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Death in the ICU —the Halifax experience

Mortalité à l’USI-l’expérience d’Halifax

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Conclusions

From the perspective of process, be careful what is said during procedures involving disciplinary actions and what is written afterwards. The Minutes of any such meetings should be scrutinized for accuracy and corrected as needed. It is always wise to consider how the documentation would appear if printed on the front page of a national newspaper or broadcast on the radio or television. In any criminal case, the likelihood of such documents being used as evidence and subsequently becoming public knowledge is real. Regarding end of life care in the ICU, there is a clear need for dialogue. Physicians would do well to educate themselves about end of life care and to become involved in efforts to increase public awareness of the issues. Given the variability of care demonstrated during the withdrawal of life support process, our admission of an increasingly elderly and sick patient population, and the lack of appropriate dialogue at Federal and Provincial levels concerning modification of the current statutes, the likelihood of further legal actions (both civil and criminal) against physicians is unfortunately very real. We believe it is time for professional organizations such as the Canadian Anesthesiologists’ Society (CAS) to become more involved in these issues both from an educational and political perspective.

Conclusion

Dans l’optique de la démarche, soyez attentif à ce qui se dit pendant les procédures d’actions disciplinaires et à ce qui s’écrit sur le sujet par la suite. On devrait examiner soigneusement l’exactitude du procès-verbal de telles réunions et le faire corriger si nécessaire. Il est toujours bon de penser comment la documentation serait présentée à la une du journal national ou diffusée à la radio ou à la télévision. Dans tout procès criminel, il est vraisemblable que des documents utilisés en preuve soient ensuite rendus publics. À propos des soins aux mourants à l’USI, il y a un réel besoin de dialogue. Les médecins gagneraient à s’informer sur ce genre de soins et à s’engager à faire connaître le sujet au public.Étant donné la variabilité des soins qu’on a pu observer pendant la période où l’assistance des fonctions vitales a été suspendue, l’admission à l’hôpital d’une population de patients plus âgés et plus malades et le manque de dialogue approprié aux niveaux fédéral et provincial sur la modification des statuts actuels, la possibilité de futures actions en justice (autant civile que criminelle) est malheureusement très réelle. Nous croyons qu’il est temps qu’une organisation professionnelle comme la Société des anesthésiologistes canadiens (SAC) s’occupe davantage de cette question d’un point de vue formatif et politique.

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Correspondence to Richard I. Hall.

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Hall, R.I., Duncan, P.J. & Rocker, G. Death in the ICU —the Halifax experience. Can J Anesth 46, R57–R69 (1999). https://doi.org/10.1007/BF03013182

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Keywords

  • Intensive Care Unit
  • Nova Scotia
  • Life Support
  • Criminal Code
  • Life Care