Healthcare Quarterly, 29(2) July 2026: 41-45.doi:10.12927/hcq.2026.27904
Healthcare Ethics
Ethical Decision-Making in Direct Service Funding: Lessons From a Toronto Developmental Services Organization
Andria Bianchi, Cecile Recto, Felix Camposano and Terri Hewitt
Abstract
Direct service funding is re-shaping Canada's developmental services sector and beyond, increasing individual choice while introducing new ethical challenges for providers. This paper examines one organization's transition to Ontario's needs-based autism program, where families receive direct funding to purchase services. Although the model enhances choice, it raises concerns about equity, two-tiered access and non-recommended service requests. In response, the organization used an ethics decision-making framework and developed nine ethics principles. These principles now serve as a compass that guides organizational decision-making for relevant ethical dilemmas. Sharing this experience aims to support others navigate ethical complexities associated with direct service funding.
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