genetics and an Assistant Professor of Paediatrics at U of T. Her academic work focuses on improving care and reducing health care disparities for children with rare genetic conditions. She is involved in numerous projects, research endeavours and quality improvement initiatives that work to enhance the understanding of the ethical issues that arise in the field of clinical genetics. She is particularly interested in the application of new technologies in health care, such as machine learning, virtual care and rapid genetic testing.
Jonathan Hellmann is a Senior Clinical Bioethics Associate and an Emeritus Professor of Pediatrics at U of T. He was the Clinical Director of the Neonatal Intensive Care Unit (NICU) at SickKids for 17 years and joined the Bioethics Department in 2012. He completed a Masters in Bioethics and taught in the MHSc program at the Joint Centre for Bioethics for 11 years. He has an interest in ethics education, is involved in creating a neonatal ethics fellowship and is working on a book on bioethics in the NICU. He is a volunteer in the Department and contributes to all its activities, including consultation, education and research.
Andrew Helmers is a staff physician in the Department of Critical Care Medicine, and an assistant professor in the Department of Paediatrics at U of T. He completed an MSc at U of T and medical training at McGill University, followed by paediatric and paediatric critical care training at SickKids. Most recently, he completed an MHSc in Bioethics through the Dalla Lana School of Public Health at U of T. His academic work in Bioethics focuses on shared decision-making, best interests standard, end-of-life care and professional fiduciary responsibilities.
Roxanne Kirsch is a Staff Physician in the Department of Critical Care Medicine, Division of Cardiac Critical Care, and in the Department of Bioethics. She completed her Master’s degree in Biomedical Ethics at the University of Pennsylvania in 2016. Kirsch’s academic and research work focuses on the ethical and social challenges of stopping advanced therapies, end of life care, and use of non-beneficial ICU therapies in life-limiting illness, and in the development of frameworks for resource allocation.
Sarah Lord is a Staff Physician in Pediatric Medicine whose work focuses on the Paediatric Advanced Care Team (PACT) and the Complex Care Program. Lord completed her medical school and residency training at U of T and then pursued fellowship training in palliative care at SickKids. She received her MHSc in Bioethics at the Joint Centre for Bioethics at U of T. Her ethics and clinical work intersect commonly on issues related to end of life care, chronic life-prolonging technologies, and perinatal palliative care.
Kevin Weingarten is a Staff Physician with both the Paediatric Advanced Care Team (PACT) and the Division of Haematology/Oncology at SickKids. After completing his residency in paediatrics, Kevin completed his fellowship in Paediatric Haematology/Oncology at SickKids and a fellowship in Paediatric Palliative Care at Boston Children’s Hospital. Weingarten received his Masters in Bioethics at the Joint Centre for Bioethics. Weingarten is currently the Fellowship Director for Paediatric Palliative Care at SickKids.
Our affiliation with University of Toronto
SickKids and the University of Toronto Joint Centre for Bioethics (JCB) have had a 25-year history of collaboration. The Bioethics Department is an affiliated health organization of the JCB and the SickKids Bioethicists are active affiliates of the JCB’s Clinical, Organizational, and Research Ethics (CORE) Network.
Education and training opportunities
For students registered in corresponding university programs, we offer electives, selectives and practicums. We also take on research volunteers.
To apply for any of the above opportunities, email Randi Zlotnik Shaul and include the following:
- Curriculum Vitae (CV)
- Writing sample
- Letter describing:
a. Why you are interested in a trainee opportunity with our department
b. Your background in Bioethics to date
c. Topics in paediatric bioethics that you would be interested in researching and writing about during your placement
We will contact potential candidates for an in-person or telephone interview with two members of our department. We will request the names of two references.
Are you an international student looking for an observership in paediatric bioethics? Please contact International Education.
SickKids is a leading institution in innovative research and scholarship in paediatric bioethics. Research questions are grounded in clinical, organizational and research ethics issues associated with the health and health care of young people. Our research and scholarship contribute to accountability and to ethically-informed health care decision making.
Areas of focus include:
- child and family-centred care
- best interests of the child
- emerging autonomy of young people
- young people as participants in genetics research
- allocation of health care resources
- ethical issues associated with novel technologies like digital health, artificial intelligence, and machine learning
Our department’s research and scholarship is affiliated with the Child Health Evaluative Sciences and Genetics & Genome Biology research programs at SickKids, the University of Toronto, and the Joint Centre for Bioethics. Our Bioethicists have academic appointments in the Department of Paediatrics; Institute for Health Policy, Management and Evaluation; and Dalla Lana School of Public Health, all at the University of Toronto.
For researchers looking to collaborate, please contact a member of our team directly. For patients and families interested in getting involved in research, browse current research studies on Research4Kids.
Select research publications
- Zuo K, Gold A, Zlotnik Shaul R, Ho E, Zuker R. Pediatric upper extremity VCA Progress and insights. Reconstructive Transplantation and Regenerative Medicine, 2021. (forthcoming)
- Baba A, Saha A, McCradden MD, Boparai K, Zhang S, Pirouzmand F, Edelstein K, Zadeh G, Cusimano MD. Development and validation of a patient-centred meningioma-specific quality of life questionnaire (MQoL). Journal of Neurosurgery, 2021
- McCradden MD, Sarker T, Paprica P. A. Conditionally positive: a qualitative study of public perceptions about using health data for artificial intelligence research. BMJ Open, 2020.
- Cruz Rivera S, Liu X, Chan A-W, Denniston AK, Calvert MJ, and the SPIRIT-AI and CONSORT-AI Working Group. Reporting guidelines for clinical trial reports for interventions involving artificial intelligence: the SPIRIT-AI extension. *Published simultaneously in: Nature Medicine, Lancet Digital Health, BMJ, 2020.
- Liu X, Cruz Rivera S, Moher D, Calvert MJ, Denniston AK, and the SPIRIT-AI and CONSORT-AI Working Group. Reporting guidelines for clinical trial reports for interventions involving artificial intelligence: the CONSORT-AI extension. * Published simultaneously in: Nature Medicine, Lancet Digital Health, BMJ, 2020.
- McCradden MD. When is accuracy off-target? Translational Psychiatry, 2021.
- Liu X, Glocker B, McCradden MD, Denniston AK, Oakden-Rayner L. The medical algorithmic audit. Lancet Digital Health, 2021 (forthcoming)
- McCradden MD, Patel E, Chad L. The point-of-care use of a facial phenotyping tool in the Genetics Clinic: An Ethics Tête-à-Tête. American Journal of Medical Genetics, 2020.
- McCradden MD, Stephenson EA, Anderson JA. Clinical research underlies ethical adoption of healthcare artificial intelligence. Nature Medicine, 2020.
- McCradden MD, Chad L. Screening for facial differences worldwide: equity and ethics. Lancet Digital Health, 2021. [Invited Comment]
- Clinical research underlies ethical integration of healthcare artificial intelligence. McCradden M, Stephenson E. Anderson JA. Nature Medicine, 2020
- Ethical limitations of algorithmic fairness solutions. McCradden MD, Joshi S, Mazwi M, Anderson JAA. Lancet Digital Health, 2020.
- Ethical concerns around use of artificial intelligence in health care research from the perspective of patients with meningioma, caregivers and health care providers: a qualitative study. MD McCradden, A Baba, A Saha, S Ahmad, K Boparai, P Fadaiefard, Cusimano MD. CMAJ Open 8 (1), E90.
- Patient safety and quality improvement: Ethical principles for a regulatory approach to bias in healthcare machine learning. McCradden M, Joshi S, Anderson J, Mazwi M, Goldenberg A, Zlotnik Shaul R. J of Am Med Info Assoc 2020, 1-4 doi: 1093/jamia/ocaa085
- Reconciling the best interest standard with shared decision-making – introducing the shared optimum approach. Streuli JC, Anderson J, Alef-Defoe S, Bergsträsser E, Jovana J, Meyer S, Zlotnik Shaul R, Vayena E. European Journal of Pediatrics.
- Reporting guidelines for clinical trial reports for interventions involving artificial intelligence: the SPIRIT-AI extension. Cruz Rivera S, Liu X, Chan A-W, Denniston AK, Calvert MJ, and the SPIRIT-AI and CONSORT-AI Working Group [McCradden MD]. Nature Medicine, 2020.
- Reporting guidelines for clinical trial reports for interventions involving artificial intelligence: the CONSORT-AI extension. Liu X, Cruz Rivera S, Moher D, Calvert MJ, Denniston AK, and the SPIRIT-AI and CONSORT-AI Working Group [McCradden MD]. Nature Medicine, 2020.
- Sawyer JL, Mishna F, Bouffett E, Saini M, Zlotnik Shaul R. Bridging the Gap: Exploring the Impact of Hospital Isolation on Peer Relationships among Children and adolescents with a Malignant Brain Tumor. Child Adolesc Social Work J. 2021.
- Zlotnik Shaul R, Shaul D, Anderson J, McCradden M. The Gift in Precision Medicine: Unwrapping the Significance of Reciprocity and Generosity. AJOB 2021.
- Helmers A, McCradden M, Kirsch R, Zlotnik Shaul R. Cracking the Code: COVID-19 and the Future of Professional Promises. AJOB, 2020.
- McCradden MD, Anderson JA, Zlotnik Shaul R. Accountability in the Machine Learning Pipeline: The Critical Role of Research Ethics Oversight. AJOB, 2020.
- Zuo K, Gold A, Zlotnik Shaul R, Ho ES, Borschel GH, Zuker R. Pediatric Upper Extremity Vascularized Composite Allotransplantation: progress and Future. Current Transplantation Reports, 2020.
- Clinical Duty to Recontact in Genetic testing: Insights from the Safety Duty to Recall. Storey M, Zlotnik Shaul R, Meyn S, Chad L, Shuman C. Journal of Canadian Health Policy. August 2019
- Continuing the Conversation About Medical Assistance in Dying. DeMichelis C, Zlotnik Shaul R, Rapoport A. Journal of Medical Ethics. August 2019
- Discharge Against Medical Advice (DAMA) in Paediatrics: An Approach to Promote Safety and Ethics. Kavanagh A, Ostrow O, Zlotnik Shaul R. Paediatrics and Child Health. 2019; April 18. doi: 10.1093/pck/pxz052
- Dual-Role Research and Consent by Unique Specialists. Da Silva M, Zlotnik Shaul R, Simpson C, Boydell K. The American Journal of Bioethics. 2019; April 17; 19(4):46-48. doi: 10.1080/15265161.2019.1572817.
- Staying true to Rowan’s Law: how changing sport culture can realize the goal of the legislation. McCradden MD, Cusimano MD. Canadian Journal of Public Health, 2019; 1-4.
- Views from the clinic: Healthcare provider perspectives on whole genome sequencing in paediatrics. Szego MJ, Meyn MS, Shuman C, Zlotnik Shaul R, Anderson JA, Bowdin S, Monfared N, Hayeems RZ. European Journal of Medical Genetics 62 (2019) 350-356.
- What Clinicians Want: Contextualizing Explainable Machine Learning for Clinical End Use. Tonekaboni S, Joshi S, McCradden MD, Goldenberg A. Proceedings of Machine Learning Research, 2019;1-21.
- When is death in a child’s best interest? Examining decisions following severe brain injury. McCradden MD, Anderson J, Cusimano MD. JAMA Pediatrics, 2019.
- Adolescent decision-making in Canadian medical contexts: Integrating neuroscience and consent frameworks. Schwartz Y, Williams TS, Roberts SD, Hellmann, J, Zlotnik Shaul R. Paediatric and Child Health. 2018, 7 April;23(6): 374-376. doi: 10.1093/pch/pxy037.
- Medical Assistance in Dying at a paediatric hospital. DeMichelis C, Zlotnik Shaul R, Rapoport A. Journal of Medical Ethics. 2018; September 21 45:60-67. doi: 10.1136/medethics-2018-104896.
- Putting our best foot forward: Clinical, treatment-based and ethical considerations of nusinersen therapy in Canada for spinal muscular atrophy. Vukovic S, McAdam L, Zlotnik Shaul R, Amin R. Journal of Paediatrics and Child Health. 2018, September 23; 55(1):18-24.doi: 10.1111/jpc.14226.
- The voices of survivors: “you will not destroy our light.” McCradden MD, Cusimano MD. British Journal of Sport Medicine, 2018.
- Enzyme replacement therapy in perinatal hypophosphatasia: case report of a negative outcome and lessons for clinical practiceCostain G, Moore AM, Munroe L, Williams A, Zlotnik Shaul R, Rockman-Greenberg C, Offringa M, Kannu P. Molecular Genetics and Metabolism Reports. 2017, November 7; 14:22-26. doi: 10.10161j.ywgwr.2017.10.006.
- Fair Innings: Equality and Children’s Health. Long K, Zlotnik Shaul R. Bioethique Online. 2017, January; 6. doi: 10.7zoz/1044619ar.
- Familiar ethical issues amplified: How members of research ethics committees describe ethical distinctions between disaster and non-disaster research. Tansey CM, Anderson JA, Boulanger RF, Eckenwiler L, Pringle J, Schwartz L, Hunt M. BMC Medical Ethics 2017 Jun 28 18(1): 44.
- Developing a bioethics curriculum for medical students from divergent geo-political regions. Greenberg RA, Kim C, Stolte H, Hellmann J, Zlotnik Shaul R, Valani R, Scolnik D. BioMed Central Medical Education. 2016, July 27; 16:193.
- Maximizing the benefit and mitigating the risks of moral hazard. Zlotnik Shaul R, Unger W. American Journal of Bioethics. 2016, June 13; 16(7):44-46.
- Parents perspectives on whole genome sequencing for their children: Qualified enthusiasm? Anderson JA, Meyn MS, Shuman C, Zlotnik Shaul R, Mantella LE, Szego MJ, Bowdin S, Monfared N, Hayeems RZ. Journal of Medical Ethics Published Online First: November 25, 2016 doi:10.1136/medethics-2016-103564.
In the early 1980s an Ethics Committee was created at SickKids. This was initially a large body of professional and lay members who undertook reviews of ethical issues in clinical care. Dr. Abbyann Lynch, then Director of the Westminster Institute was invited to assist the committee in its deliberations. In 1991, with recognition of the increasing need for bioethics expertise, Dr. Lynch was appointed as Bioethicist and a Bioethics Department was created. The Department functioned in collaboration with the Committee and its Chair. Work groups developed a consultation process, an educational task force and other initiatives to enhance ethics awareness throughout the hospital. A second bioethicist was recruited to the Department within a short period of Dr. Lynch’s tenure.
The Department under Dr. Lynch was extremely active and productive: they published a number of books and research papers, developed a paediatric ethics teaching manual for residents, initiated a newsletter, held numerous ethics education sessions and many other activities to raise awareness.
It became clear that the optimal means for ethics consultation was through the expertise of the Bioethicists, with the committee focusing more on organizational and educational initiatives. Over time these activities also became incorporated into the functioning and responsibility of the Bioethics Department. Bioethics activity at SickKids became the responsibility of the Bioethics Department, led by the Director. This pattern continued under Dr. Christine Harrison and the current Director, Dr. Randi Zlotnik Shaul.
This model has served the institution extremely well and the Bioethics Department is well recognized for its expertise and excellence in clinical consultation, education, research activity, scholarship and policy development. It has established an international name as a major centre of academic bioethics, collaborating locally, nationally and internationally, in the understanding and addressing of complex ethical issues affecting children’s health care.