Blog

CCB Stirring Again…

Applications to the Consent and Capacity Board to resolve end of life conflict are not new. Typically, patients are critically ill and dependent on various life support systems in the ICU before a physician (or group of physicians) is willing to challenge a substitute decision-maker that the level of intervention is not in the best interests

Continue Reading →

View the most commonly accessed pages on this site: 1. Consent and Capacity Board decisinos that focus on end of life decision making  2. Consent and Capacity Board decisions that focus on admission to long-term care facilities 3. Our checklist for meeting ethical and legal obilgations in treatment decisions

Continue Reading →

CMAJ piece re: CPSO policy mandating consent for DNR

  CMAJ. 2016 Mar 1;188(4):245-6. doi: 10.1503/cmaj.151205. Epub 2016 Jan 4. Mandate to obtain consent for withholding nonbeneficial cardiopulmonary resuscitation is misguided. Downar J1, Warner M2, Sibbald R2.    

Continue Reading →

Clarifying roles in medical decision making (ON)

Our partners spearheading the PoET project, ie. Preventing of Errors in Transfers (between care settings), recently developed this very accessible explanation of the various roles in decision making for healthcare in Ontario. Please share where you think it would be useful. Hospitals might consider making this available to patients and their families.  

Continue Reading →

Slow Codes Returning to Ontario?

In wake of the recent decision by the College of Physicians and Surgeons of Ontario to approve their new policy "Planning for and Providing Quality End of Life Care" – many of us are scratching our heads trying to make sense of the actions that are now required of Ontario physicians. The following excerpt from

Continue Reading →

The Trouble With Conflict in Paediatric Cases

The delicate balance between medical paternalism and patient directed medicine (in the name of autonomy) has recently shown signs of weakness. For the most part, physicians are content to allow patients to direct their own care, so long as the decisions can be justified by medical standards of care. Sometimes, they can't – and physicians are then

Continue Reading →

How Terminology Matters

In consent, terminology matters a lot. I was recently asked whether we should be providing antibiotics to a 95 yo patient who arrived from Long Term Care with anĀ “advanced directive” that indicated he was DNR, and did not wish to be transferred to hospital for any life ending complications. He wished only comfort measuresĀ for the

Continue Reading →

CPSO Drafts Problematic EoL Policy

Toward the end of 2014, the College of Physicians and Surgeons of Ontario (CPSO) released a draft policy entitled “Planning for and Providing Quality End of Life Care“. This was to be an update of an earlier End of Life Policy that by all accounts was overly vague regarding the precise obligations of physicians in

Continue Reading →

A Different Approach to ACP

I was going through the documents of several websites that offer tools on advanced care planning. In Canada, the leading site is SpeakUp. And while I applaud the efforts I’ve seen on these websites, I can’t help but struggle with the missed opportunity. We seem to have transitioned over the past few years from the

Continue Reading →

Evidence Based Advance Care Planning

If we recognize that as difficult as end of life discussions are, that the vast majority of them are adequately navigated in a manner that everyone can accept – then we can focus on the ‘problem’ cases where conflict arises, differences of opinion are not settled, and interpretations of patient values are questionable. These cases

Continue Reading →

@ConsentQI