Health Policy 89 (2009) 58–71 Available online at www.sciencedirect.com Ethics frameworks in Canadian health policies: Foundation, scaffolding, or window dressing? Mita Giacomini a,b,* , Nuala Kenny c , Deirdre DeJean a,b a Department of Clinical Epidemiology and Biostatistics, McMaster University, Canada b Centre for Health Economics and Policy Analysis, McMaster University, Canada c Department of Bioethics, Dalhousie University, Canada Abstract Health policy documents increasingly feature ethics frameworks that outline key guiding principles. It is unclear whether such frameworks function as scaffolding for creating policy, foundations for responding to policy, or mere aesthetic frames to make policies appear ethical. This study investigates the nature and quality of ethics frameworks in Canadian health documents. We reviewed the ethics frameworks of 24 strategic health policy documents published from 1998 to 2005 by Canadian government agencies. We found that frameworks typically appear as a list of principles or values. These elements vary widely across the terminal, procedural, and substantive values of conventional ethics, and many are better characterized as goals than as ethics. No two ethics frameworks matched, despite common topic areas and presumably broadly shared values within the Canadian health system. Elements shared by at least half of the documents include: access, accountability, autonomy, client-centredness, collaboration, efficiency, equity, and evidence. However, common elements are interpreted quite differently. The genesis of the framework and its elements is seldom described. Only one third of the documents relate specific ethical elements to specific policies. In conclusion, we draw on the clinical guidelines literature to propose some features of a robust, coherent and meaningful ethics framework. © 2008 Elsevier Ireland Ltd. All rights reserved. Keywords: Health policy; Policy making; Social values; Ethics 1. Introduction Health policy documents increasingly feature ethics frameworks that outline guiding principles * Corresponding author at: Centre for Health Economics and Policy Analysis, McMaster University, 1200 Main Street West, HSC- 3H1C Hamilton, Ontario L8N 3Z5, Canada. Tel.: +1 905 525 9140 x22879. E-mail address: giacomin@mcmaster.ca (M. Giacomini). [1–4]. Ethicists are now commonly engaged as con- sultants in policy formulation [5], and policy makers often create a place for ethics in public deliberations, particularly in health science [6]. These trends span local, national, and international jurisdictions. They indicate an important point of convergence between the fields of health policy and ethics, which meet in their essential concern with the definition, achievement, and protection of the “good” [7]. 0168-8510/$ – see front matter © 2008 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.healthpol.2008.04.010