A recent Canadian Supreme Court ruling establishes for specific end-of-life medical decisions what American conservatives refer to derisively as a “death panel.”

The high court ruled in October that doctors cannot unilaterally choose to withdraw a comatose patient from life support against a family’s wishes. Rather, medical care providers must apply to a federal “Consent and Capacity Board” when family members oppose pulling the plug. The decision was the final appeal from family members of Hassan Rasouli, 61, who has been on life support since 2010.

Doctors at Sunnybrook Health Sciences in Toronto had recommended Rasouli be taken off his ventilator given “no hope of recovery,” though family members say he responds to stimulation and displays some ability to communicate. Rasouli remains on several waiting lists for transfer to other facilities, including nearby West Park Healthcare Centre, with approximately 40 such beds. Though Canada offers its people a single-payer medical system that is free of most costs, as much as one-third of Canada’s health care costs are paid out-of-pocket. Residents at West Park, for example, pay $1,707 per month for the stay.

Now, medical experts in Canada expect the ruling to not only influence end-of-care matters but quality of care, too.

"First, the ruling will likely affect standard of medical care and practice well beyond Ontario,” Robert Sibbald, an adjunct professor at Western University in London, wrote Monday in the Canadian Medical Association Journal. "Ontario's Consent and Capacity Board is a quasijudicial tribunal that does not benefit from expertise in critical care medicine. Yet it is now the first line of legal adjudication in the province in one of the most complex fields of medicine.”

Sibbald also noted the new power of the federal board to establish national quality of care standards, even against professional medical opinion. “The Consent and Capacity Board, although useful in some cases, should have no role in questioning the judgement of trained, experienced physicians about whether a medical treatment is beyond the standard of care.”

The term “death panel” was coined in 2009 by former Alaska Gov. Sarah Palin in opposition to federal health privacy legislation in the United States. While opposing the expansion of Medicaid and other subsidies to expand medical coverage, many conservatives say they fear the emergence of death panels in the U.S. would lead to cases of denied care, with regard specifically to end-of-life care.

 

Source: Sibbald R, Chidwick P, Hawryluck L. Standard Of Care And Resource Implications Of The Cuthbertson v. Rasouli Ruling. CMAJ. 2014.