RT Journal Article SR Electronic T1 The impact of the Rasouli decision: a Survey of Canadian intensivists JF Journal of Medical Ethics JO J Med Ethics FD BMJ Publishing Group Ltd and Institute of Medical Ethics SP 180 OP 185 DO 10.1136/medethics-2015-102856 VO 42 IS 3 A1 Cape, David A1 Fox-Robichaud, Alison A1 Turgeon, Alexis F A1 Seely, Andrew A1 Hall, Richard A1 Burns, Karen A1 Singal, Rohit K A1 Dodek, Peter A1 Bagshaw, Sean A1 Sibbald, Robert A1 Downar, James YR 2016 UL http://jme.bmj.com/content/42/3/180.abstract AB 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.