Adult End of Life Decisions

Witholding/Withdrawing LST Cases


Year Case Excerpt Rationale
2013 Cuthbertson v. Rasouli – 2013 SCC 53 _”The difficulty with the physicians’ argument is that it substitutes a physician-made criterion for treatment (medical benefit) for the criterion specified in the HCCA for consent (health-related purpose)” Statutory Scheme
2013 Cefarelli v. Hamilton Health Sciences – 2013 ONCA 413 _”the November 2012 treatment plan (which was consented to) gives the responsible physician discretion regarding which components of cardiopulmonary resuscitation are to be used and which are not.” Physicians Discretion
2011 Rasouli v. Sunnybrook Health Sciences Centre – 2011 ONCA 482 _“…we are prepared to accept that the [HCCA] does not require doctors to obtain consent from a patient or substitute decision-maker to withhold or withdraw “treatment” that they view as medically ineffective or inappropriate.” Medically ineffective – Inappropriate
2008 Rotaru v. Vancouver General Hospital Intensive Care Unit – 2008 BCSC 318 _“Rather – the Petition raises the issue of whether – after certain treatment has ceased – the Court is in a position to order that the treatment resume where the medical advisors state that it is in their bona” fide clinical judgment that the former treatment is contra-indicated. [16] When faced with a similar situation – the Lord Justices in Re J – supra – were of the view that they could not conceive of any circumstances in which it would be other than an abuse of power to require a medical practitioner to act contrary to the fundamental duty which that practitioner owed to his or her patient. The statements to that effect set out in clear and strong language the position taken in Re J – supra. I agree with that view.” Contra-indicated – Duty to patient
2008  Golubchuk v. Salvation Army Grace General Hospital et al.- 2008 MBQB 49  Should this issue be resolved by whether the treatment in question is an act of commission or omission? Should withholding of treatment and withdrawal of treatment be treated the same? Are there are other criteria or factors to be considered? Does the plaintiff have a right to continuation of the treatment that is in place – either at common law or under the Charter? In my view – the resolution of these questions is wide open. They may be decided for the defendants. They may be decided for the plaintiff.
2008 Children’s Aid Society of Ottawa-Carleton v. M.C. – [2008] O.J. No.3795 – 301 D.L.R. (4th) 194 – (Ont. Sup.Ct.) _“The decision to withdraw or withhold life-sustaining treatment is inherently a medical one – with the sole purview of a patient’s treating doctors. Consent is not needed for the doctors to make use of their professional judgment and discretion to cease treatment or give only palliative care.” Medical judgment
1997 Child & Family Services of Central Manitoba v. L. (R.) [1997] – 154 D.L.R (4th) 409 Man. R. (2d) 135 (C.A.) _“There is no legal obligation on a medical doctor to take heroic measures to maintain the life of a patient in an irreversible vegetative state. [N]either a consent nor a court order in lieu is required for a medical doctors to issue a non-resuscitation direction where – in his or her judgment – the patient is in an irreversible vegetative state.” Vegetative state
1997  London Health Science Centre v. R.K. 1997 CanLII 14487 (ON SC) _” If what is being sought is a declaration that a physician has a legal right in these circumstances to withdraw life support from R.K.- I am not at all certain that is a declaration a court should make. Questions such as this involving as they do complex moral/ethical/religious/legal issues are best dealt with in a multicultural society by Parliament rather than the courts. They lie essentially within the purview of the legislative branch of government whose function is to decide upon and enumerate policy – and not within that of the judicial branch.”