Canadian Court to Address End of Life Support

Paul Levy

Posted 1/15/12 on Not Running A Hospital

The Supreme Court of Canada will soon be taking up the issue of whether doctors need consent before taking a patient off life support. As reported here in The Globe and Mail:

The country’s top court has granted leave to appeal to the doctors of . . . a man who has been in a coma at Toronto’s Sunnybrook Health Sciences Centre since October, 2010. His doctors diagnosed him as being in a “permanently vegetative state” and recommended he be taken off life support, but his wife and substitute decision-maker . . . strongly opposed. Now the doctors have turned to the Supreme Court in hopes of disconnecting Mr. Rasouli from the medical machines that are keeping him alive.

The outcome of the case could set a national precedent on protocol for end-of-life care when physicians and families don’t see eye-to-eye. The issue is fraught: Medical technology can now keep patients technically alive, so their loved ones sometimes keep them connected to machines for months or years, even when doctors advise against it.

As it stands, all provinces but New Brunswick require consent from the patient or substitute decision-maker for medical treatment, and Ontario is the only one with a tribunal that makes decisions on a patient’s behalf.

Of course, the ideal is for the patient and family and doctor to have talked through such matters in advance, but where that has not occurred, a clear legal standard will come in handy.In my former hospital, we had a procedure in place for those instances in which a doctor felt that a patient or family was demanding a harmful or ineffective treatment.  But as I re-read that policy today, it seems to be focused on the initiation of such treatment.  I am not sure whether it should or could apply to the withdrawal of treatment, i.e., the kind of case being considered here by the Canadian court.

I think, too, in the United States, that these would be matters of state, and not national, jurisdiction.  Perhaps readers who are more familiar with the various states’ laws on these issues will provide us all with the benefit of your comments.

About Brian Klepper

Brian Klepper is a health care analyst and the Chief Development Officer of WeCare TLC onsite clinics.
This entry was posted in Benefits, Conflicts of Interest, Medical Management, Physicians, Policy/Law/Regulation, Politics, Quality and tagged , , , . Bookmark the permalink.

One Response to Canadian Court to Address End of Life Support

  1. Heather says:

    My common law husband had a severe stroke in 2011 and was in hospital for about 2 weeks before his children decided to pull his breathing tube. He had a living will that stated he did not want to be kept alive on machines.. and if he was not cognitive to make that decision his son should make it for him. According to his son the doctors said he would never recover and they (the doctors and his son) did not feel he should asked before they pulled the breathing tube. I told the son that he was cognitive enough to make that decision, that he understood what was going on and to prove this he would ask to have his hands tied down when he was left alone because he had woken up 3 times and pulled the breathing tube out. This indicated to me that he was not ready to die.
    After they pulled the tube he all of a sudden became cognitive because he could now speak and said he wanted to live.
    He lived for 3 days while his lungs filled with fluid and he died in my arms.
    So he had a procedure in place but his wishes where not followed. If they had asked him he would have asked to see his lawyer first. He was cognitive enough to make that decision before they pulled the breathing tube but since his son found out from his lawyer that he had not signed a new will that he had drafted that included me in it the son decided to pull the breathing tube..

    So although everything was legal and sanctioned by the Doctors it was not right and honest. It was a legal murder and I blame myself because it was me that told him to get a living will not realizing it could be used in this way.

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