End-of-life decision-making is difficult (problems with the Consent and Capacity Board)

  • Robert SibbaldEmail author

To the Editor,

Family members face difficult decisions when an incapable loved one is nearing death or in a state of permanent incapacity being supported by technology. It is a tragic consequence of modern medicine and current consent legislation that family members are often put in the position of weighing conflicting plans for death—one characterized by minimizing potential harms or indignities and one characterized by chronic life support and ongoing resuscitation.

Physicians can face difficult decisions when families in such circumstance do not recognize that death is at the end of either choice. These families often opt for a “fight”—against evidence, odds, and the advice of experienced clinicians—seemingly against death itself. While statements and position papers offer nuanced advice for clinicians,1,2there are limited realistic strategies in the face of intractable conflict (i.e., conflict that endures beyond mediation, compromise, ethics consults, etc.). Physicians can make...


Conflict of interest

The author has no competing interests to declare.

Editorial Responsibility

This submission was handled by Dr. Hilary P. Grocott, Editor-in-Chief, Canadian Journal of Anesthesia.


  1. 1.
    Canadian Critical Care Society Ethics Committee; Bandrauk N, Downar J, Paunovic B.. Withholding and withdrawing life-sustaining treatment: The Canadian Critical Care Society Position Paper. Can J Anesth 2018; 65: 105-22.CrossRefPubMedGoogle Scholar
  2. 2.
    Bosslet GT, Pope TM, Rubenfeld GD, et al. An official ATS/AACN/ACCP/ESICM/SCCM policy statement: Responding to requests for potentially inappropriate treatments in intensive care units. Am J Resp Crit Care Med 2015; 191: 1318-30.CrossRefPubMedGoogle Scholar
  3. 3.
    Health Care Consent Act, 1996, S.O. 1996, c. 2, s. 21. Sched. A. Available from URL: (accessed June 2018).

Copyright information

© Canadian Anesthesiologists' Society 2018

Authors and Affiliations

  1. 1.Department of Family Medicine, Schulich School of MedicineWestern UniversityLondonCanada
  2. 2.London Health Sciences CentreLondonCanada

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