Next Up: A Proposal for Values-Based Law Reform on Unilateral With-Holdings and Withdrawal of Potentially Life-Sustaining Treatment
Bibliographic record
Abstract
As the legalization of assisted dying shifts from a project for law reform to one ofimplementation, the gaze for Canadian end of life law and policy academics and practitioners should be turned quickly to another pressing issue – the unilateralwithholding and withdrawal of potentially life-sustaining treatment. What should happen when the health care team believes that treatment should not be provided and the patient’s loved ones believe that it should? While the future of end of life law and policy no doubt includes many other issues, this is an urgent and immediate horizon issue for Canada as well as a number of other countries (e.g., the United States, Australia, and New Zealand) and a more distant horizon (but inevitable) issue for many other countries as they move beyond the debate of whether to even withholding or withdrawal of potentially life-sustaining treatment (e.g., South Korea).In this paper, we attempt to take a step back from the drama and vitriol surrounding conflict that can arise when the health care team believes that treatment should not be provided and the patient’s loved ones believe that it should. We suggest and model an approach to law and policy reform in this area. To that end, we begin with a review of what is known about what is going on in relation to unilateral withholding and withdrawal of treatment (without the consent or knowledge of the patient or patient's substitute decision-maker) demonstrating that: it is happening; it is controversial; it is being challenged in courts; and it is not being approached by the law in the same way in every country (or indeed, even in the same way within a country). We then present a process for pursuing law reform, exploring Canada as a case study, to provide a model strategy for approaching law reform in other countries and to advance the project of law reform in Canada. To that end, we reflect on the fundamental values that should underpin a legal framework for decision-making on whether potentially life-sustaining treatment should be withheld or withdrawn. These values and the ways to balance these values against each other are drawn from the constitution, legislation, the common law, conventions and treaties that have been ratified by Canada, and “fundamental values of Canadian society” within which the ethical debate about the unilateral withholding and withdrawal of potentially life-sustaining treatment is situated. We then develop a proposal for how the law could be reformed such that it will more closely align with thefundamental values it is supposed to serve. We hope that in the end, this proposal might help us to move forward from friction to accord and, ultimately, to a future of better care for both the living and the dying.
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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 | 0.055 | 0.065 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.004 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.009 | 0.044 |
| Scholarly communication | 0.018 | 0.031 |
| Open science | 0.007 | 0.010 |
| Research integrity | 0.050 | 0.032 |
| Insufficient payload (model declined to judge) | 0.008 | 0.002 |
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".