Hospital policy on appropriate use of life-sustaining treatment. University of Toronto Joint Centre for Bioethics/Critical Care Medicine Program Task Force.
OBJECTIVE
To describe the issues faced, and how they were addressed, by the University of Toronto Critical Care Medicine Program/Joint Centre for Bioethics Task Force on Appropriate Use of Life-Sustaining Treatment. The clinical problem addressed by the Task Force was dealing with requests by patients or substitute decision makers for life-sustaining treatment that their healthcare providers believe is inappropriate.


METHODS
Case study.


METHODS
The University of Toronto Joint Centre for Bioethics/Critical Care Medicine Program Task Force on Appropriate Use of Life-Sustaining Treatment.


METHODS
The 24-member Task Force included physician and nursing leaders from five critical care units, bioethicists, a legal scholar, a health administration expert, a social worker, and a hospital public relations professional.


METHODS
None.


RESULTS
Our specific lessons learned include a) a policy focus on process; b) use of a negotiation and mediation model, rather than a hospital ethics committee model, for this process; and c) the policy development process is itself a negotiation, so we recommend equal involvement of interested groups including patients, families, and the public.


CONCLUSIONS
This article describes the key issues faced by the Task Force while developing its policy. It will provide a useful starting point for other groups developing policy on appropriate use of life-sustaining treatment.
Singer
P A
PA
University of Toronto Joint Centre for Bioethics,  Ontario, Canada.
Barker
G
G
Bowman
K W
KW
Harrison
C
C
Kernerman
P
P
Kopelow
J
J
Lazar
N
N
Weijer
C
C
Workman
S
S
D006739:Hospital Administration; D006801:Humans; D007324:Institutional Management Teams; D007400:Interprofessional Relations; D008020:Life Support Care / Q000706:statistics & numerical data*; D018447:Medical Futility; D017146:Models, Organizational; D017008:Negotiating; D009864:Ontario; D019982:Organizational Case Studies; D016134:Organizational Policy; D011050:Policy Making