title: Hospital policies on life-sustaining treatments and advance directives in Canada.
abstract: OBJECTIVE
  To determine the prevalence and content of hospital policies on life-sustaining treatments (cardiopulmonary resuscitation [CPR], mechanical ventilation, dialysis, artificial nutrition and hydration, and antibiotic therapy for life-threatening infections) and advance directives in Canada.
  
  
  METHODS
  Cross-sectional mailed survey.
  
  
  METHODS
  Canada.
  
  
  METHODS
  Chief executive officers or their designates at public general hospitals.
  
  
  METHODS
  Information regarding the existence of policies on life-sustaining treatments or advance directives and the content of the policies.
  
  
  RESULTS
  Questionnaires were completed for 697 (79.2%) of the 880 hospitals surveyed. Of the 697 respondents 362 (51.9%) sent 388 policies; 355 (50.9%) sent do-not-resuscitate (DNR) policies (i.e., policies that addressed CPR alone or in combination with other life-sustaining treatments). Of the 388 policies 327 (84.3%) addressed CPR alone, 28 (7.2%) addressed CPR plus other life-sustaining treatments, 10 (2.6%) addressed advance directives, and the remaining 23 (5.9%) addressed other life-sustaining treatments. Of the 355 DNR policies 1 (0.3%) stated that routine discussion with patients is required, 315 (88.7%) restricted their scope to terminally or hopelessly ill patients, 187 (52.7%) mentioned futility, 29 (8.2%) mentioned conflict resolution, 9 (2.5%) and 13 (3.7%) required explicit communication of the decision to the competent patient or family of the incompetent patient respectively, 110 (31.0%) authorized the family of an incompetent patient to rescind the DNR order, 224 (63.1%) authorized the nursing staff to do so, and 217 (61.1%) authorized physicians to do so.
  
  
  CONCLUSIONS
  Although about half of the public general hospitals surveyed had DNR policies few had policies regarding other life-sustaining treatments or advance directives. Existing policies could be improved if hospitals encouraged routine advance discussions, removed the restriction to terminally or hopelessly ill patients, scrutinized the use of the futility standard, stipulated procedures for conflict resolution, explicitly required communication of the decision to competent patients or substitute decision-makers of incompetent patients and scrutinized the provision allowing families and health care professionals to rescind the wishes of now incompetent patients.
authors.affiliation: Centre for Bioethics, University of Toronto, Ont.
authors.forename: I
authors.initials: I
authors.lastname: Rasooly
authors.forename: J V
authors.initials: JV
authors.lastname: Lavery
authors.forename: S
authors.initials: S
authors.lastname: Urowitz
authors.forename: S
authors.initials: S
authors.lastname: Choudhry
authors.forename: N
authors.initials: N
authors.lastname: Seeman
authors.forename: E M
authors.initials: EM
authors.lastname: Meslin
authors.forename: F H
authors.initials: FH
authors.lastname: Lowy
authors.forename: P A
authors.initials: PA
authors.lastname: Singer
mesh_terms: D001294:Attitude to Health; D002170:Canada; D003430:Cross-Sectional Studies; D006291:Health Policy; D006761:Hospitals / Q000639:trends*; D006801:Humans; D016414:Resuscitation Orders; D011795:Surveys and Questionnaires