Hospital policies on life-sustaining treatments and advance directives in Canada

I. Rasooly, J. V. Lavery, S. Urowitz, S. Choudhry, N. Seeman, E. M. Meslin, F. H. Lowy, P. A. Singer

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Objective: To determine the prevalence and content of hospital policies on life-sustaining treatments (cardiopulmonary resuscitation [CPR], mechanical ventilation, dialysis, artificial nutrition and hydration, and antibiotic therapy for life-threatening infections) and advance directives in Canada. Design: Cross-sectional mailed survey. Setting: Canada. Participants: Chief executive officers or their designates at public general hospitals. Main outcome measures: Information regarding the existence of policies on life-sustaining treatments or advance directives and the content of the policies. Results: Questionnaires were completed for 697 (79.2%) of the 880 hospitals surveyed. Of the 697 respondents 362 (51.9%) sent 388 policies; 355 (50.9%%) sent do-not-resuscitate (DNR) policies (i.e., policies that addressed CPR alone or in combination with other life-sustaining treatments). Of the 388 policies 327 (84.3%) addressed CPR alone, 28 (7.2%) addressed CPR plus other life-sustaining treatments, 10 (2.6%) addressed advance directives, and the remaining 23 (5.9%) addressed other life-sustaining treatments. Of the 355 DNR policies 1 (0.3%) stated that routine discussion with patients is required. 315 (88.7%) restricted their scope to terminally or hopelessly ill patients, 187 (52.7%) mentioned futility, 29 (8.2%) mentioned conflict resolution, 9 (2.5%) and 13 (3.7%) required explicit communication of the decision to the competent patient or family of the incompetent patient respectively, 110 (31.0%) authorized the family of an incompetent patient to rescind the DNR order, 224 (63.1%) authorized the nursing staff to do so, and 217 (61.1%) authorized physicians to do so. Conclusions: Although about half of the public general hospitals surveyed had DNR policies few had policies regarding other life-sustaining treatments or advance directives. Existing policies could be improved if hospitals encouraged routine advance discussions, removed the restriction to terminally or hopelessly ill patients, scrutinized the use of the futility standard, stipulated procedures for conflict resolution, explicitly required communication of the decision to competent patients or substitute decision-makers of incompetent patients and scrutinized the provision allowing families and health care professionals to rescind the wishes of now incompetent patients.

Original languageEnglish (US)
Pages (from-to)1265-1270
Number of pages6
JournalCanadian Medical Association Journal
Volume150
Issue number8
StatePublished - 1994
Externally publishedYes

Fingerprint

Advance Directives
Canada
Cardiopulmonary Resuscitation
Therapeutics
Medical Futility
Public Hospitals
Negotiating
General Hospitals
Communication
Resuscitation Orders
Family Health
Nursing Staff
Artificial Respiration
Dialysis
Cross-Sectional Studies
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Rasooly, I., Lavery, J. V., Urowitz, S., Choudhry, S., Seeman, N., Meslin, E. M., ... Singer, P. A. (1994). Hospital policies on life-sustaining treatments and advance directives in Canada. Canadian Medical Association Journal, 150(8), 1265-1270.

Hospital policies on life-sustaining treatments and advance directives in Canada. / Rasooly, I.; Lavery, J. V.; Urowitz, S.; Choudhry, S.; Seeman, N.; Meslin, E. M.; Lowy, F. H.; Singer, P. A.

In: Canadian Medical Association Journal, Vol. 150, No. 8, 1994, p. 1265-1270.

Research output: Contribution to journalArticle

Rasooly, I, Lavery, JV, Urowitz, S, Choudhry, S, Seeman, N, Meslin, EM, Lowy, FH & Singer, PA 1994, 'Hospital policies on life-sustaining treatments and advance directives in Canada', Canadian Medical Association Journal, vol. 150, no. 8, pp. 1265-1270.
Rasooly I, Lavery JV, Urowitz S, Choudhry S, Seeman N, Meslin EM et al. Hospital policies on life-sustaining treatments and advance directives in Canada. Canadian Medical Association Journal. 1994;150(8):1265-1270.
Rasooly, I. ; Lavery, J. V. ; Urowitz, S. ; Choudhry, S. ; Seeman, N. ; Meslin, E. M. ; Lowy, F. H. ; Singer, P. A. / Hospital policies on life-sustaining treatments and advance directives in Canada. In: Canadian Medical Association Journal. 1994 ; Vol. 150, No. 8. pp. 1265-1270.
@article{6ad6581f437e4a52947e49903dc96f9c,
title = "Hospital policies on life-sustaining treatments and advance directives in Canada",
abstract = "Objective: To determine the prevalence and content of hospital policies on life-sustaining treatments (cardiopulmonary resuscitation [CPR], mechanical ventilation, dialysis, artificial nutrition and hydration, and antibiotic therapy for life-threatening infections) and advance directives in Canada. Design: Cross-sectional mailed survey. Setting: Canada. Participants: Chief executive officers or their designates at public general hospitals. Main outcome measures: Information regarding the existence of policies on life-sustaining treatments or advance directives and the content of the policies. Results: Questionnaires were completed for 697 (79.2{\%}) of the 880 hospitals surveyed. Of the 697 respondents 362 (51.9{\%}) sent 388 policies; 355 (50.9{\%}{\%}) sent do-not-resuscitate (DNR) policies (i.e., policies that addressed CPR alone or in combination with other life-sustaining treatments). Of the 388 policies 327 (84.3{\%}) addressed CPR alone, 28 (7.2{\%}) addressed CPR plus other life-sustaining treatments, 10 (2.6{\%}) addressed advance directives, and the remaining 23 (5.9{\%}) addressed other life-sustaining treatments. Of the 355 DNR policies 1 (0.3{\%}) stated that routine discussion with patients is required. 315 (88.7{\%}) restricted their scope to terminally or hopelessly ill patients, 187 (52.7{\%}) mentioned futility, 29 (8.2{\%}) mentioned conflict resolution, 9 (2.5{\%}) and 13 (3.7{\%}) required explicit communication of the decision to the competent patient or family of the incompetent patient respectively, 110 (31.0{\%}) authorized the family of an incompetent patient to rescind the DNR order, 224 (63.1{\%}) authorized the nursing staff to do so, and 217 (61.1{\%}) authorized physicians to do so. Conclusions: Although about half of the public general hospitals surveyed had DNR policies few had policies regarding other life-sustaining treatments or advance directives. Existing policies could be improved if hospitals encouraged routine advance discussions, removed the restriction to terminally or hopelessly ill patients, scrutinized the use of the futility standard, stipulated procedures for conflict resolution, explicitly required communication of the decision to competent patients or substitute decision-makers of incompetent patients and scrutinized the provision allowing families and health care professionals to rescind the wishes of now incompetent patients.",
author = "I. Rasooly and Lavery, {J. V.} and S. Urowitz and S. Choudhry and N. Seeman and Meslin, {E. M.} and Lowy, {F. H.} and Singer, {P. A.}",
year = "1994",
language = "English (US)",
volume = "150",
pages = "1265--1270",
journal = "CMAJ",
issn = "0008-4409",
publisher = "Canadian Medical Association",
number = "8",

}

TY - JOUR

T1 - Hospital policies on life-sustaining treatments and advance directives in Canada

AU - Rasooly, I.

AU - Lavery, J. V.

AU - Urowitz, S.

AU - Choudhry, S.

AU - Seeman, N.

AU - Meslin, E. M.

AU - Lowy, F. H.

AU - Singer, P. A.

PY - 1994

Y1 - 1994

N2 - Objective: To determine the prevalence and content of hospital policies on life-sustaining treatments (cardiopulmonary resuscitation [CPR], mechanical ventilation, dialysis, artificial nutrition and hydration, and antibiotic therapy for life-threatening infections) and advance directives in Canada. Design: Cross-sectional mailed survey. Setting: Canada. Participants: Chief executive officers or their designates at public general hospitals. Main outcome measures: Information regarding the existence of policies on life-sustaining treatments or advance directives and the content of the policies. Results: Questionnaires were completed for 697 (79.2%) of the 880 hospitals surveyed. Of the 697 respondents 362 (51.9%) sent 388 policies; 355 (50.9%%) sent do-not-resuscitate (DNR) policies (i.e., policies that addressed CPR alone or in combination with other life-sustaining treatments). Of the 388 policies 327 (84.3%) addressed CPR alone, 28 (7.2%) addressed CPR plus other life-sustaining treatments, 10 (2.6%) addressed advance directives, and the remaining 23 (5.9%) addressed other life-sustaining treatments. Of the 355 DNR policies 1 (0.3%) stated that routine discussion with patients is required. 315 (88.7%) restricted their scope to terminally or hopelessly ill patients, 187 (52.7%) mentioned futility, 29 (8.2%) mentioned conflict resolution, 9 (2.5%) and 13 (3.7%) required explicit communication of the decision to the competent patient or family of the incompetent patient respectively, 110 (31.0%) authorized the family of an incompetent patient to rescind the DNR order, 224 (63.1%) authorized the nursing staff to do so, and 217 (61.1%) authorized physicians to do so. Conclusions: Although about half of the public general hospitals surveyed had DNR policies few had policies regarding other life-sustaining treatments or advance directives. Existing policies could be improved if hospitals encouraged routine advance discussions, removed the restriction to terminally or hopelessly ill patients, scrutinized the use of the futility standard, stipulated procedures for conflict resolution, explicitly required communication of the decision to competent patients or substitute decision-makers of incompetent patients and scrutinized the provision allowing families and health care professionals to rescind the wishes of now incompetent patients.

AB - Objective: To determine the prevalence and content of hospital policies on life-sustaining treatments (cardiopulmonary resuscitation [CPR], mechanical ventilation, dialysis, artificial nutrition and hydration, and antibiotic therapy for life-threatening infections) and advance directives in Canada. Design: Cross-sectional mailed survey. Setting: Canada. Participants: Chief executive officers or their designates at public general hospitals. Main outcome measures: Information regarding the existence of policies on life-sustaining treatments or advance directives and the content of the policies. Results: Questionnaires were completed for 697 (79.2%) of the 880 hospitals surveyed. Of the 697 respondents 362 (51.9%) sent 388 policies; 355 (50.9%%) sent do-not-resuscitate (DNR) policies (i.e., policies that addressed CPR alone or in combination with other life-sustaining treatments). Of the 388 policies 327 (84.3%) addressed CPR alone, 28 (7.2%) addressed CPR plus other life-sustaining treatments, 10 (2.6%) addressed advance directives, and the remaining 23 (5.9%) addressed other life-sustaining treatments. Of the 355 DNR policies 1 (0.3%) stated that routine discussion with patients is required. 315 (88.7%) restricted their scope to terminally or hopelessly ill patients, 187 (52.7%) mentioned futility, 29 (8.2%) mentioned conflict resolution, 9 (2.5%) and 13 (3.7%) required explicit communication of the decision to the competent patient or family of the incompetent patient respectively, 110 (31.0%) authorized the family of an incompetent patient to rescind the DNR order, 224 (63.1%) authorized the nursing staff to do so, and 217 (61.1%) authorized physicians to do so. Conclusions: Although about half of the public general hospitals surveyed had DNR policies few had policies regarding other life-sustaining treatments or advance directives. Existing policies could be improved if hospitals encouraged routine advance discussions, removed the restriction to terminally or hopelessly ill patients, scrutinized the use of the futility standard, stipulated procedures for conflict resolution, explicitly required communication of the decision to competent patients or substitute decision-makers of incompetent patients and scrutinized the provision allowing families and health care professionals to rescind the wishes of now incompetent patients.

UR - http://www.scopus.com/inward/record.url?scp=0028237390&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0028237390&partnerID=8YFLogxK

M3 - Article

VL - 150

SP - 1265

EP - 1270

JO - CMAJ

JF - CMAJ

SN - 0008-4409

IS - 8

ER -