Evidence map›Paper›PMID 35761229›Full record

SynthesisBMC medical ethics2022

"Everything has been tried and his heart can't recover…": A Descriptive Review of "Do Everything!" in the Archive of Ontario Consent and Capacity Board.

Holly Yim, Syeda Shanza Hashmi, Brian Dewar, Claire Dyason, Kwadwo Kyeremanteng, Susan Lamb, Michel Shamy

Abstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMC medical ethics, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Holly YimDepartment of Medicine, University of Ottawa, 1053 Carling Avenue, Ottawa, ON, Canada. hyim@toh.ca.
Syeda Shanza HashmiDepartment of Psychiatry, University of Toronto, 250 College Street, Toronto, ON, Canada.
Brian DewarOttawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, ON, Canada.
Claire DyasonDepartment of Medicine, University of Ottawa, 1053 Carling Avenue, Ottawa, ON, Canada.
Kwadwo KyeremantengDepartment of Medicine, University of Ottawa, 1053 Carling Avenue, Ottawa, ON, Canada.
Susan LambDepartment of Innovation in Medical Education, Jason A. Hannah Chair in History of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, Canada.
Michel ShamyDepartment of Medicine, University of Ottawa, 1053 Carling Avenue, Ottawa, ON, Canada.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundIn end-of-life situations, the phrase "do everything" is sometimes invoked by physicians, patients, or substitute decision-makers (SDM), though its meaning is ambiguous. We examined instances of the phrase "do everything" in the archive of the Ontario Consent and Capacity Board (CCB) in Canada, a tribunal with judicial authority to adjudicate physician-patient conflicts in order to explore its potential meanings.

methodsWe systematically searched the CCB's online public archive from its inception to 2018 for any references to "do everything" in the context of critical care medicine and end-of-life care. Two independent assessors reviewed decisions, collected characteristics, and identified key themes.

resultsOf 598 cases in the archive, 41 referred to "do everything" in end-of-life situations. The phrase was overwhelmingly invoked by SDMs (38/41, 93%), typically to advocate for life-prolonging measures that contradicted physician advice. Physicians generally related "doing everything" to describe the interventions they had already performed (3/41, 7%), using it to recommend focusing on patients' quality of life. SDMs were generally reluctant to accept death, whereas physicians found prolonging life at all costs to be morally distressing. The CCB did not interpret appeals to "do everything" legally but followed existing laws by deferring to patients' prior wishes whenever known, or to concepts of "best interests" when not. The CCB generally recommended against life-prolonging measures in these cases (26/41, 63%), focusing on patients' "well-being" and "best interests."

conclusionsIn this unique sample of cases involving conflict surrounding resuscitation and end-of-life care, references to "do everything" highlighted conflicts over quantity versus quality of life. These appeals were associated with signs of cognitive distress on the behalf of SDMs who were facing the prospect of a patient's death, whereas physicians identified moral distress related to the prolongation of patients' suffering through their use of life-sustaining interventions. This divergence in perspectives on death versus suffering was consistently the locus of conflict. These findings support the importance of tools such as the Serious Illness Conversation Guide that can be used by physicians to direct conversations on the patients' goals, wishes, trade-offs, and to recommend a treatment plan that may include palliative care.

trial registrationNot applicable.

Indexed as

Decision MakingQuality of LifeDeathHumansInformed ConsentOntarioBioethicsCommunicationCritical careGoals of carePalliative care

Identifiers

PMID35761229
PMCPMC9237977

What OpenQuestion holds

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LicenceCC BY
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.