Physician Authority, Family Choice, and the Best Interest of the Child.

Two of the most poignant decisions in pediatrics concern disagreements between physicians and families over imperiled newborns. When can the family demand more life-sustaining treatment (LST) than physicians want to provide? When can it properly ask for less? The author looks at these questions from the point of view of decision theory, and first argues that insofar as the family acts in the child's best interest, its choices cannot be constrained, and that the maximax and minimax strategies are equally in the child's best interest. He then proposes a guideline according to which the family can demand LST if it is physiologically possible to preserve a life the child can be expected to welcome, and refuse such treatment if it causes suffering that is "more than can be borne" even if an uncompromised life is expected to emerge.

How to Legalize Medically Assisted Death in a Free and Democratic Society.

In 2015, the Supreme Court of Canada struck down the criminal law prohibiting physician assisted death in Canada. In 2016, Parliament passed legislation to allow what it called 'medical assistance in dying (MAID).' The authors first describe the arguments the Court used to strike down the law, and then argue that MAID as legalized in Bill C-14 is based on principles that are incompatible with a free and democratic society, prohibits assistance in dying that should be permitted, and makes access to medically-assisted death unnecessarily difficult. They then propose a version of MAID legislation ('Ideal MAID') that gives proponents and opponents of MAID everything they can legitimately want, contend that it is the only way to legalize MAID that is compatible with a free and democratic society, and conclude that it is the way to legalize MAID in Canada and other similarly free and democratic societies.

Physician-Assisted Death in Canada.

The Criminal Code of Canada prohibits persons from aiding or abetting suicide and consenting to have death inflicted on them. Together, these provisions have prohibited physicians from assisting patients to die. On February 6, 2015, the Supreme Court of Canada declared void these provisions insofar as they "prohibit physician-assisted death for a competent adult person who (1) clearly consents to the termination of life and (2) has a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition." This declaration of invalidity was scheduled to take effect one year (later extended by six months) after the ruling, to give the government time to put legislation in place. We trace the history of this decision, discuss how it has forever changed the debate on physician-assisted dying, and identify the issues that must be resolved to write the legislation. Of special importance here are the topics of access, safeguards, and conscientious objection.

[Le leadership en santé et l'éthique de la gestion des attentes des soignants et des patients].

Les dispensateurs de soins et les patients sont souvent déçus du niveau de soins que les hôpitaux publics peuvent prodiguer. La solution consiste à réduire les attentes. Les dispensateurs devraient être amenés à considérer que leur obligation consiste à prodiguer les meilleurs soins en fonction des ressources. Le public devrait être bien informé des services que les hôpitaux de soins actifs peuvent ou non lui offrir et participer aux prises de décision. Les leaders en santé peuvent jouer des rôles novateurs à cet égard.

Healthcare leadership and the ethics of managing expectations of caregivers and patients.

Healthcare providers and patients are often disappointed by the level of care public hospitals can deliver. The remedy is to lower expectations. Providers should be brought to see their obligations as only to give the best care resources allow. The public should be clearly told what care hospitals can and cannot provide and involved in decision-making. Healthcare leaders can play innovative roles in both these remedies.

Using a harm reduction approach with clients who have alcohol/drug dependencies in a spinal cord rehabilitation program.

BACKGROUND: Dissatisfied with the frequently adversarial nature of relationships with clients who use alcohol or drugs while rehabilitation inpatients, and the often less than optimal outcomes for these individuals, the Spinal Cord Program at the G.F. Strong Rehabilitation Center in Vancouver, BC, decided to pilot a new approach. OBJECTIVE: The goal of the pilot project is to promote successful rehabilitation, including less conflict in rehabilitation, a completed rehabilitation program, and continued connection after discharge if needed. METHOD: A dedicated team was formed and trained to work with these clients using harm reduction principles. PARTICIPANTS: From its inception in December 2000, through May 2001, the team worked with 6 inpatients, 12% of admissions to the Spinal Cord Program during that period. RESULTS: Outcomes based on the above goals have been positive. There have been no discharges against a client's will or instances of significant conflict with the team. Several clients have returned to the center for assistance or to visit post-discharge. Only 1 client left rehabilitation prematurely.