Abstract
End-of-life disputes in Ontario are currently overwhelmingly assessed through the singular lens of patient autonomy. The current dispute resolution mechanism(s) does not adequately consider evidence-based medical guidelines, standards of care, the patient’s best interests, expert opinion, or distributive justice. We discuss two cases adjudicated by the Consent and Capacity board of Ontario that demonstrate the over emphasis on patient autonomy. Current health care policy and the Health Care Consent Act also place emphasis on patient autonomy without considering other ethically defensible factors. We argue that current policy and legislation require amendment, and unless there are measures undertaken to modify them, both the quality of care provided and the long-term capabilities of the health care system to remain publicly-funded, comprehensive and equitable, are at stake.
Highlights
End-of-life decision-making and dispute resolution requires a more clearly defined and ethically-sound foundation In their recent commentary, Savulescu and Singer [3] argue that, There are three justifications for withholding or withdrawing potentially life prolonging medical treatment: the patient validly refuses it; the expected utility is too low to warrant the public resources necessary to provide it; or it is against the patient’s best interests.On autonomy Respect for patient autonomy is a central pillar of ethical medical practice
In the context of the Intensive Care Unit (ICU), a majority of such conflicts involve the withholding or withdrawal of potentially life-prolonging medical treatment, and we argue that the current mechanisms in place for resolving these issues are limited by current policy and law
We argue that current policy and legislation require amendment to consider ethically-defensible factors in addition to patient autonomy
Summary
The struggle between what can versus what should be provided to patients, in terms of medical intervention, has led to an increasing number of conflicts between physicians and patients or substitute decision-makers (SDMs). In the context of the Intensive Care Unit (ICU), a majority of such conflicts involve the withholding or withdrawal of potentially life-prolonging medical treatment, and we argue that the current mechanisms in place for resolving these issues are limited by current policy and law. We challenge modifications to the College of Physicians and Surgeons of Ontario (CPSO) Planning for and Providing Quality End-of-Life Care policy [1], in conjunction with a dated Health Care Consent Act (HCCA) [2] that favors patient autonomy over all other elements. We present two cases and arguments recently penned by Bioethicists Julian Savulescu and Peter Singer [3] and apply the three justifications they provide for withholding or withdrawing potentially life-prolonging medical treatments to our current context. We argue that current policy and legislation require amendment to consider ethically-defensible factors in addition to patient autonomy
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