Withholding cardiopulmonary resuscitation (CPR)—Canadian law and college policies: Informing the standard of care in medicine following the Superior Court decision of Wawrzyniak v. Livingstone
Jeremy J. Dawson, Laura A. DawsonIntroduction:
This article is a scoping review of major Canadian legal precedents and medical college policies informing the standard of care in medicine as they pertain to the question: ‘When is withholding cardiopulmonary resuscitation (CPR) permitted from a medico-legal perspective?’ No previous scoping review and summary of the legal conclusions and applicable college policies has been published since the outcome of the Superior Court case of Wawrzyniak v. Livingstone, 2019. This landmark Superior Court case defines legal requirements as they pertain to the issue of writing a ‘do not resuscitate’ order in a manner that falls within the standard of care and does not require the consent of the patient or substitute decision maker.
Methods:
Three provinces (Ontario, Manitoba, and Saskatchewan) have accessible policy statements from their respective colleges relating to this topic. No other Canadian provinces or territories are found to have directed college policies pertaining to the topic of withholding CPR at this time. These college policies are delineated alongside federal laws in order to determine when withholding CPR is permissible from a medico-legal perspective by province or territory in Canada.
Results:
This research is then synthesized into decision-making frameworks that outline each province's college policies, in tandem with applicable federal laws, surrounding the issue of withholding CPR. The purpose of these frameworks is to provide concise, practical summaries for physicians in the clinical setting when making the decision to withhold CPR.
Discussion:
The result of our study is the amalgamation of provincial and federal expectations into practical clinical guides for physicians in Canada, by province, when making the decision to withhold CPR. We caution that care must be taken to follow new policies and laws as they arise.