This month, the Ontario Health Professions Appeal and Review (HPARB) issued a third decision in the unilateral DNR case involving Douglas DeGuerre and his substitute decision maker Elizabeth Wawrzyniak. Earlier HPARB decisions were released in January 2012 and August 2014.
There is no denying that Elizabeth Wawrzyniak is tenacious. In 2008, physicians Chapman and Livingstone at Sunnybrook Health Sciences Center wrote a DNR order for her father, Douglas DeGuerre, without her consent or knowledge. Wawrzyniak filed complaints with various medical licensing boards as well as a lawsuit for damages.
The College of Physicians and Surgeons of Ontario twice ruled that the conduct of the physicians was appropriate (in January 2010 and September 2012). Both times, Wawrzyniak appealed to the HPARB. Each time the HPARB told the College to reconsider. Finally, in its third decision in the matter, in May 2015, the College came to a different conclusion (see also Toronto Star). The College held:
- The physicians “demonstrated good clinical judgment in determining that extreme measures to preserve life would be futile and would only further exacerbate Mr. DeGuerre’s suffering. . . . Mr. DeGuerre’s death was inevitable . . . and the actions of [the physicians] . . . did not decrease Mr. DeGuerre’s life span in any meaningful way.”
- But the College held that the physicians “did not take adequate steps to discuss the proposed change [in code status]. They failed to make “reasonable or sufficient efforts to have a proper discussion with Ms. Wawrzyniak.”
- Accordingly, the College issued a “written caution” to the physicians “on failing to ensure proper communication with the patient’s SDM.”
- The College ordered the physicians to “carefully and fully review the HCCA and provide the Committee with a written report, approximately 2-4 pages in length . . . about what they have learned . . . on how their practices will change in the future.”
Wawrzyniak was dissatisfied with this mere “written caution” ordered by the College and appealed to the HPARB a third time. But this time, the HPARB was satisfied that the College reached an appropriate result.