Hastening Death in Canadian ICUs: End-of-Life Care in the
Era of Medical Assistance in Dying*
Andersen, Sarah K.; Stewart, Samuel; Leier, Brendan; Alden,
Lynn E.; Townsend, Derek R.; Garros, Daniel
Critical Care Medicine: May 2022 -
Volume 50 - Issue 5 - p 742-749
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.
