In Rasouli v. Sunnybrook Health Sciences Centre, the Ontario Court of Appeal held that the removal of life support when it is no longer medically indicated is a form of "treatment" requiring the consent of the patient under the Health Care Consent Act.
The respondent (represented by his litigation guardian) developed bacterial meningitis after surgery to remove a benign brain tumour, which left him reliant on life support for survival. According to medical consensus, there was no hope for recovery, and the life support measures were no longer medically beneficial or indicated. The appellants, the respondent's attending physicians, sought to remove the respondent from life support and begin palliative care. They argued that a patient's consent is not required when a doctor withdraws treatment that is not medically indicated or necessary, because such withdrawal does not constitute "treatment".
The Court held that the removal of life support constitutes "treatment" under the Act, and therefore requires the consent of the substitute decision maker, or of the Consent and Capacity Board. The Court reasoned that, in this case, the withdrawal of life support would necessitate the immediate administration of palliative care, in contrast to other situations involving the removal of treatment and future administration of pallitaive care, in which there may be a time gap of indeterminate length, such as the withdrawal of chemotherapy that has failed to benefit a cancer patient. Thus, the Court analyzed the withdrawal of life support and subsequent administration of palliative care as one "treatment package" or one “plan of treatment” under Section 2.1 of Act. Treating physicians must therefore obtain consent to the entire treatment package, either from the substitute decision-maker as per s.21 of the Act, or from the Board, as per s.37.
June 29, 2011
Link to Decision
Webnesh Haile
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