by Thaddeus Mason Pope, JD, PhD
On October 18, 2013, the Supreme Court of Canada issued its long-awaited opinion in Cuthbertson v. Rasouli. Many lawyers and ethicists have already offered significant commentary on the case. So, after briefly summarizing the litigation and the ruling, I will proceed to draw some important, but less obvious, observations and implications.
Summary of the Case
Cuthbertson v. Rasouli was a typical medical futility dispute. The patient, Hassan Rasouli, has been a patient in Toronto’s Sunnybrook Health Sciences Center for over three years, dependent on life-sustaining treatment. By early 2011, Mr. Rasouli’s clinicians determined that ICU medicine offered him no prospect for recovery or benefit. Therefore, they thought it was appropriate to stop life-sustaining medical treatment. But Mr.…
“I have often thought it would be important to instruct physicians how to behave in cases of incurable disease: not so much to tell them what to do; rather what not to do.”
Letter from Johann Stieglitz to Karl F.H. Marx (15 December 1826).
In a new article in the Clinical Journal of the American Society of Nephrology, the authors discuss how continued dialysis violates ethical and legal principles of care in patients in a persistent vegetative state.
Professional guidelines have long re…
Monday, November 18th, 2013, at Cardozo Law School
Opening Keynote Speech
Panel 1: Clinical Ethics Consultation
- Nancy Dubler (moderator)
- Autumn Fiester
- Thaddeus Pope
- Charity Scott
Lunch Keynote Speech
- Arthur Caplan, “Rationing Evidence and Obamacare”
Panel 2: Obamacare and ADR
- Michelle Skipper (moderator)
- Mindy Hatton
- Michael Kosnitzky
- Joe Miller
Panel 3: End-of-Life Decision Making
- Carol Liebman (moderator)
- Edward Bergman
- Nancy Berlinger
- Ellen Waldman
Closing Keynote Speech
I blogged about the Eddie Cortez Smith case when it was before the intermediate appellate court in Minnesota last Fall. That court rejected a drunken driver’s claim that he was not responsible for the death of a 93-year-old woman killed in a 2010…
Based on a criminal complaint and indictment filed in the U.S. District Court for the Eastern District of Michigan, Dr. Farid Fata may be one of the most irresponsible doctors in the United States. He is being charged with defrauding Medicare by …
This is a brief rebuttal to Jason Manne’s recent response to my post “ Dangerous Catholic Attack on POLST .”
Manne’s letter misses the point. First, POLST is not just a form but also a process and conversation. And POLST is continually improving: (1) through conducting a range of research projects to determine best practices, (2) through enhancing education, and (3) through quality assessment. POLST Paradigm continues to work toward better patient-centered care by encouraging advance care planning conversations, for those nearing the end of their lives, to ensure that clinicians honor both patient wishes to receive and patient wishes to limit treatment.…
Earlier this month, the Ontario Health Professions Appeal and Review Board affirmed a decision of the Inquiries, Complaints and Reports Committee of the College of Physicians and Surgeons of Ontario, counsel a physician to ensure that he has thorough discussions with patients and their families regarding care plans and end of life planning, and to document the same.
Here is the background. On October 20, 2010, Dr. D.G.C. noted “DNR” (do not resuscitate) on
R.V.’s chart. Three days later, on October 23, 2010, R.V.
died from a bilateral bronchopneumonia with coronary artery disease as a
contributing factor. Nursing staff made
no attempts to resuscitate the patient when he was found with vital signs
R.V.’s son, J.V., subsequently filed a
complaint with the Inquiries, Complaints and Reports Committee of the College
of Physicians and Surgeons of Ontario. J.V. alleged that D.G.C. failed to accurately document DNR status, thereby preventing
In response, D.G.C. explained that he had a conversation
with the family members on October 20, 2010 in which he explained that to offer
resuscitation to someone in the patient’s condition would not be “an honest
offer.” D.G.C. further explained that he documented a DNR order in the
patient’s chart following that discussion and that he was unable to explain J.V.’s differing point of view. Finally, D.G.C. noted that resuscitation would not have
worked, given the patient’s accumulated burden of illness.
The Committee investigated the complaint and decided to counsel D.G.C. to ensure that he has thorough discussions with patients and their
families regarding care plans and end of life planning, and to document the
same. Regarding the DNR status, the
Committee noted that entries in the chart were very brief and that it had
difficulty determining the content and context of the end of life discussion
between D.G.C. and the patient’s family. The Committee stated that it
would expect such discussions to be detailed and thoroughly documented and
decided to counsel D.G.C. regarding this aspect of his care.
Thaddeus Mason Pope, JD PhD
The Physician Orders for Life-Sustaining Treatment (POLST) program is proving to be a highly effective mechanism for assuring that the life-sustaining treatment seriously ill patients want is the same treatment those patients get. A number of scientifically rigorous studies have demonstrated POLST’s material benefits. And a growing number of states have been adopting POLST through legislation, regulation, or clinical consensus. But despite this notable quality improvement, a number of Catholic leaders and organizations have called on Catholic healthcare facilities to “not accept POLST forms and to decline to participate in POLST programs.”
POLST is a tool for translating patient’s goals of care into medical orders so that they are easily located and portable across care settings. POLST is not just a specific set of medical orders documented on a bright, colorful form. It is also an approach to end-of-life planning based on conversations between patients, loved ones, and medical professionals. The POLST Paradigm is designed to ensure that seriously ill patients can choose the treatments they want and that their wishes are honored by medical providers.…