P0451 / #921: END-OF-LIFE CARE IN CANADIAN ICUS: A SURVEY OF INTENSIVISTS’ PERCEPTIONS AND PRACTICES
Bibliographic record
Abstract
Aims & Objectives: A compassionate withdrawal of life sustaining therapies (WLST) is common practice in ICUs at the end of life (EoL). Recent Medical Assistance in Dying (MAiD) legislation in Canada has continued to transform EoL care by legalizing active euthanasia for defined adult populations; the intangible effects of which are unknown in ICUs. We aimed to describe Canadian intensivists’ approach to WLST and determine if and how practices have changed following MAiD. Methods: A survey was created in REDCAP, tested and then distributed via email (period: 10 to 27/1/2020) to physicians and fellows across Canadian ICUs (adult and pediatric) regarding their views and practices at EoL. The survey combined cases, likert scales, short answer and three vignettes. Results: Preliminary sub-analysis with data from 55 pediatric practitioners (response rate: >50%) reveals >75% have no protocol for WLST. A vast majority (84%) have received requests to hasten the death; nearly 1 in 5 of whom had requests specifically for euthanasia. Half of respondents have observed medications administered in doses higher than needed to treat EoL symptoms, with 20% having either ordered or personally administered such doses. Over 80% are familiar with MAiD legislation, with 75% in favour,18% conflicted. Nearly 60% of respondents feel it is ethically permissible to provide interventions that intentionally hasten death for patients in whom death is expected following WLST. Conclusions: This study describes the state of EoL care in Canadian ICUs, highlighting a possible shift in the ethical understanding of WLST, while demonstrating potential challenges in a shifting landscape.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".