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Andersen SK, Stewart S, Leier B, et al. Hastening Death in Canadian ICUs: End-of-Life Care in the Era of Medical Assistance in Dying. Crit Care Med. 2021;doi: 10.1097/CCM.0000000000005359.
Andersen, S. K., Stewart, S., Leier, B., Alden, L. E., Townsend, D. R., & Garros, D. (2021). Hastening Death in Canadian ICUs: End-of-Life Care in the Era of Medical Assistance in Dying. Critical care medicine, . https://doi.org/10.1097/CCM.0000000000005359
Andersen, Sarah K, et al. "Hastening Death in Canadian ICUs: End-of-Life Care in the Era of Medical Assistance in Dying." Critical care medicine vol. (2021). doi: https://doi.org/10.1097/CCM.0000000000005359
Andersen SK, Stewart S, Leier B, Alden LE, Townsend DR, Garros D. Hastening Death in Canadian ICUs: End-of-Life Care in the Era of Medical Assistance in Dying. Crit Care Med. 2021 Oct 04; doi: 10.1097/CCM.0000000000005359. Epub 2021 Oct 04. PMID: 34605780.
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Crit Care Med. 2021 Oct 04; doi: 10.1097/CCM.0000000000005359. Epub 2021 Oct 04.

Hastening Death in Canadian ICUs: End-of-Life Care in the Era of Medical Assistance in Dying.

Critical care medicine

Sarah K Andersen, Samuel Stewart, Brendan Leier, Lynn E Alden, Derek R Townsend, Daniel Garros

Affiliations

  1. Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada. Alberta Health Services, Edmonton, AB, Canada. Division of Pediatric Critical Care, Department of Pediatrics, University of Alberta, Edmonton Clinic Health Academy, Edmonton, AB, Canada. Dossetor Health Ethics Center, University of Alberta, Edmonton, AB, Canada. Department of Psychology, University of British Columbia, Vancouver, BC, Canada.

PMID: 34605780 DOI: 10.1097/CCM.0000000000005359

Abstract

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.

Copyright © by 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

Conflict of interest statement

The authors have disclosed that they do not have any potential conflicts of interest.

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