Physicians wanted to withdraw life support from a patient who couldn't consent and provide palliative care. The patient's wife, his substitute decision maker, refused. The majority held that the proposed course was treatment subject to Ontario's statutory consent regime.
The Court dismissed the physicians' appeal. Its holding is specific to the Ontario Health Care Consent Act and the treatment at issue. It isn't a declaration that every end of life disagreement in another province has an identical answer. The case demonstrates why an institution needs to identify the legal decision maker and the route for resolving a dispute.
Hassan Rasouli suffered serious brain injury following surgery, and his physicians considered continued mechanical ventilation medically inappropriate. His wife, acting as substitute decision maker, did not consent to withdrawal. The majority interpreted withdrawal of life support accompanied by palliative care as part of a course of treatment governed by the Ontario Health Care Consent Act. Under that statute, doctors could not bypass the consent process merely by describing continued life support as medically futile.
The Court identified a defined dispute process. Physicians determine what care is medically indicated and seek consent to a proposed change. A substitute decision maker must apply the patient's applicable prior wishes or best interests. If consent is refused in a way the physicians believe contravenes the statute, they may apply to the Consent and Capacity Board. The Court dismissed the physicians' appeal without resolving the medical merits of withdrawing support. The distinction between clinical judgment, legal consent authority and tribunal oversight is especially important when institutional decisions affect a person who cannot express a choice.