Issue link: https://digital.canadianlawyermag.com/i/425225
15 treatment for terminally ill patients, can be invaluable for clarifying your wishes and avoiding disputes. Patients, or their legally appointed substitute decision makers, have the right to refuse emergency treatment such as CPR or defibrillation if they feel prolonging their life may also prolong their suffering. Given the potential for doctor-patient disagreement, these kinds of orders are often included in a power of attorney and patients and their substitutes should be explicit with their doctor if they desire a DNR. Ontarians can ask their doctor for a do-not-resuscitate confirmation form through the Ministry of Health and Long- Term Care, which stands as a directive for paramedics and firefighters in emergency situations. On the other hand, patients and their proxies can also request to be "full code" — as Wawrzyniak did — meaning doctors should employ all available measures to save the patient's life. Complications, however safeguarded, can arise when medical professionals enter the picture, creating a situation that sometimes pits doctors against their own patients in a battle over who has the final say. Under Ontario's Health Care Consent Act, a healthcare professional can sometimes overrule the wishes of a patient or substitute decision-maker, providing treatment without consent. Withholding treatment, as doctors did with DeGuerre, isn't covered by the act. Physicians, however, may base their decisions on factors such as the ethics and responsibility behind providing "futile care" — treatment that extends the patient's suffering with no reasonable hope of recovery. In 1995, the Canadian Medical Association and others released a joint policy paper saying, in part: "there is no obligation to offer a person futile or non-beneficial treatment." But doctors can't make that choice unilaterally. Ontario's provincial watchdog, the Consent and Capacity Board. ruled in 2014 that Sunnybrook broke the law in the DeGuerre case, reinforcing the importance of familial consent. Despite the ruling, Swadron says the public is still at a disadvantage, as uninformed decision-makers might feel compelled to accept a doctor's decision simply because of their superior knowledge and authority. He wants patients and their legal guardians to know they have options. "The substitute decision- maker has a right to dispute what the doctors have decided and there is a quick resolution vehicle or mechanism to overcome that." Disputes over DNRs and other end-of-life decisions should go to the province's Health Services Appeal and Review Board, which can render a decision in as little as 24 hours. He encourages families and other substitute decision-makers to become familiar with their rights, question the doctor's decision, and speak up in any dispute. "Sometimes there's the means to keep someone alive, but for whatever reason, for reasons of economy, bed shortage, caseload, [doctors] view a person's life should be ended, but the family members should not feel that they are without a remedy." LRG dnRs ? FaMiLiEs and oThER subsTiTuTE dECision-MakERs shouLd bECoME FaMiLiaR wiTh ThEiR LEGaL RiGhTs, quEsTion ThE doCToR's dECision, and sPEak uP in anY disPuTE.