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.