Article Text
Abstract
Introduction In a landmark 2013 decision, the Supreme Court of Canada (SCC) ruled that the withdrawal of life support in certain circumstances is a treatment requiring patient or substitute decision maker (SDM) consent. How intensive care unit (ICU) physicians perceive this ruling is unknown.
Objectives To determine physician knowledge of and attitudes towards the SCC decision, as well as the self-reported changes in practice attributed to the decision.
Methods We surveyed intensivists at university hospitals across Canada. We used a knowledge test and Likert-scale questions to measure respondent knowledge of and attitudes towards the ruling. We used vignettes to assess decision making in cases of intractable physician-SDM conflict over the management of patients with very poor prognoses. We compared management choices pre-SCC decision versus post-SCC decision versus the subjective, respondent-defined most appropriate choice. Responses were compared across predefined subgroups. We performed qualitative analysis on free-text responses.
Results We received 82 responses (response rate=42%). Respondents reported providing high levels of self-defined inappropriate treatment. Although most respondents reported no change in practice, there was a significant overall shift towards higher intensity and less subjectively appropriate management after the SCC decision. Attitudes to the SCC decision and approaches to disputes over end-of-life (EoL) care in the ICU were highly variable. There were no significant differences among predefined subgroups.
Conclusions Many Canadian ICU physicians report providing a higher intensity of treatment, and less subjectively appropriate treatment, in situations of dispute over EoL care after the Supreme Court of Canada's ruling in Cuthbertson versus Rasouli.
- End of Life Care
- Bills, Laws and Cases
- Clinical Ethics
- Demographic Surveys/Attitudes
- Decision-making
Statistics from Altmetric.com
Read the full text or download the PDF:
Other content recommended for you
- Physicians’ perspective on potentially non-beneficial treatment when assessing patients with advanced disease for ICU admission: a qualitative study
- Shared decision-making in the ICU from the perspective of physicians, nurses and patients: a qualitative interview study
- Exploring the experiences and perspectives of substitute decision-makers involved in decisions about deceased organ donation: a qualitative study protocol
- Improving comfort and communication in the ICU: a practical new tool for palliative care performance measurement and feedback
- Quality of dying and death in intensive care units: family satisfaction
- Withdrawing life support and resolution of conflict with families
- Patient and family satisfaction levels in the intensive care unit after elective cardiac surgery: study protocol for a randomised controlled trial of a preoperative patient education intervention
- Protocol for a randomised trial of an interprofessional team-delivered intervention to support surrogate decision-makers in ICUs
- Prospective cohort study protocol to describe the transfer of patients from intensive care units to hospital wards
- Protocol to describe the analysis of text-based communication in medical records for patients discharged from intensive care to hospital ward