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At its January meeting the Council approved the guideline on end of life care. This was the culmination of a long period of development by a number of individuals and consultation with stakeholders.
Providing appropriate care in end of life situations can be a very significant challenge for physicians. Among other benefits of the guideline, it assists physicians when they are deciding whether to withhold or withdraw life-sustaining treatment on the basis that the treatment is futile. It provides information to assist physicians to consider how to make those decisions.
The foundational principles that formed the basis for the guideline state:
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Treatment can only be provided to a patient with the consent of the patient, or, if the patient lacks capacity, according to previously expressed written wishes in an advanced care directive, or, in the absence of that, with the consent of the substitute decision-maker.
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A physician who provides treatment contrary to the direction of a competent patient, or who provides treatment to an incompetent patient contrary to the directions set out in an advance care directive, may be found to have committed a battery on the patient.
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Shared decision making between a physician and the patient or the patient’s substitute decision-maker (SDM) is the expected standard of care in addressing all care, including end-of-life care.
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Communication with the patient and/or the patient’s family or substitute healthcare decision-maker is critical. Pursuant to The Health Information Protection Act, a physician can only disclose personal health information to a patient’s family with the consent of the patient or in circumstances in which that information can be provided without patient consent.
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Neither the patient, nor the patient’s SDM, has a right to insist or require that a physician provide or continue life sustaining treatment if, in the treating physician’s opinion, that treatment is futile.
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A physician is not required to provide or continue life-sustaining treatment which the physician concludes is futile.
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Physicians who provide care to patients in end-of-life situations should inform the patient or the patient’s substitute decision-maker at the earliest opportunity if the physician will not be providing or continuing certain forms of life-sustaining treatment.
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The College recognizes that irreversible cessation of cardiorespiratory function or the irreversible cessation of all brain function constitutes death. |
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The guideline also establishes expectations for physicians who provide longitudinal care:
It is expected that physicians who provide ongoing longitudinal care to patients whose medical condition makes it a reasonable possibility that end-of-life decisions will have to be made in the foreseeable future will:
a. discuss those issues with the patient;
b. encourage their patient to discuss those issues with their SDM and family;
c. be willing to discuss those issues with the patient’s SDM or family if requested by the patient; and
d. document those discussions.
The College encourages all physicians to review the guideline on its website and to act consistently with the expectations in the guideline.
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