The government of Ontario is being asked by their main advisory board to temporarily suspend the law requiring doctors to get patient or family consent before withdrawing life support or ventilator support from people facing a grim prognosis, in the instance that COVID-19 cases begin to overwhelm hospitals.
Though a 2013 Supreme Court ruling made it clear that a hospital couldn’t withdraw life-support without a family’s consent, the government is being urged to use an Executive Order to suspend the province’s Health Care Consent Act for withdrawal of treatment in the ICU. This would take the power away from the family to decide if their loved ones should be removed from ventilators and putting the power in the hands of the hospital where they are being hosted, in order to make room for those better able to survive their COVID-19 diagnosis.
The group making the recommendation is not small group of crackpots, however. Rather, The Bioethics Table “is an advisory body that provides ethics input and guidance to support decision-making at the Ministry of
Health COVID-19 Command Table, Ontario Health COVID-19 Oversight Table, and other Tables as appropriate. They comprise the best of the best in terms of Canadian “bioethics experts from health institutions, universities, and non-governmental organizations.”
James Downer, head of the division of palliative care at the University of Ottawa and a member of the Bioethics Table said:
Nobody likes the idea of ever withdrawing life-support on somebody without their permission, without their consent. But in a triage scenario, we’re talking about a scenario where the focus is no longer on the individual himself, but now on our population as a whole, and trying to maximize the number of people who will survive an overwhelming surge.
Peter Goldberg agrees. He’s the head of critical care at Montreal’s McGill University Health Centre and explains that it’s not practical to get the patient’s and their families’ input when it comes to pulling the plug, because most will just opt-out. This is why it should be in the hands of the doctors, not the families to decide:
We are going to say, ‘by the way, we are taking your family member off the ventilator in lieu of another patient who we feel has a better prognosis, given this pandemic condition. Do you agree?’ I think that if we did that we would not get consent. Nobody is going to give us consent.
Ontario has a population of nearly 15 million people, and has had 5,632 deaths so far from COVID-19.
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