Fourth, restricting the use of the doctrine to end-of-life care neglects that everyday medical decisions carry with them the risk of adverse and even fatal effects. The casual prescribing of opioids for pain relief without consideration of the risk of addiction has had fatal results within the ongoing opioid crisis, with 2861 opioid related deaths in 2016 in Canada [44]. Similarly, polypharmacy is strongly associated with mortality [45], especially among the elderly. In both cases, what might seem like straightforward clinical decisions can lead to tragic results when the potential negative effects of initiating treatment are not considered. Deeper reflection on the intentions and reasons behind medical decisions should not be limited to end-of-life care.
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