Chief Justice Beverley McLachlin stated that Ontario’s Health Care Consent Act (HCCA) provides a mechanism for resolving the dispute. Under this act, medical treatment is more than just what doctors consider to be of “medical benefit” to a patient and that end-of-life care is a treatment that can still benefit this patient.
The decision enumerates “While the common law of consent to medical treatment works well for patients who have the capacity to decide on consent to treatment, that approach is problematic when a patient is incapable of appreciating the nature, purpose, and consequences of the proposed treatment. The HCCA sets out clear rules requiring consent before treatment can occur, identifying who can consent for an incapable patient, stating the criteria on which consent must be granted or refused, and creating a specialized body to settle disputes, including those between Substitute Decision Makers and physicians over consent regarding life support. Board decisions are subject to judicial review ensuring that the Board acts within its mandate and in accordance with the Constitution.”
Mr. Hassan Rasouli has been in a persistent vegetative/minimally conscious state and ventilator dependent since October 2010. After an extensive internal review and negotiation with the family, a decision was made that CPR and intensive life support was not the standard of care for patients with this diagnosis, as prolonged medical benefit could not be realized. The family disagreed.
It is important to realize that these cases are extremely rare. In most situations, the clinical team and surrogate decision makers can reach agreement on the goals of care with the support of social work, palliative care, pastoral care, and medical ethics. Clinicians will often provide treatment that is not medically indicated while this process of negotiation proceeds. This case is about how should conflicts between families and clinical teams be resolved to determine the standard of care for patients.
The Canadian Hospice Palliative Care Association believes that situations like this can best be avoided through advance care planning and establishing a substitute decision maker who is aware of the patient’s advance care plan. Advance care planning is not necessarily about creating a document or writing things down, it’s more about having conversations with a substitute decision maker, family, friends, health care professionals, and maybe even financial/legal professionals about preferences for care. To learn more about advance care planning and free resources through the “Speak Up: Start the conversation about end-of-life care” campaign, please visit www.advancecareplanning.ca.
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