Hospital policy on appropriate use of life-sustaining treatment

Objective: To describe the issues faced, and how they were addressed, by th e University of Toronto Critical Cam Medicine Program/Joint Centre for Bioe thics Task Force on Appropriate Use of Life-Sustaining Treatment. The clini cal problem addressed by the Task Force was dealing with requests by patien ts or substitute decision makers far life-sustaining treatment that their h ealthcare providers believe is inappropriate. Design: Case study. Setting: The University of Toronto Joint Centre for Bioethics/Critical Care Medicine Program Task Force on Appropriate Use of Life-Sustaining Treatmen t. Participants: The 24-member Task Force included physician and nursing reade rs from five critical care units, bioethicists, a legal scholar, a health a dministration expert, a social worker, and a hospital public relations prof essional. Interventions: None. Measurements and Main Results: Our specific lessons learned include a) a po licy focus on process; b) use of a negotiation and mediation model, rather than a hospital ethics committee model, far this process; and c) the policy development process is itself a negotiation, so we recommend equal involve ment 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 far ot her groups developing policy an appropriate use of life-sustaining treatmen t.