Studying patients during the end of life is important, as it has the potential to lead to improvements in care for the dying. For patients who die after a controlled withdrawal of life-sustaining therapies in the intensive care unit, information about the natural history of death and the process of removing life support has additionally led to advances in practice for deceased organ donation. However, this unique population of severely critically ill and imminently dying patients has been difficult to study, largely due to assumptions made by research teams and ethics boards alike about the logistical difficulties of obtaining consent and completing research procedures before or during the process of withdrawal of life-sustaining therapies. In this paper, we describe the ethics substudy of the first prospective observational research study in Canada to obtain consent and collect clinical data on patients during the process of withdrawal of life-sustaining therapies in the intensive care unit. We describe in detail the process of protocol development, review by five institutional research ethics boards and bedside staff satisfaction with the study. We conclude that prospective research on a critically ill and imminently dying population is feasible and can be conducted in an ethical manner. Further information is needed about the experiences and motivations of families and substitute decision makers who provide consent for research on critically ill intensive care unit patients at the end of life.
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Contributors AvB, LH and SD: participated in the conception, design, analysis, interpretation, drafting and the critical revising for important intellectual content of this manuscript and have seen and approved the final version. RW and JC-E: participated in the conception, design, analysis, interpretation and the critical revising for important intellectual content of this manuscript and have seen and approved the final version. KM: participated in the drafting and the critical revising for important intellectual content of this manuscript and has seen and approved the final version.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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