Withholding and withdrawing treatment in Canada: implications of the Supreme Court of Canada’s decision in the Rasouli case

James Downar; Robert W. Sibbald; Tracey M. Bailey; Brian P. Kavanagh

doi:10.1503/cmaj.140054

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Is the key distinction immediate or imminent death?
T. Keefe Davis

Posted on: 10 December 2014

Posted on: (10 December 2014)
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Is the key distinction immediate or imminent death?
T. Keefe Davis, Pediatric Nephrologist
The article by Downar et al.1 analyzing the implications of Canada's Supreme Court decision in Cuthbertson v. Rasouli was excellent. The authors should be commended for specifically discussing "implications for practice." Although I do not practice in Canada, intractable conflicts between families and healthcare professions involving the withdrawal of life support occur regardless of the country or health system. Havin...
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The article by Downar et al.1 analyzing the implications of Canada's Supreme Court decision in Cuthbertson v. Rasouli was excellent. The authors should be commended for specifically discussing "implications for practice." Although I do not practice in Canada, intractable conflicts between families and healthcare professions involving the withdrawal of life support occur regardless of the country or health system. Having recently cared for a young patient in a persistent vegetative state whose family requested dialysis when the healthcare team recommended withdrawal of treatment I appreciate the authors attempt to differentiate intermittent hemodialysis as a life support measure versus mechanical ventilation in the eyes of the law. However, based upon the authors' suggestion as to why the Supreme Court required consent for withdrawal ". . . in part derived from administration of additional therapy, need for physical contact, and the anticipation of death shortly after withdrawal of life support" I would argue that dialysis may require consent for withdrawal. In patients with ESRD the withdrawal of dialysis does not result in immediate death, but death is imminent- occurring a median of 10 days after discontinuation.2 Furthermore it would be appropriate after discontinuation to offer palliative care if pain or air hunger were to develop as these patients often develop progressive encephalopathy as uremia evolves.
1. Downar J, Sibbald RW, Bailey TM, Kavanagh BP. Withholding and withdrawing treatment in Canada: implications of the Supreme Court of Canada's decision in the Rasouli case. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne. Nov 4 2014;186(16):E622-E626.
2. Cohen LM, McCue JD, Germain M, Kjellstrand CM. Dialysis discontinuation. A 'good' death? Archives of internal medicine. Jan 9 1995;155(1):42-47.
Conflict of Interest:
None declared
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Competing Interests: None declared.