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The future of decision-making in critical care after Cuthbertson v. Rasouli

  • Laura Hawryluck
  • Andrew J. Baker
  • Andrew Faith
  • Jeffrey M. Singh
Review Article/Brief Review

Abstract

Purpose

The Supreme Court of Canada (SCC) ruling on Cuthbertson v. Rasouli has implications for all acute healthcare providers. This well-publicized case involved a disagreement between healthcare providers and a patient’s family regarding the principles surrounding withdrawal of life support, which the physicians involved considered no longer of medical benefit and outside the standard of care, and whether consent was required for such withdrawals. Our objective in writing this article is to clarify the implications of this ruling on the care of critically ill patients.

Source

SCC ruling Cuthbertson v. Rasouli.

Principal findings

The SCC ruled that consent must be obtained for all treatments that serve a “health-related purpose”, including withdrawal of such treatments. The SCC did not fully consider what the standard of care should be. Health-related purpose is not sufficient in and of itself to mandate treatment, and clinicians must still ensure that their patients or decision-makers are aware of the possible medical benefits, risks, and expected outcomes of treatments. The provision of treatments that have no potential to provide medical benefit and carry only risks would still fall outside the standard of care. Nevertheless, due to their health-related purpose, physicians must seek consent for the discontinuation of these treatments.

Conclusion

The SCC ruled that due to the legal definition of “health-related purpose”, which is distinct from medical benefit, consent is required to withdraw life-support and outlined the steps to be taken should conflict arise. The SCC decision did not directly address the role of medical standard of care in these situations. In order to ensure optimal decision-making and communication with patients and their families, it is critical for healthcare providers to have a clear understanding of the implications of this legal ruling on medical practice.

Keywords

Palliative Care Critical Care Medical Standard Healthcare Team Medical Benefit 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

L’avenir de la prise de décision dans les soins critiques après l’affaire Cuthbertson contre Rasouli

Résumé

Objectif

Le jugement de la Cour suprême du Canada (CSC) dans l’affaire Cuthbertson contre Rasouli a des implications pour tout personnel de la santé donnant des soins aigus. Ce cas dont il a été largement fait état impliquait un désaccord entre des professionnels de la santé et la famille d’un patient concernant les principes entourant le retrait du système de maintien des fonctions vitales, que les médecins concernés estimaient ne plus apporter de bénéfice médical et dépasser les normes de soin, et la nécessité d’un consentement pour un tel retrait. En rédigeant cet article, notre objectif est de clarifier les implications que ce jugement a sur les soins de patients dans un état critique.

Source

Jugement de la CSC dans l’affaire Cuthbertson contre Rasouli.

Constatations principales

La CSC a jugé qu’un consentement doit être obtenu pour tous les traitements qui servent un « objectif lié à la santé », y compris le retrait de tels traitements. La CSC n’a pas pleinement pris en compte ce que devaient être les normes de soins. Un objectif lié à la santé n’est pas en soi suffisant pour exiger un traitement et les cliniciens doivent encore s’assurer que leurs patients ou ceux qui prennent les décisions sont informés des avantages et risques éventuels ainsi que des résultats escomptés des traitements. La fourniture de traitements qui n’apporteraient pas d’avantages médicaux et qui comporteraient uniquement des risques serait toujours exclue des normes de soins. Néanmoins, en raison de leur objectif lié à la santé, les médecins doivent obtenir un consentement pour l’interruption de ces traitements.

Conclusion

La CSC a jugé que, compte tenu de la définition légale d’un « objectif lié à la santé » qui est distinct d’un bénéfice médical, un consentement est requis pour le retrait du système de maintien des fonctions vitales et a détaillé les étapes en suivre dans le cas d’un conflit. La décision de la CSC n’a pas directement abordé le rôle de la norme médicale des soins dans ces situations. Afin d’assurer une prise de décision optimale et une communication avec les patients et leurs familles, il est essentiel que le personnel de la santé comprenne clairement les implications de ce jugement sur la pratique médicale.

Notes

Conflicts of interest

None declared.

References

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Copyright information

© Canadian Anesthesiologists' Society 2014

Authors and Affiliations

  • Laura Hawryluck
    • 1
    • 2
  • Andrew J. Baker
    • 1
    • 3
  • Andrew Faith
    • 4
  • Jeffrey M. Singh
    • 1
    • 2
  1. 1.Interdepartmental Division of Critical Care MedicineUniversity of TorontoTorontoCanada
  2. 2.University Health NetworkTorontoCanada
  3. 3.St. Michael’s HospitalTorontoCanada
  4. 4.Polley Faith LLPTorontoCanada

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