By Joel Goldenberg
The Suburban
The Quebec Court of Appeal recently upheld a Superior Court ruling agreeing with the McGill University Health Centre’s position that a 77-year-old patient (identified as N.G.) must be allowed to die with dignity according to a palliative care plan, and not continue futile and unethical “life-sustaining treatment.”
The appellant, the sister of the patient acting on his behalf, refused to consent to the palliative care plan.
“The judge performed a structured and thorough analysis ‘in accordance with legal requirements and with utmost respect for human rights,’” Judges Robert Mainville, Guy Cournoyer and Judith Harvie ruled. “The proposed Care Plan makes it possible to put an end to futile treatments and preserve the patient’s human dignity up to the very last moment through care that is humane and provides comfort measures until his death, a death which appears inevitable in this case given his distressing medical condition and the absence of any reasonable expectation of improvement.”
The patient, in 2007, authorized his sister, “in the event of his incapacity, to consent to any care required by his state of health ‘to the extent that such care is beneficial.’”
The court document points out the patient had a perforated stomach ulcer, an abdominal hernia, “for which he declined surgical treatment,” a left femur injury, a broken hip and a kidney obstruction.
Over time, he refused treatment and on five occasions, left the medical institutions that were treating him, each time resulting in rehospitalizations. At one point, he declined medications and, through his sister, insisted on being intubated, even as this course of treatment risked infection.
This prompted the MUHC to seek two psychiatric assessments, both of which recommended confinement for 30 days.
One MUHC doctor opined that while patients have the right to refuse care, “the objection to basic standard care while insisting on all other life sustaining measures is illogical and harmful in the long run to the patient.”
The patient left the hospital again and then quickly had to be rehospitalized.
The Superior Court subsequently, last May, authorized a 12-month care plan, which was initially successful, but the patient then experienced seven minutes of cardiac arrest and suffered brain damage, never regaining consciousness. The MUHC recommended palliative care instead of life-sustaining treatment.
However, the sister believed her brother could still recover and “considered that he… had the right to live.”
The hospital felt the life-sustaining care was “causing unnecessary pain and suffering by prolonging the patient’s agony,” that he was in a vegetative state, “mortality was inevitable” and recommended the halting of various measures, including resuscitation.
The Superior Court ruled last October that “the patient is incapable of giving consent and cannot participate in decision making regarding his care” and that the sister’s refusal to accept this is “unreasonable and unjustified.” The judge also agreed that death was inevitable.
The sister appealed the Superior Court judgment, arguing that it “infringes the patient’s right to life.” The MUHC countered that “continuing the [life-sustaining] treatment violates medical principles and ethics.”
The Court of Appeal agreed with the Superior Court judgment. n