Withholding and withdrawing treatment in Canada: implications of the Supreme Court of Canada's decision in the Rasouli case.
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ABSTRACT:
SUBMITTER: Downar J
PROVIDER: S-EPMC4216277 | biostudies-literature | 2014 Nov
REPOSITORIES: biostudies-literature
Publications
Withholding and withdrawing treatment in Canada: implications of the Supreme Court of Canada's decision in the Rasouli case.
Downar James J Sibbald Robert W RW Bailey Tracey M TM Kavanagh Brian P BP
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne 20140623 16
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Project description:BackgroundDecisions of withholding or withdrawing life sustaining-treatments in emergency department are part of current practice but the decision-making process remains poorly described in the literature.Study objectiveWe conducted a study in two phases, the first comprising a retrospective chart review study of patients dying in the ED and the second comprising survey study of health care workers at 10 urban emergency departments in France.MethodIn a first step, we analyzed medical records based on fifteen criteria of the decision-making process grouped into four categories: the collegiality, the traceability, the management and the communication as recommended by the international guidelines. In a second step, we conducted an auto-administrated survey to assess how the staff members (medical, paramedical) feel with the decision-making process.ResultsThere were 273 deaths which occurred in the ED over the study period and we included 145 (53.1%) patients. The first-step analysis revealed that the traceability of the decision and the information given to patient or the relatives were the most reported points according to the recommendations. Three of the ten emergency departments had developed a written procedure. The collegial discussion and the traceability of the prognosis assessment were significantly increased in emergency department with a written procedure as well as management of pain, comfort care, and the communication with the patient or the relatives. In the second-step analysis, among the 735 staff members asked to take part in the survey, 287 (39.0%) answered. The medical and paramedical staff expressed difficult experience regarding the announcement and the communication with the patient and the relatives.ConclusionThe management of the decision to withhold or withdraw life-sustaining treatments must be improved in emergency departments according to the guidelines. A standard written procedure could be useful in clinical practice despite the lack of experienced difference between centers with and without procedures.
| S-EPMC7282105 | biostudies-literature
Project description:ObjectiveTo identify sociodemographic and clinical factors associated with withholding or withdrawing life-sustaining treatment (WWLST) for extremely low gestational age neonates.DesignObservational study of prospectively collected registry data from 19 National Institute of Child Health and Human Development Neonatal Research Network centres on neonates born at 22-28 weeks gestation who died >12 hours through 120 days of age during 2011-2016. Sociodemographic and clinical factors were compared between infants who died following WWLST and without WWLST.ResultsOf 1168 deaths, 67.1% occurred following WWLST. Withdrawal of assisted ventilation (97.4%) was the primary modality. WWLST rates were inversely proportional to gestational age. Life-sustaining treatment was withheld or withdrawn more often for non-Hispanic white infants than for non-Hispanic black infants (72.7% vs 60.4%; 95% CI 1.00 to 1.92) or Hispanic infants (72.7% vs 67.2%; 95% CI 1.32 to 3.72). WWLST rates varied across centres (38.6-92.6%; p<0.001). The centre with the highest rate had adjusted odds 4.89 times greater than the average (95% CI 1.18 to 20.18). The adjusted odds of WWLST were higher for infants with necrotiing enterocolitis (OR 1.77, 95% CI 1.21 to 2.59) and severe brain injury (OR 1.98, 95% CI 1.44 to 2.74).ConclusionsAmong infants who died, WWLST rates varied widely across centres and were associated with gestational age, race, ethnicity, necrotiing enterocolitis, and severe brain injury. Further exploration is needed into how race, centre, and approaches to care of infants with necrotiing enterocolitis and severe brain injury influence WWLST.
| S-EPMC8055718 | biostudies-literature
Project description:Previous studies suggest a significant role of language in the court room, yet none has identified a definitive correlation between vocal characteristics and court outcomes. This paper demonstrates that voice-based snap judgments based solely on the introductory sentence of lawyers arguing in front of the Supreme Court of the United States predict outcomes in the Court. In this study, participants rated the opening statement of male advocates arguing before the Supreme Court between 1998 and 2012 in terms of masculinity, attractiveness, confidence, intelligence, trustworthiness, and aggressiveness. We found significant correlation between vocal characteristics and court outcomes and the correlation is specific to perceived masculinity even when judgment of masculinity is based only on less than three seconds of exposure to a lawyer's speech sample. Specifically, male advocates are more likely to win when they are perceived as less masculine. No other personality dimension predicts court outcomes. While this study does not aim to establish any causal connections, our findings suggest that vocal characteristics may be relevant in even as solemn a setting as the Supreme Court of the United States.
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Project description:Palliative sedation (PS) is the use of medications to induce decreased or absent awareness in order to relieve otherwise intractable suffering at the end of life. Although uncommon, some patients undergoing aggressive symptom control measures still have severe suffering from underlying disease or therapy-related adverse effects. In these circumstances, use of PS is considered. Although the goal is to provide relief in an ethically acceptable way to the patient, family, and health care team, health care professionals often voice concerns whether such treatment is necessary or whether such treatment equates to physician-assisted suicide or euthanasia. In this review, we frame clinical scenarios in which PS may be considered, summarize the ethical underpinnings of the practice, and further differentiate PS from other forms of end-of-life care, including withholding and/or withdrawing life-sustaining therapy and physician-assisted suicide and euthanasia.
| S-EPMC2947968 | biostudies-literature
Project description:It has been widely argued among researchers that the application of big data analytics promises to reduce human bias and provide a scientific and evidence-based approach to the judicial process. In this dataset, historical data consisting of appeal cases presented at the Supreme Court of Nigeria (SCN) were collected from an online repository (Primsol Law Pavillion). A total of 5585 appeal cases brought before the SCN were collected from the archive. The dataset consisted of both criminal and civil appeal cases brought before the SCN. Variables that are related to court case proceedings were identified from related literature, verified by legal experts and used as a basis for generating an electronic structured version of the dataset stored as a spreadsheet file from the unstructured data. From the collected data, thirteen input variables were identified with one output/decision variable. The distribution of the numerical variables was presented as a descriptive statistical summary in terms of the minimum, maximum, mode, mean and standard deviation. The developed dataset can assist researchers to build predictive systems by training their models. Various feature extraction techniques can also be applied on the dataset to remove irrelevant or redundant features for increased performance of such classifiers that are needed to predict the outcome of legal cases.
| S-EPMC10425661 | biostudies-literature
Project description:BackgroundWith paediatric patients, deciding whether to withhold/withdraw life-sustaining treatments (LST) at the end of life is difficult and ethically sensitive. Little is understood about how and why physicians decide on withholding/withdrawing LST at the end of life in paediatric patients. In this study, we aimed to synthesise results from the literature on physicians' perceptions about decision-making when dealing with withholding/withdrawing life-sustaining treatments in paediatric patients.MethodsWe conducted a systematic review of empirical qualitative studies. Five electronic databases (Pubmed, Cinahl®, Embase®, Scopus®, Web of Science™) were exhaustively searched in order to identify articles published in English from inception through March 17, 2021. Analysis and synthesis were guided by the Qualitative Analysis Guide of Leuven.ResultsThirty publications met our criteria and were included for analysis. Overall, we found that physicians agreed to involve parents, and to a lesser extent, children in the decision-making process about withholding/withdrawing LST. Our analysis to identify conceptual schemes revealed that physicians divided their decision-making into three stages: (1) early preparation via advance care planning, (2) information giving and receiving, and (3) arriving at the final decision. Physicians considered advocating for the best interests of the child and of the parents as their major focus. We also identified moderating factors of decision-making, such as facilitators and barriers, specifically those related to physicians and parents that influenced physicians' decision-making.ConclusionsBy focusing on stakeholders, structure of the decision-making process, ethical values, and influencing factors, our analysis showed that physicians generally agreed to share the decision-making with parents and the child, especially for adolescents. Further research is required to better understand how to minimise the negative impact of barriers on the decision-making process (e.g., difficult involvement of children, lack of paediatric palliative care expertise, conflict with parents).
| S-EPMC9229823 | biostudies-literature
Project description: Not available
| S-EPMC10370256 | biostudies-literature
Project description:ObjectiveTo predict take-up of private health insurance and Medicaid following the U.S. Supreme Court decision upholding the Affordable Care Act (ACA).Data sourcesData came from three large employers and a sampling of premiums from ehealthinsurance.com. We supplemented the employer data with information on state Medicaid eligibility and costs from the Kaiser Family Foundation. National predictions were based on the MEPS Household Component.Study designWe estimated a conditional logit model of health plan choice in the large group market. Using the coefficients from the choice model, we predicted take-up in the group and individual health insurance markets. Following ACA implementation, we added choices to the individual market corresponding to plans that will be available in state and federal exchanges. Depending on eligibility for premium subsidies, we reduced the out-of-pocket premiums for those choices. We simulated several possible patterns for states opting out of the Medicaid expansion, as allowed by the Supreme Court.Principal findingsThe ACA will increase coverage substantially in the private insurance market and Medicaid. HSAs will remain desirable in both the individual and employer markets.ConclusionsIf states opt out of the Medicaid expansion, this could increase the federal cost of health reform, while reducing the number of newly covered lives.
| S-EPMC3626326 | biostudies-literature
Project description:BackgroundDecisions of withholding or withdrawing life-sustaining treatment are frequent in emergency departments (ED) and patients are often unable to communicate their wishes concerning end of life desires.ObjectiveTo evaluate the participation of general practitioners (GPs) during the decision-making process of withholding or withdrawing life-sustaining treatments in ED.DesignProspective observational multicenter study.PatientsWe included patients for whom a decision of withdrawing or withholding life-sustaining treatments was made in ED. For each patient, we enrolled one general practitioner.Main measuresGPs were interviewed about their perception of end of life patient's management and the communication with ED and families.Key resultsThere were 109 potential patient participants. We obtained answers from 54 (49.5%) of the patient's associated GPs. Only 4 (7.4%) GPs were involved during the decision-making process of withholding or withdrawing life-sustaining treatments. Among GPs, 29 (53.7%) were contacted by family after the decision, most often to talk about their difficult experience with the decision. A majority (94%) believed their involvements in these decisions were important and 68% wished to "always" participate in end of life decisions despite the fact that they usually don't participate in these decisions. Finally, 66% of GPs believed that management of end of life in the emergency department was a failure and should be anticipated.ConclusionsGPs would like to be more involved and barriers to GP involvement need to be overcome. We do not have any outcome data to suggest that routine involvement of GPs in all end of life patients improves their outcomes. Moreover, it requires major system and process-based changes to involve all primary care physicians in ED decision-making.Nih trial registry numberNCT02844972.
| S-EPMC6957665 | biostudies-literature
Project description:BackgroundThe use of policies in medical treatment reimbursement decisions, in which only future patients are affected, prompts a moral dilemma: is there an ethical difference between withdrawing and withholding treatment?DesignThrough a preregistered behavioral experiment involving 1,067 participants, we tested variations in public attitudes concerning withdrawing and withholding treatments at both the bedside and policy levels.ResultsIn line with our first hypothesis, participants were more supportive of rationing decisions presented as withholding treatments compared with withdrawing treatments. Contrary to our second prestated hypothesis, participants were more supportive of decisions to withdraw treatment made at the bedside level compared with similar decisions made at the policy level.ImplicationsOur findings provide behavioral insights that help explain the common use of policies affecting only future patients in medical reimbursement decisions, despite normative concerns of such policies. In addition, our results may have implications for communication strategies when making decisions regarding treatment reimbursement.HighlightsWe explore public' attitudes toward withdrawing and withholding treatments and how the decision level (bedside or policy level) matters.People were more supportive of withholding medical treatment than of withdrawing equivalent treatment.People were more supportive of treatment withdrawal made at the bedside than at the policy level.Our findings help clarify why common-use policies, which impact only future patients in medical reimbursement decision, are implemented despite the normative concerns associted with thesepolicies.
| S-EPMC11346081 | biostudies-literature