Résumés
Abstract
This paper deals with changes in code status policy in Ontario and endorses a new College of Physicians and Surgeons of Ontario (CPSO) policy. We argue that the recent policy changes in this area necessitate an active educational strategy around end-of-life care to prevent harm to dying patients.
Keywords:
- medical education,
- medicolegal,
- DNR,
- cardiopulmonary resuscitation,
- code status,
- health policy,
- end of life,
- palliative care
Résumé
Cet article traite des changements apportés à la politique sur le statut des codes en Ontario et soutient une nouvelle politique de l’Ordre des médecins et chirurgiens de l’Ontario (OMCO). Nous soutenons que les récents changements de politique dans ce domaine nécessitent une stratégie éducative active autour des soins de fin de vie afin de prévenir les préjudices causés aux patients mourants.
Mots-clés :
- éducation médicale,
- médico-légal,
- NPR,
- réanimation cardio-pulmonaire,
- statut du code,
- politique de santé,
- fin de vie,
- soins palliatifs
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Parties annexes
Acknowledgements / Remerciements
TA is supported by a University of Toronto Department of Family & Community Medicine Investigator Award and an AMS Healthcare Fellowship. TA, MS, & DS conceptualized the paper, TA drafted the initial manuscript, and all three authors edited and refined the manuscript and approved it before submission. The authors wish to acknowledge the generous commentaries of Drs. Jeff Myers, Anne Woods, and Jill Dombroski during the editorial process.
TA bénéficie d’une bourse de recherche du département de médecine familiale et communautaire de l’Université de Toronto et d’une bourse de santé de l’AMS. TA, MS et DS ont conceptualisé l’article, TA a rédigé le manuscrit initial, et les trois auteurs ont révisé et affiné le manuscrit et l’ont approuvé avant de le soumettre. Les auteurs souhaitent remercier les Drs Jeff Myers, Anne Woods et Jill Dombroski pour leurs généreux commentaires au cours du processus de rédaction.
Bibliography
- 1. Hall CC, Lugton J, Spiller JA, Carduff E. CPR decision-making conversations in the UK: An integrative review. BMJ Supportive & Palliative Care. 2019;9:1-11.
- 2. Bjorklund P, Lund DM. Informed consent and the aftermath of cardiopulmonary resuscitation: Ethical considerations. Nursing Ethics. 2019;26(1):84-95.
- 3. College of Physicians & Surgeons of Ontario. Planning for and Providing Quality End-of-Life Care. Sept 2015.
- 4. College of Physicians & Surgeons of Ontario. Planning for and Providing Quality End-of-Life Care. May 2016.
- 5. College of Physicians & Surgeons of Ontario. Planning for and Providing Quality End of Life Care. Sept 2019.
- 6. College of Physicians & Surgeons of Ontario. Decision-Making for End-of-Life Care. Mar 2023.
- 7. College of Physicians & Surgeons of Ontario. Draft Policy: Decision-Making for End-of-Life Care. 2022.
- 8. Downar J, Close E, Sibbald R. Do physicians require consent to withhold CPR that they determine to be nonbeneficial? CMAJ. 2019;191(47):E1289-90.
- 9. Medico-Legal Society of Toronto. Re: Policy Review: "Planning for and Providing Quality End-of-Life Care". 2021.
- 10. Landry JT, Patel R, Neilipovitz D, Kyeremanteng K, D’Egidio G. Ethical failings of CPSO policy and the health care consent act: case review. BMC Medical Ethics. 2019;20:20.
- 11. Vivas L, Carpenter T. Meaningful futility: requests for resuscitation against medical recommendation. Journal of Medical Ethics. 2021;47(10):654-56.
- 12. Downar J, Warner M, Sibbald R. Mandate to obtain consent for withholding nonbeneficial cardiopulmonary resuscitation is misguided. CMAJ. 2016;188(4):245-46.
- 13. Hawryluck L, Oczkowski SJ, Handelman M. “Must do CPR??”: strategies to cope with the new College of Physicians and Surgeons of Ontario policy on end-of-life care. Canadian Journal of Anesthesia/Journal canadien d’anesthésie. 2016;63(8):973-80.
- 14. Wawryzniak vs. Livingstone. Ontario Superior Court of Justice, ONSC 4900, 2019.
- 15. Canadian Critical Care Society. Re: The revision of the College of Physicians and Surgeons of Ontario’s (CPSO) policy on Decision-Making for End-of-Life Care. 24 Aug 2022.
- 16. Ontario Medical Association. Ontario Medical Association (OMA) Submission: College of Physicians & Surgeons of Ontario (CPSO) Policy Consultations: Decision Making for End-of-Life Care. Aug 2022.
- 17. Canadian Medical Protective Association. Re: Consultations on the Revised Decision-Making for End-of-Life Care Policy and Advice. 27 Jul 2022.
- 18. College of Physicians & Surgeons of Ontario. Advice to the Profession: End-of-Life Care. 2023.
- 19. EGJW v MGC. Ontario Health Professions Appeal and Review Board, ON HPARB 49888, 2014.
- 20. McKitty vs Hayani. Ontario Court of Appeal, ONCA 805, 2019.
- 21. MW (Re) - Humber River Hospital. Ontario Consent & Capacity Board, 2018.
- 22. College of Physicians & Surgeons of Ontario. Advice to the Profession: Planning For and Providing Quality End-of-Life Care. 2019.
- 23. Canadian Critical Care Society. Re: The revision of the College of Physicians and Surgeons of Ontario’s (CPSO) policy on Planning for and Providing Quality End of Life Care. 2021.
- 24. College of Physicians & Surgeons of Ontario. Planning for and Providing Quality End of Life Care. 2006.
- 25. Cutherbertson vs Rasouli. Supreme Court of Canada, SCC 53, 2013.
- 26. Miller, B. Nurses in the know: The history and future of advance directives. OJIN: The Online Journal of Issues in Nursing. 2017;22(3).
- 27. Shemie SD, Hornby L, Baker A, et al. International guideline development for the determination of death. Intensive Care Medicine. 2014;40:788-97.
- 28. Siems A, Tomaino E, Watson A, Spaeder MC, Su L. Improving quality in measuring time to initiation of CPR during in-hospital resuscitation. Resuscitation. 2017;118:15-20.
- 29. Wharton C, King E, MacDuff A. Frailty is associated with adverse outcome from in-hospital cardiopulmonary resuscitation. Resuscitation. 2019;143:208-11.
- 30. Ibitoye SE, Rawlinson S, Cavanagh A, Phillips V, Shipway DJH. Frailty status predicts futility of cardiopulmonary resuscitation in older adults. Age and Ageing. 2021;50(1):147-52.
- 31. McMillan J. Futility: a perennial issue for medical ethics. Journal of Medical Ethics. 2021;47(10):649.
- 32. Bandrauk N, Downar J, Paunovic B, On Behalf of the Canadian Critical Care Society Ethics. Withholding and withdrawing life-sustaining treatment: The Canadian Critical Care Society position paper. Canadian Journal of Anesthesia/Journal canadien d’anesthésie. 2018;65(1):105-22.
- 33. Beck K, Vincent A, Cam H, et al. Medical futility regarding cardiopulmonary resuscitation in in-hospital cardiac arrests of adult patients: A systematic review and Meta-analysis. Resuscitation. 2022;172:181-93.
- 34. Borenko C. Healthcare providers’ understanding of the law: Impact on advance care planning processes. Master of Health Studies, Faculty of Health Disciplines, Athabasca University. Sept 2021.
- 35. Cartwright C, Montgomery J, Rhee J, Zwar N, Banbury A. Medical practitioners’ knowledge and self‐reported practices of substitute decision making and implementation of advance care plans. Internal Medicine Journal. 2014;44(3):234-39.
- 36. Wahl J, Dykeman M, Walton T. Health Care Consent, Advance Care Planning, and Goals of Care Practice Tools: The Challenge to Getting it Right: Improving the Last Stages of Life. Law Commission of Ontario. Dec 2016.
- 37. Pereira J, Giddings G, Sauls R, Harle I, Antifeau E, Faulkner J. Navigating design options for large-scale interprofessional continuing palliative care education: Pallium Canada’s experience. Palliative Medicine Reports. 2021;2(1):226-36.
- 38. Pereira J, Chary S, Moat JB, et al. Pallium Canada’s curriculum development model: A framework to support large-scale courseware development and deployment. Journal of Palliative Medicine. 2020;23(6):759-66.
- 39. Chidwick P, Bell J, Connolly E, et al. Exploring a model role description for ethicists. HEC Forum. 2010;22:31-40.
- 40. Frolic A, Drolet K, Bryanton K, et al. Opening the black box of ethics policy work: Evaluating a covert practice. The American Journal of Bioethics. 2012;12(11):3-15.
- 41. Quill TE, Holloway R. Time-limited trials near the end of life. JAMA. 2011;306(13):1483-84.
- 42. Donaldson TM. The moral problems with time-limited trials at the end-of-life, especially when clinicians and patients have different goals. Intensive Care Medicine. 2022;48(9):1262-63.
- 43. Shrime MG, Ferket BS, Scott DJ, et al. Time-limited trials of intensive care for critically ill patients with cancer: How long is long enough? JAMA Oncology. 2016;2(1):76-83.
- 44. Vink EE, Azoulay E, Caplan A, Kompanje EJO, Bakker J. Time-limited trial of intensive care treatment: an overview of current literature. Intensive Care Medicine. 2018;44:1369-77.
- 45. Myers J, Cosby R, Gzik D, et al. Provider tools for advance care planning and goals of care discussions: A systematic review. American Journal of Hospice and Palliative Medicine. 2018;35(8):1123-32.
- 46. Myers J, Steinberg L, Seow H. Controversies about advance care planning. JAMA. 2022;327(7):685.
- 47. College of Physicians & Surgeons of Manitoba. Standard of Practice: Withholding & Withdrawing Life Sustaining Treatment. 14 Dec 2022.
- 48. College of Physicians & Surgeons of Saskatchewan. Guideline: End-of-Life Care. 28 Jan 2022.