In both law and ethics, precedent shapes the deliberation of novel issues. Despite the interconnection between new and old decisions, few research ethics boards have an explicit mechanism for archiving issue-based research ethics decisions to inform future decisions. With the intent of promoting expediency, consistency, and accountability in REB decision-making, Sunnybrook Health Sciences Centre implemented a “decision bank”: a formal mechanism for systematically capturing institutional REB decisions. We describe the development of the decision bank, its implementation, and the lessons we (...) have learned from both. The decision bank, which is categorized by general issue themes such as consent, study design, and privacy, is still in the early implementation phase, but it provides a much-needed method to address the paucity of formal mechanisms and literature in a biomedical field otherwise inundated with evidence-based information. (shrink)

To the Editor: It was with great interest that our Canadian Palliative Sedation Therapy Guideline working group read Jeffrey Berger's recent article ("Rethinking Guidelines for the Use of Palliative Sedation," May-June 2010). Given our own group's efforts to develop national guidelines, we have rethought the issue of palliative sedation therapy several times over the past year.The use of clear and concise definitions is fundamental to the development of any consensus guidelines on this topic. In the article, the term "palliative sedation (...) to unconsciousness," or PSU, implies the concerning assumption that sedation will knowingly be to unconsciousness in the palliative case under consideration. This conflicts with .. (shrink)