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A glimmer of hope.

Thread by me.

Canada: Doctors Must Get Consent Before Cutting Lifesaving Care

The Rasouli family and the Euthanasia Prevention Coalition (EPC) have won a precedent setting decision in the Court of Appeal for Ontario.

EPC applauds the unanimous decision of the Ontario Court of Appeal to uphold a lower court decision which requires that doctors obtain consent from substitute decision-makers before unilaterally withdrawing life-support where such a decision is anticipated to result in the death of the patient.

The unanimous Court of Appeal ruled that it is necessary for doctors to raise any objections or concerns they may have about consent before the Ontario Consent and Capacity Board who has the jurisdiction to determine the issue of consent and to address any challenges to that consent made by a doctor.

A contrary decision would have effectively provided doctors with unilateral authority to withdraw life-support and end the life of a patient without any oversight, due process or procedural safeguards to patients, says Toronto lawyer Hugh Scher, who represented the EPC at the Court of Appeal.

Today’s ruling is perhaps the most significant end of life decision ever made by a Canadian court. It suggests that other provinces ought to be looking at implementing a similar regime of a board or tribunal to address such matters where they arise, according to Mark Handelman, who is a former Vice-Chair of the Consent and Capacity Board and who also served as counsel to EPC on their intervention.

The three judge panel decided that:

“we are of the view that the application judge reached the correct result in this case. In short, we are satisfied that the plan of care proposed by the appellants does amount to “treatment” as defined in the Act.”

The Rasouli case concerns Hassan Rasouli who underwent surgery on October 7, 2010 at Sunnybrook Health Sciences Centre for a benign brain tumour. He experienced a bacterial meningitis infection that caused him significant cognitive damage.

On October 16, Mr Rasouli was placed on a ventilator and a tube was inserted to provide him hydration and nutrition. His condition remains similar, even though the Rasouli family insist that he can now respond.

His doctors determined that Mr. Rasouli was in PVS and decided to withdraw the ventilator, but his wife, Parichehr Salasel, who is also a physician, refused to give consent to the withdrawal of the ventilator.

The Rasouli family applied to the Superior Court of Justice to obtain an injunction to prevent the doctors at Sunnybrook hospital from unilaterally withdrawing the ventilator.

The case was heard over three days in February and March (2011) and the decision by Justice Himel was released on March 9, 2011. Link to the Himel decision.

Justice Himel decided that the Rasouli family did not need an injunction because the doctors are required to obtain consent before withdrawing medical treatment, which in this case was the ventilator.

The doctors appealed the decision of Justice Himel and thus the case went to the Court of Appeal for Ontario.

Link to the previous blog posting about the Appeals court trial.

Link to the previous blog posting about concerning the Euthanasia Prevention Coalition being granted intervener status in the Rasouli case.

This is a huge victory for individual rights and it assures that the rights of individuals will be respected.

This decision has profound implications for patients throughout Ontario and Canada in terms of feeling safe and secure in accessing medical services near the end of life,

The decision maintains the role of the Consent and Capacity Board. Doctors continue to have the right to seek consent from the Consent and Capacity Board when consent is refused by the person or the attorney for personal care.

Link to the decision.

The UK embraces the "duty to die" and Switzerland continues to make the slippery slope even steeper.

Two threads by me.

Wesley J. Smith: Duty to Die Gains Traction in UK

The so-called “duty to die” has been quietly discussed in bioethics for more than a decade. Now, a major British Medical Association leader proposed an implicit duty to die by stating that terminally ill people may have to be denied life-extending treatments due to the costs of their care. From the Scotsman story:

THE leader of Scotland’s doctors has questioned whether society can afford to pay thousands of pounds to keep terminally-ill people alive for weeks or months when health service budgets are under unprecedented strain. Dr Brian Keighley, chairman of the British Medical Association Scotland, said in some cases tens of thousands of pounds were spent on drugs to extend cancer patients’ lives for relatively short periods.

Speaking ahead of his organisation’s annual meeting, the GP said the country had to debate the merits of these kinds of aggressive treatments and the effects they had on the NHS budget. But he stressed any decision had to be made at a society level, rather than being left to doctors.

He’s right about the last part. Doctors should not decide which patients live and which don’t live. But you have to ask yourselves what kind of a society would we become if we decided that when one needs care the most, it will be denied because of the cost (and, let’s face it, their lack of current productivity).

If we (this matter involves far more than the UK) are going to have a “conversation” about which treatments not to fund, I suggest we start with non elective procedures and treatments, i.e. those that are required to preserve life or treat serious illnesses and injuries. We should also reduce over utilization by requiring patients to pay deductibles and co-pays (via means testing). Better that people pay for part or more (depending on where you live) of your own care than throw the most sick and disabled among us out of the life boat. At the very least, those who need care most should not be the first ones denied it.

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Swiss back off restrictions on assisted suicide

Despite controversy at home and abroad over its law on assisted suicide, the Swiss government has decided not to modify it. Instead, it plans to promote palliative care and suicide prevention.

Justice Minister Simonetta Sommaruga says that abuses of the system can be tackled under the existing legislation. “Revising the current legislation could give an official stamp of approval to organisations offering their services for assisted suicide,” she said.

Over the past ten years the Swiss justice ministry has studied several options for dealing with assisted suicide clinics which help Swiss citizens and foreigners to die. In its latest, it proposed tougher regulation of assisted suicide groups.

Switzerland’s main assisted suicide organisations, Exit and Dignitas, welcomed the decision. Ludwig Minelli, of Dignitas, told SwissInfo that abuses of assisted suicide in Switzerland are extremely rare.

The number of cases of “suicide tourism” from other countries dropped from 195 in 2006, to 97 in 2010, according to the Federal Health Office. However, the number of presumed assisted suicide cases involving Swiss residents increased to 257 from 150.

"We will not be silent.
We are your bad conscience.
The White Rose will give you no rest."