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Court ruling carries lesson on need for advance directives: CMA

One of the main lessons Canadians should learn from an Oct. 18 ruling by the Supreme Court of Canada is the need to spell out the medical treatment they desire in the event they become incapable of making such decisions, the CMA says.

"There are no winners and losers in a tragic situation like this, but this case does show clearly that all Canadians must make their wishes clear with advance care directives," says CMA President-elect Chris Simpson.

He was referring to a case involving Hassan Rasouli of Toronto, who suffered severe brain damage after undergoing surgery three years ago. His physicians argued that the damage had left him minimally conscious and unlikely to improve further, and suggested that life support be ended. Rasouli's family disagreed with the prognosis and asked that life support continue.

By a 5-2 margin, the court ruled that Rasouli's physicians must apply to Ontario's Consent and Capacity Board for permission to withdraw life support.

Simpson said that because medicine's capacity for extending life is growing, it is crucial that Canadians have detailed conversations with family members and their physicians about the type of treatment they want in the event they become incapacitated.

"It is important to note that it is rare for there to be a disagreement of this type and that physicians strive to work and communicate with patients and their families when faced with these heart-rending decisions," said Simpson, who noted that he has not seen a similar case during his 21 years in practice.

He is not surprised that end-of-life care is capturing Canadians' attention. "That's as it should be," he said. "Physicians are also grappling with these issues, and the CMA believes broader societal debate about end-of-life care is required. Early next year we intend to encourage such discussion by launching a national public dialogue."

Regardless of the decisions that are made, said Simpson, the country must intensify efforts to broaden the availability of palliative care. "These services must be available to all Canadians, where and when they need them," he said.

Forward any comments about this article to: cmanews@cma.ca.