No abstract

Introduction:On February 6th, 2015, the Supreme Court of Canada (SCC) concluded that “the prohibition on physician-assisted dying is void insofar as it deprives a competent adult of such assistance where (1) the person affected clearly consents to the termination of life; and (2) the person has a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.”[1]. The Court added, “The declaration of invalidity is suspended for 12 months,”[1] to allow the government to respond with appropriate legislation to guide and regulate the practice of Physician-Assisted Death (PAD).Dr. Jeff Blackmer is the Vice President of Medical Professionalism at the Canadian Medical Association (CMA). He holds a Masters in Medical Ethics from the University of Toronto. He served as the Executive Director of the CMA’s Office of Ethics, Professionalism and International Affairs and has been the interim Director of Ethics for the World Medical Association in Geneva. In an interview on February 11th, Dr. Blackmer kindly agreed to help us navigate through an array of ethical and practical ramifications stemming from the decision on Carter v. Canada.

Introduction: Atrial Fibrillation (AF) is a common arrhythmia but its pathogenesis remains incompletely understood. Alterations in metabolism may play a role. 18F-fluorodeoxyglucose (FDG) PET reflects glucose uptake in metabolically active tissue but studies evaluating the relationship between atrial FDG uptake and atrial fibrillation are limited. Hypothesis: We hypothesized that patients with ischemic cardiomyopathy who have had AF have increased atrial wall FDG uptake compared to patients without AF (no-AF). Methods: Atrial uptake was assessed visually and quantitatively on FDG-PET/CT images in 42 patients (24 AF, 18 no-AF). The maximum and mean FDG Standard Uptake Value (SUV) in the left atrium (LA), right atrium (RA) and mean blood pool activity were measured (see figure). The Tissue:Blood ratio (TBR) was calculated using the maximum atrial wall SUV (TBRmax) and mean SUV (TBRmean). Results: Median age was 72 years; (78% male). Mean LVEF was similar between AF vs. No-AF patients (24+/-10% vs. 26+/-11%, p=0.57). The RA was visualized in 88% of AF and 44% of no-AF patients (p=0.002). The LA was visualized in 88% of AF and 72% of no-AF patients (p=0.22). See table for TBR results. TBRmax and TBRmean were significantly increased in the RA wall of patients with AF vs. no-AF. There was a trend for increased FDG in the LA wall of AF patients. Conclusion: Among patients with ischemic cardiomyopathy, significantly greater FDG uptake was noted in the RA of patients with AF vs. No-AF (with a trend for LA uptake). These findings suggest increased glucose metabolism in the atria in patients with AF. Further study is warranted to determine the clinical and biological significance of these findings.

No abstract