A Canadian Academic Hospital's Initial MAID Experience: A Health-Care Systems Review.

Background:: Following the Supreme Court of Canada's Carter Decision, medical assistance in dying (MAID) became possible with individual court orders in February 2016. Subsequently, on June 17, 2016, legislation was passed that eliminated the need for court orders, essentially making physicians the arbiters of these requests. Canadian health-care facilities now face the challenge of addressing this unprecedented patient health-care need.

Managing access and flow through appropriate discharge: preventing common errors and improving processes.

Increased pressure on acute care hospitals to move patients seamlessly through the healthcare system has resulted in more attention to the process of discharging patients, particularly seniors, from hospitals. When alignment with the Health Care Consent Act is lacking, errors can occur in the process. Examples of mistakes by healthcare professionals include these: taking direction from the wrong substitute decision-maker (SDM); taking direction from a family member when the patient is capable; allowing an SDM to make an advance directive on behalf of a patient; being aware of a known prior expressed wish but ignoring that wish when considering a placement plan; waiting for an SDM who is not available, willing and capable instead of proceeding down the hierarchy of decision-makers; or permitting families to propose discharge plans.

Ethical framework for resource allocation during a drug supply shortage.

Drug supply shortages are common in health systems due to manufacturing and other delays. Frequently, shortages are successfully addressed through conservation and redistribution efforts, with limited impact on patient care. However, when Sandoz Canada Inc.

Checklist to meet ethical and legal obligations to critically ill patients at the end of life.

Despite improvements in communication, errors in end-of-life care continue to be made. For example, healthcare professionals may take direction from the wrong substitute decision-maker, or from family members when the patient is capable; permit families to propose treatment plans; conflate values and beliefs with prior expressed wishes or fail to inquire about prior expressed wishes. Sometimes healthcare professionals know what prior expressed wishes are but do not respect them; others do not believe they have enough time to have an end-of-life discussion or lack the confidence, willingness and skills to manage one.

Why do patients agree to a "Do not resuscitate" or "Full code" order? Perspectives of medical inpatients.

Background: The majority of patients who die in hospital have a "Do Not Resuscitate" (DNR) order in place at the time of their death, yet we know very little about why some patients request or agree to a DNR order, why others don't, and how they view discussions of resuscitation status.

Methods: We conducted semi-structured interviews of English-speaking medical inpatients who had clearly requested a DNR or full code (FC) order after a discussion with their admitting team, and analyzed the transcripts using a modified grounded-theory approach.

Results: We achieved conceptual saturation after conducting 44 interviews (27 DNR, 17 FC) over a 4-month period.

Best interests at end of life: a review of decisions made by the Consent and Capacity Board of Ontario.

Purpose: When patients are unable to communicate their own wishes, surrogates are commonly used to aid in decision making. Although each jurisdiction has its own rules or legislation governing how surrogates are to make health care decisions, many rely on the notion of "best interests" when no prior expressed wishes are known.

Methods: We purposively sampled written decisions of the Ontario Consent and Capacity Board that focused on the best interests of patients at the end of life.

Bench-to-bedside review: Ethical challenges for those in directing roles in critical care units.

Though much attention in the medical literature has focused on the ethics of critical care, it seems to be disproportionately weighted toward clinical issues. On the presumption that the operational management of an intensive care unit (ICU) also requires ethical considerations, it would be useful to know what these are. This review undertook to identify what literature exists with regard to the non-clinical issues of ethical importance in the ICU as encountered by clinician-managers.