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Hastening Death in Canadian ICUs: End-of-Life Care in the Era of Medical Assistance in Dying*
Critical Care Medicine ( IF 8.8 ) Pub Date : 2022-05-01 , DOI: 10.1097/ccm.0000000000005359
Sarah K Andersen 1 , Samuel Stewart 1, 2 , Brendan Leier 3 , Lynn E Alden 3 , Derek R Townsend 1 , Daniel Garros 1, 2, 3, 4, 5
Affiliation  

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.



中文翻译:

加拿大重症监护室加速死亡:临终医疗援助时代的临终关怀*

目标: 

自 2016 年以来,加拿大在死亡立法中根据联邦医疗援助的严格标准允许安乐死。本研究的目的是确定加拿大重症医生如何看待临终医疗援助,以及他们是否认为在引入临终医疗援助后,他们停止生命维持治疗的方法发生了变化。

设计: 

电子调查。

环境: 

参与者是从加拿大各地的 11 个 PICU 项目和 14 个成人 ICU 项目中招募的。所有有联系信息的项目负责人都被联系以参与。

参加者: 

我们邀请 2019 年 12 月至 2020 年 5 月期间雇用的重症监护医师和重症监护实习生参与,采用滚雪球抽样技术,由部门领导分发研究信息。所有回复都是匿名的。使用描述性统计分析定量数据。使用皮尔逊卡方检验分析分类变量。

干预措施: 

不适用。

测量和主要结果: 

我们获得了 150 份完整的问卷(回复率为 33%),其中 50% 是成人从业者,50% 是儿童。大多数来自学术中心(81%,n = 121)。在受访者中,86%(n = 130)熟悉临终医疗援助立法,71% 支持,14% 反对,11% 反对。只有 5% ( n = 8) 认为这影响了他们停止维持生命治疗的方法。一半的参与者在其所在单位没有停止维持生命治疗的标准化方案,41% ( n = 62) 观察到在停止维持生命治疗期间服用了不成比例的高剂量药物,其中 13% 的人亲自服用过此类剂量。大多数人(80%,n = 120)曾经历过家人明确要求加速死亡,几乎一半(47%,n = 70)认为在停止维持生命的治疗后故意加速死亡在道德上是允许的。

结论: 

大多数接受调查的加拿大重症医生并不认为临终医疗援助改变了他们在 ICU 中临终的方式。相当少数人对加拿大目前的辅助死亡/安乐死方法存在伦理冲突。几乎一半的人认为,如果预期会死亡,在停止维持生命的治疗期间故意加速死亡是合乎道德的。

更新日期:2022-05-01
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