Attitudes toward withholding antibiotics from people with dementia lacking decisional capacity: findings from a survey of Canadian stakeholders

BMC Medical Ethics

Gina Bravo¹  Lise Trottier²  Marcel Arcand³  Jocelyn Downie⁴  Lieve Van den Block⁵ 

[1] Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada;Research Centre On Aging, CIUSSS de l’Estrie – CHUS, 1036 South Belvedere Street, J1H 4C4, Sherbrooke, Canada;Research Centre On Aging, CIUSSS de l’Estrie – CHUS, 1036 South Belvedere Street, J1H 4C4, Sherbrooke, Canada;Research Centre On Aging, CIUSSS de l’Estrie – CHUS, 1036 South Belvedere Street, J1H 4C4, Sherbrooke, Canada;Department of Family Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada;Schulich School of Law and Faculty of Medicine, Dalhousie University, Halifax, Canada;VUB-UGhent End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB), Brussels, Belgium;

关键词: Dementia;    Decisional incapacity;    Advance directive;    Infection;    Antibiotics;    Continuous deep sedation;    Euthanasia;    Medical assistance in dying (MAID);    Survey;    Canada;   

DOI  :  10.1186/s12910-021-00689-1

来源: Springer

【 摘 要 】

BackgroundHealthcare professionals and surrogate decision-makers often face the difficult decision of whether to initiate or withhold antibiotics from people with dementia who have developed a life-threatening infection after losing decisional capacity.MethodsWe conducted a vignette-based survey among 1050 Quebec stakeholders (senior citizens, family caregivers, nurses and physicians; response rate 49.4%) to (1) assess their attitudes toward withholding antibiotics from people with dementia lacking decisional capacity; (2) compare attitudes between dementia stages and stakeholder groups; and (3) investigate other correlates of attitudes, including support for continuous deep sedation (CDS) and medical assistance in dying (MAID). The vignettes feature a woman moving along the dementia trajectory, who has refused in writing all life-prolonging interventions and explicitly requested that a doctor end her life when she no longer recognizes her loved ones. Two stages were considered after she had lost capacity: the advanced stage, where she likely has several more years to live, and the terminal stage, where she is close to death.ResultsSupport for withholding antibiotics ranged from 75% among seniors and caregivers at the advanced stage, to 98% among physicians at the terminal stage. Using the generalized estimating equation approach, we found stakeholder group, religiosity, and support for CDS and MAID, to be associated with attitudes toward antibiotics.ConclusionsFindings underscore the importance for healthcare professionals of discussing underlying values and treatment goals with people at an early stage of dementia and their relatives, to help them anticipate future care decisions and better prepare surrogates for their role. Findings also have implications for the scope of MAID laws, in particular in Canada where the extension of MAID to persons lacking decisional capacity is currently being considered.

【 授权许可】

CC BY