Requests for somatic support after neurologic death determination: Canadian physician experiences
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REPORTS OF ORIGINAL INVESTIGATIONS
Requests for somatic support after neurologic death determination: Canadian physician experiences Demandes de soutien des fonctions vitales apre`s un diagnostic de de´ce`s neurologique : les expe´riences des me´decins canadiens . Andrew Healey, MD . Jennifer Chandler, LLM . Amanda van Beinum, MSc Sonny Dhanani, MD . Michael Hartwick, MD, MEd . Ariane Lewis, MD . Calista Marshall, BSc . Jocasta Marshall, LLB . Sam Shemie, MD . Jeffrey M. Singh, MD, MSc Received: 5 July 2020 / Revised: 24 August 2020 / Accepted: 28 August 2020 Canadian Anesthesiologists’ Society 2020
Abstract Purpose Neurologic determination of death (NDD) is legally accepted as death in Canada but remains susceptible to misunderstandings. In some cases, families request continued organ support after NDD. Conflicts can escalate to formal legal challenges, causing emotional, financial, and moral distress for all involved. We describe prevalence, characteristics, and common experiences with requests for continued organ support following NDD in Canada.
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12630-020-01852-9) contains supplementary material, which is available to authorized users. A. van Beinum, MSc (&) Department of Sociology and Anthropology, Carleton University, B750 Loeb Building, 1125 Colonel By Drive, Ottawa, ON K1S 5B6, Canada e-mail: [email protected] A. Healey, MD Critical Care, William Osler Health System, Brampton, ON, Canada Division of Emergency Medicine, McMaster University, Hamilton, ON, Canada J. Chandler, LLM Centre for Health Law, Policy and Ethics, Faculty of Law, University of Ottawa, Ottawa, ON, Canada S. Dhanani, MD Department of Critical Care, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
Methods Mixed-methods design combining anonymous online survey with semi-structured interviews of Canadian critical care physicians (448 practitioners, adult and pediatric). Results One hundred and six physicians responded to the survey and 12 participated in an interview. Fifty-two percent (55/106) of respondents had encountered a request for continued organ support after NDD within two years, 47% (26/55) of which involved threat of legal action. Requests for continued support following NDD ranged from appeals for time for family to gather before ventilator removal to disagreement with the concept of NDD. Common responses to requests included: consultation with an additional physician (54%), consultation with M. Hartwick, MD, MEd Department of Medicine, University of Ottawa, Ottawa, ON, Canada Divisions of Critical Care and Palliative Medicine, The Ottawa Hospital, Ottawa, ON, Canada A. Lewis, MD Departments of Neurology and Neurosurgery, Affiliate of the Department of Population Health-Division of Medical Ethics, NYU Langone Medical Center, New York, NY, USA C. Marshall, BSc Royal College of Surgeons, Dublin, Ireland J. Marshall, LLB St. George’s University School of Medicine, St. George’s, Grenada
Faculty of Medicine, Unive
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