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Canadian Journal of Anesthesia/Journal canadien d'anesthésie

Erschienen in:

10.11.2020 | Reports of Original Investigations

Requests for somatic support after neurologic death determination: Canadian physician experiences

verfasst von: Amanda van Beinum, MSc, Andrew Healey, MD, Jennifer Chandler, LLM, Sonny Dhanani, MD, Michael Hartwick, MD, MEd, Ariane Lewis, MD, Calista Marshall, BSc, Jocasta Marshall, LLB, Sam Shemie, MD, Jeffrey M. Singh, MD, MSc

Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Ausgabe 3/2021

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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.

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 spiritual services (41%), and delay of one to three days for NDD acceptance (49%). Respondents with prior experience were less likely to recommend ancillary tests (P = 0.004) or consultation with bioethics services (P = 0.004). Qualitative analysis revealed perceptions that requests for continued organ support were driven by mistrust, tensions surrounding decision-making, and cultural differences rather than a lack of specific information about NDD.

Conclusions

Family requests for continued somatic support following NDD were encountered by half our sample of Canadian critical care physicians. Mitigation strategies require attention to the multifaceted social contexts surrounding these complex scenarios.

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Titel: Requests for somatic support after neurologic death determination: Canadian physician experiences
verfasst von: Amanda van Beinum, MSc
Andrew Healey, MD
Jennifer Chandler, LLM
Sonny Dhanani, MD
Michael Hartwick, MD, MEd
Ariane Lewis, MD
Calista Marshall, BSc
Jocasta Marshall, LLB
Sam Shemie, MD
Jeffrey M. Singh, MD, MSc
Publikationsdatum: 10.11.2020
Verlag: Springer International Publishing
Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Ausgabe 3/2021
Print ISSN: 0832-610X
Elektronische ISSN: 1496-8975
DOI: https://doi.org/10.1007/s12630-020-01852-9

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Requests for somatic support after neurologic death determination: Canadian physician experiences