OBJECTIVES: Since 2016, Canada has allowed for euthanasia based on strict criteria under federal ... more OBJECTIVES: Since 2016, Canada has allowed for euthanasia based on strict criteria under federal medical assistance in dying legislation. The purpose of this study was to determine how Canadian intensivists perceive medical assistance in dying and whether they believe their approach to withdrawal of life-sustaining therapies has changed following introduction of medical assistance in dying. DESIGN: Electronic survey. SETTING: Participants were recruited from 11 PICU programs and 14 adult ICU programs across Canada. All program leaders for whom contact information was available were approached for participation. PARTICIPANTS: We invited intensivists and critical care trainees employed between December 2019 and May 2020 to participate using a snowball sampling technique in which department leaders distributed study information. All responses were anonymous. Quantitative data were analyzed using descriptive statistics. Categorical variables were analyzed using Pearson chi-square test. INTERVENTIONS: Not applicable. MEASUREMENTS AND MAIN RESULTS: We obtained 150 complete questionnaires (33% response rate), of which 50% were adult practitioners and 50% pediatric. Most were from academic centers (81%, n = 121). Of respondents, 86% (n = 130) were familiar with medical assistance in dying legislation, 71% in favor, 14% conflicted, and 11% opposed. Only 5% (n = 8) thought it had influenced their approach to withdrawal of life-sustaining therapies. Half of participants had no standardized protocol for withdrawal of life-sustaining therapies in their unit, and 41% (n = 62) had observed medications given in disproportionately high doses during withdrawal of life-sustaining therapies, with 13% having personally administered such doses. Most (80%, n = 120) had experienced explicit requests from families to hasten death, and almost half (47%, n = 70) believed it was ethically permissible to intentionally hasten death following withdrawal of life-sustaining therapies. CONCLUSIONS: Most Canadian intensivists surveyed do not think that medical assistance in dying has changed their approach to end of life in the ICU. A significant minority are ethically conflicted about the current approach to assisted dying/euthanasia in Canada. Almost half believe it is ethical to intentionally hasten death during withdrawal of life-sustaining therapies if death is expected.
The right to life has been raised as the central issue in a wide variety of health care debates. ... more The right to life has been raised as the central issue in a wide variety of health care debates. However, the assertions advanced by Jotkowitz and colleagues (2010) have little to do with such a right. Instead, Jotkowitz and colleagues present several arguments about the ...
R eproduced with permission of the copyright owner. Further reproduction prohibited without permi... more R eproduced with permission of the copyright owner. Further reproduction prohibited without permission.
First used to describe the weariness the public felt in response to some societal crises, the ter... more First used to describe the weariness the public felt in response to some societal crises, the term compassion fatigue was taken up by health professionals to name-along with burnout, vicarious traumatization, compassion stress, and secondary traumatic stress - the condition of caregivers who become "too tired to care". Compassion, long seen as the foundation of ethical caring, is increasingly understood as a threat to the well-being of those who offer it. Through the lens of hermeneutic phenomenology, the authors present an insider's perspective on compassion fatigue, its effects on the body, on the experience of time and space, and on personal and professional relationships. Accounts of health professionals, alongside examinations of poetry, images, movies, and literature, are used to explore the notions of compassion, hope and hopelessness as they inform the meaning of caring work. The authors frame their expose with the very Canadian metaphor "of lying down in ...
Management and Leadership – A Guide for Clinical Professionals, 2015
Ethically complex issues are commonly encountered in critically ill patients in intensive care un... more Ethically complex issues are commonly encountered in critically ill patients in intensive care units and usually relate to disagreements about care in such high risk situations. Because the clinical course is often uncertain and unpredictable, serious disagreements about the plan and priorities of care occur. This is presented simplistically as a conflict between the (surrogate) autonomy of the family members and the physician (health care professional) authority, in promoting the patient’s best interests. The ethical issues emerge only when discussion includes broader concerns about morbidity, mortality, and meaning to family and the hospital staff. We review the theoretical ethical basis of decision-making in such situations in the context of neonatal intensive care units and recommend that the physician focuses on the professional role of advocate for the infant’s best interests. Reflective conversations with family, including openness about uncertainty and willingness to re-evaluate care plans, are essential to maintain trust. This mediation approach supports different moral views in an atmosphere of mutual respect. Expert ethics assistance early on in high risk cases is recommended. We suggest that this be provided by an ethics consulting service readily available to the staff for optimizing care and preventing the development of crises.
The emergence of bovine spongiform encephalopathy (BSE) in British cattle has received significan... more The emergence of bovine spongiform encephalopathy (BSE) in British cattle has received significant media attention since its discovery in 1986. Transmission of this prion from cattle to humans has been documented, and the BSE prion is believed to be the causative agent for variant Creutzfeldt-Jakob disease (vCJD). Evidence of this spread is a significant threat to public health, and, although there has never been a proven case, there is a theoretical risk of transmission between humans by blood transfusions. In addition, recent animal studies have documented spread in this fashion, raising the question of whether vCJD should be included as part of informed consent for blood transfusions. The process of informed consent requires disclosure of material risks, defined as the risks that a reasonable person, under such circumstances, would want to know. Consent should, therefore, include the risks of a transfusion reaction, as well as the known infectious risks of blood. It should also include the unknown or theoretical risks of blood transfusions because full disclosure of even remote risks preserves the patient/physician trust relationship, which if breached, is very difficult to mend. Given the high level of public awareness, the potential lethality of the infection, and the theoretical risk of transmission by blood, vCJD can be considered a material risk, and consequently, it is reasonable to include it in the informed consent process.
The right to life has been raised as the central issue in a wide variety of health care debates. ... more The right to life has been raised as the central issue in a wide variety of health care debates. However, the assertions advanced by Jotkowitz and colleagues (2010) have little to do with such a right. Instead, Jotkowitz and colleagues present several arguments about the ...
Journal of Obstetrics and Gynaecology Canada, 2010
The troubling practice of fetal sex selection has historically been considered an Asian phenomeno... more The troubling practice of fetal sex selection has historically been considered an Asian phenomenon. However, recent evidence shows that a similar situation is emerging in North America, albeit on a smaller scale. The Society of Obstetricians and Gynaecologists of Canada has firmly stated its opposition to sex selection for non-medical reasons, as well as to the use of any technology used solely for the purpose of determining fetal sex. However, because fetal sex may be disclosed to the parents at the time of ultrasound examination if they request this information, guidance for health care professionals to assist in discouraging fetal sex selection would be useful. Because no declaration of motives or reasons is required when a woman seeks a termination of pregnancy, we suggest that health care professionals need not disclose the sex of a fetus until it has reached a gestational age at which abortion for non-medical purposes would not be possible. This proposal would facilitate consistency between clinical practice and the values of Canadian citizens, the SOGC, the Canadian Medical Association, and other professional organizations, while still respecting current laws pertaining to disclosure of patient information and patients' rights to autonomous decision-making.
OBJECTIVES: Since 2016, Canada has allowed for euthanasia based on strict criteria under federal ... more OBJECTIVES: Since 2016, Canada has allowed for euthanasia based on strict criteria under federal medical assistance in dying legislation. The purpose of this study was to determine how Canadian intensivists perceive medical assistance in dying and whether they believe their approach to withdrawal of life-sustaining therapies has changed following introduction of medical assistance in dying. DESIGN: Electronic survey. SETTING: Participants were recruited from 11 PICU programs and 14 adult ICU programs across Canada. All program leaders for whom contact information was available were approached for participation. PARTICIPANTS: We invited intensivists and critical care trainees employed between December 2019 and May 2020 to participate using a snowball sampling technique in which department leaders distributed study information. All responses were anonymous. Quantitative data were analyzed using descriptive statistics. Categorical variables were analyzed using Pearson chi-square test. INTERVENTIONS: Not applicable. MEASUREMENTS AND MAIN RESULTS: We obtained 150 complete questionnaires (33% response rate), of which 50% were adult practitioners and 50% pediatric. Most were from academic centers (81%, n = 121). Of respondents, 86% (n = 130) were familiar with medical assistance in dying legislation, 71% in favor, 14% conflicted, and 11% opposed. Only 5% (n = 8) thought it had influenced their approach to withdrawal of life-sustaining therapies. Half of participants had no standardized protocol for withdrawal of life-sustaining therapies in their unit, and 41% (n = 62) had observed medications given in disproportionately high doses during withdrawal of life-sustaining therapies, with 13% having personally administered such doses. Most (80%, n = 120) had experienced explicit requests from families to hasten death, and almost half (47%, n = 70) believed it was ethically permissible to intentionally hasten death following withdrawal of life-sustaining therapies. CONCLUSIONS: Most Canadian intensivists surveyed do not think that medical assistance in dying has changed their approach to end of life in the ICU. A significant minority are ethically conflicted about the current approach to assisted dying/euthanasia in Canada. Almost half believe it is ethical to intentionally hasten death during withdrawal of life-sustaining therapies if death is expected.
The right to life has been raised as the central issue in a wide variety of health care debates. ... more The right to life has been raised as the central issue in a wide variety of health care debates. However, the assertions advanced by Jotkowitz and colleagues (2010) have little to do with such a right. Instead, Jotkowitz and colleagues present several arguments about the ...
R eproduced with permission of the copyright owner. Further reproduction prohibited without permi... more R eproduced with permission of the copyright owner. Further reproduction prohibited without permission.
First used to describe the weariness the public felt in response to some societal crises, the ter... more First used to describe the weariness the public felt in response to some societal crises, the term compassion fatigue was taken up by health professionals to name-along with burnout, vicarious traumatization, compassion stress, and secondary traumatic stress - the condition of caregivers who become "too tired to care". Compassion, long seen as the foundation of ethical caring, is increasingly understood as a threat to the well-being of those who offer it. Through the lens of hermeneutic phenomenology, the authors present an insider's perspective on compassion fatigue, its effects on the body, on the experience of time and space, and on personal and professional relationships. Accounts of health professionals, alongside examinations of poetry, images, movies, and literature, are used to explore the notions of compassion, hope and hopelessness as they inform the meaning of caring work. The authors frame their expose with the very Canadian metaphor "of lying down in ...
Management and Leadership – A Guide for Clinical Professionals, 2015
Ethically complex issues are commonly encountered in critically ill patients in intensive care un... more Ethically complex issues are commonly encountered in critically ill patients in intensive care units and usually relate to disagreements about care in such high risk situations. Because the clinical course is often uncertain and unpredictable, serious disagreements about the plan and priorities of care occur. This is presented simplistically as a conflict between the (surrogate) autonomy of the family members and the physician (health care professional) authority, in promoting the patient’s best interests. The ethical issues emerge only when discussion includes broader concerns about morbidity, mortality, and meaning to family and the hospital staff. We review the theoretical ethical basis of decision-making in such situations in the context of neonatal intensive care units and recommend that the physician focuses on the professional role of advocate for the infant’s best interests. Reflective conversations with family, including openness about uncertainty and willingness to re-evaluate care plans, are essential to maintain trust. This mediation approach supports different moral views in an atmosphere of mutual respect. Expert ethics assistance early on in high risk cases is recommended. We suggest that this be provided by an ethics consulting service readily available to the staff for optimizing care and preventing the development of crises.
The emergence of bovine spongiform encephalopathy (BSE) in British cattle has received significan... more The emergence of bovine spongiform encephalopathy (BSE) in British cattle has received significant media attention since its discovery in 1986. Transmission of this prion from cattle to humans has been documented, and the BSE prion is believed to be the causative agent for variant Creutzfeldt-Jakob disease (vCJD). Evidence of this spread is a significant threat to public health, and, although there has never been a proven case, there is a theoretical risk of transmission between humans by blood transfusions. In addition, recent animal studies have documented spread in this fashion, raising the question of whether vCJD should be included as part of informed consent for blood transfusions. The process of informed consent requires disclosure of material risks, defined as the risks that a reasonable person, under such circumstances, would want to know. Consent should, therefore, include the risks of a transfusion reaction, as well as the known infectious risks of blood. It should also include the unknown or theoretical risks of blood transfusions because full disclosure of even remote risks preserves the patient/physician trust relationship, which if breached, is very difficult to mend. Given the high level of public awareness, the potential lethality of the infection, and the theoretical risk of transmission by blood, vCJD can be considered a material risk, and consequently, it is reasonable to include it in the informed consent process.
The right to life has been raised as the central issue in a wide variety of health care debates. ... more The right to life has been raised as the central issue in a wide variety of health care debates. However, the assertions advanced by Jotkowitz and colleagues (2010) have little to do with such a right. Instead, Jotkowitz and colleagues present several arguments about the ...
Journal of Obstetrics and Gynaecology Canada, 2010
The troubling practice of fetal sex selection has historically been considered an Asian phenomeno... more The troubling practice of fetal sex selection has historically been considered an Asian phenomenon. However, recent evidence shows that a similar situation is emerging in North America, albeit on a smaller scale. The Society of Obstetricians and Gynaecologists of Canada has firmly stated its opposition to sex selection for non-medical reasons, as well as to the use of any technology used solely for the purpose of determining fetal sex. However, because fetal sex may be disclosed to the parents at the time of ultrasound examination if they request this information, guidance for health care professionals to assist in discouraging fetal sex selection would be useful. Because no declaration of motives or reasons is required when a woman seeks a termination of pregnancy, we suggest that health care professionals need not disclose the sex of a fetus until it has reached a gestational age at which abortion for non-medical purposes would not be possible. This proposal would facilitate consistency between clinical practice and the values of Canadian citizens, the SOGC, the Canadian Medical Association, and other professional organizations, while still respecting current laws pertaining to disclosure of patient information and patients' rights to autonomous decision-making.
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