The impact of the Rasouli decision: a Survey of Canadian intensivists

Cape, D B; Fox‐Robichaud, Alison; Turgeon, Alexis F.; Seely, Andrew J. E.; Hall, Richard; Burns, Karen E. A.; Singal, Rohit K.; Dodek, Peter; Bagshaw, Sean M.; Sibbald, Robert; Downar, James

doi:10.1136/medethics-2015-102856

Cited by 11 publications

(6 citation statements)

References 16 publications

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“…The lack of documentation of value considerations concerns us and will be followed up. In Canada, the legal requirement for consent from families for patients without a decision-making capacity differs from the Norwegian legislation and may explain differences in chart documentation practices [41]. …”

Section: Discussionmentioning

confidence: 99%

Treatment-limiting decisions in patients with severe traumatic brain injury in a Norwegian regional trauma center

Robertsen

Førde

Skaga

et al. 2017

Scand J Trauma Resusc Emerg Med

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BackgroundTreatment-limiting decisions (TLD) for severe traumatic brain injury (sTBI) have been sparsely studied. This study determine prevalence, main reason for, categories and timing of TLDs in a Norwegian regional trauma setting.MethodsA retrospective study of a 2-year cohort of 579 sTBI patients admitted to Oslo University Hospital (OUH). Prospectively collected data in the OUH Trauma Registry were combined with retrospective data from a chart review regarding TLDs.ResultsTLDs were documented for 101/579 sTBI patients (17%). The situation was evaluated as futile in 59 cases and as potentially inappropriate in 42 cases. The three most frequent types of TLDs were withholding of neurosurgery, do not resuscitate orders and withdrawing of organ support. In 70% of cases, the first TLD was made within 2 days after injury, while in 14%, the first TLD was made later than day 7. Twenty percent (20/101) of the first TLDs were later adjusted, revoked in 4 patients and broadening of TLDs in 16 patients. The median time from the decision to death was 2 days (range 1–652). TLDs were documented in 93% of in-hospital death cases (n = 79). In-hospital deaths occurred in 73% of TLD group cases and 1% of non-TLD group cases. Family interaction and multi-team discussions were documented in >88% of cases, but no advanced directives were found, and notifications of patients’ preferences were found in only 7% of cases.DiscussionClinicians should consider limiting treatment if continued treatment is not in the patients best interest. A range of different types of TLDs were applied for patients after sTBI in the trauma hospital setting.ConclusionTLDs were found in 17% of sTBI patients. Value considerations behind TLDs in this care context need to be further explored.

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Section: Discussionmentioning

confidence: 99%

Treatment-limiting decisions in patients with severe traumatic brain injury in a Norwegian regional trauma center

Robertsen

Førde

Skaga

et al. 2017

Scand J Trauma Resusc Emerg Med

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“…In South Korea, passage of the “well-dying law” was associated with an improvement in the quality of death and dying in South Korean intensive care units (ICUs) as perceived by ICU clinicians . In Canada, the 2013 Supreme Court decision in Cuthbertson v Rasouli deemed the consent of the patient or substitute decision maker mandatory in certain circumstances to withdraw life support . A study using clinical vignettes to compare care choices of Canadian ICU physicians prior to and after the ruling demonstrated that after the Rasouli decision, physicians shifted to choosing courses of treatment that were of higher intensity and less “appropriate” (based on their subjective characterization) .…”

Section: Discussionmentioning

confidence: 99%

“…38 In Canada, the 2013 Supreme Court decision in Cuthbertson v Rasouli deemed the consent of the patient or substitute decision maker mandatory in certain circumstances to withdraw life support. 39,40 A study using clinical vignettes to compare care choices of Canadian ICU physicians prior to and after the ruling demonstrated that after the Rasouli decision, physicians shifted to choosing courses of treatment that were of higher intensity and less "appropriate" (based on their subjective characterization). 39 However, passage of a law also does not necessarily lead to the desired change in individual behavior.…”

Section: Relative Risk (95% Ci)mentioning

confidence: 99%

“…39,40 A study using clinical vignettes to compare care choices of Canadian ICU physicians prior to and after the ruling demonstrated that after the Rasouli decision, physicians shifted to choosing courses of treatment that were of higher intensity and less "appropriate" (based on their subjective characterization). 39 However, passage of a law also does not necessarily lead to the desired change in individual behavior. A vignette study examining Australian acute care medical specialists' care choices in light of laws concerning withholding and withdrawing life-sustaining treatment from adults who lack decisional capacity found that clinician choices were often not legally compliant.…”

Section: Relative Risk (95% Ci)mentioning

confidence: 99%

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Place of Death From Cancer in US States With vs Without Palliative Care Laws

et al. 2023

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ImportanceIn the US, improving end-of-life care has become increasingly urgent. Some states have enacted legislation intended to facilitate palliative care delivery for seriously ill patients, but it is unknown whether these laws have any measurable consequences for patient outcomes.ObjectiveTo determine whether US state palliative care legislation is associated with place of death from cancer.Design, Setting, and ParticipantsThis cohort study with a difference-in-differences analysis used information about state legislation combined with death certificate data for 50 US states (from January 1, 2005, to December 31, 2017) for all decedents who had any type of cancer listed as the underlying cause of death. Data analysis for this study occurred between September 1, 2021, and August 31, 2022.ExposuresPresence of a nonprescriptive (relating to palliative and end-of-life care without prescribing particular clinician actions) or prescriptive (requiring clinicians to offer patients information about care options) palliative care law in the state-year where death occurred.Main Outcomes and MeasuresMultilevel relative risk regression with state modeled as a random effect was used to estimate the likelihood of dying at home or hospice for decedents dying in state-years with a palliative care law compared with decedents dying in state-years without such laws.ResultsThis study included 7 547 907 individuals with cancer as the underlying cause of death. Their mean (SD) age was 71 (14) years, and 3 609 146 were women (47.8%). In terms of race and ethnicity, the majority of decedents were White (85.6%) and non-Hispanic (94.1%). During the study period, 553 state-years (85.1%) had no palliative care law, 60 state-years (9.2%) had a nonprescriptive palliative care law, and 37 state-years (5.7%) had a prescriptive palliative care law. A total of 3 780 918 individuals (50.1%) died at home or in hospice. Most decedents (70.8%) died in state-years without a palliative care law, while 15.7% died in state-years with a nonprescriptive law and 13.5% died in state-years with a prescriptive law. Compared with state-years without a palliative care law, the likelihood of dying at home or in hospice was 12% higher for decedents in state-years with a nonprescriptive palliative care law (relative risk, 1.12 [95% CI 1.08-1.16]) and 18% higher for decedents in state-years with a prescriptive palliative care law (relative risk, 1.18 [95% CI, 1.11-1.26]).Conclusions and RelevanceIn this cohort study of decedents from cancer, state palliative care laws were associated with an increased likelihood of dying at home or in hospice. Passage of state palliative care legislation may be an effective policy intervention to increase the number of seriously ill patients who experience their death in such locations.

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“…Although the ruling rested in part on Ontario's Health Care Consent Act (HCCA), the policy of the College of Physicians and Surgeons of Ontario and hospital policies, it has implications for practice across Canada. 2 Furthermore, it emphasizes the importance of policy as part of the court's determination of the standard of care. The Wawrzyniak case also addressed the common law, which is not binding outside Ontario, but may be persuasive, especially in jurisdictions where the case law on consent is unclear.…”

mentioning

confidence: 99%

Do physicians require consent to withhold CPR that they determine to be nonbeneficial?

Downar

Sibbald

2019

CMAJ

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The impact of the Rasouli decision: a Survey of Canadian intensivists

Abstract: 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.

Cited by 11 publications

References 16 publications

Treatment-limiting decisions in patients with severe traumatic brain injury in a Norwegian regional trauma center

Treatment-limiting decisions in patients with severe traumatic brain injury in a Norwegian regional trauma center

Place of Death From Cancer in US States With vs Without Palliative Care Laws

Do physicians require consent to withhold CPR that they determine to be nonbeneficial?

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