Bioethics Blogs

Implementing Rasouli – CPSO Says Ontario Physicians Must Obtain Consent to Stop Life-Sustaining Treatment

Two weeks ago, the Ontario College of Physicians and Surgeons gave final approval to its Planning for and Providing Quality End-of-Life Care policy.  

Section 5.2 concerns “Potentially Life-Saving and Life-Sustaining Treatment.”  Three paragraphs are of note:

“A decision regarding a no-CPR order cannot be made unilaterally by the physician. Where a physician is of the opinion that CPR should not be provided for a patient and that a no-CPR order should be written in the patient’s record, the College requires physicians to discuss this with the patient and/or substitute decision-maker at the earliest and most appropriate opportunity, and to explain why CPR is not being proposed. This discussion must occur before a no-CPR order can be written.”

“If the patient or substitute decision-maker disagrees and insists that CPR be provided, physicians must engage in the conflict resolution process as outlined in Section 8 of this policy which may include an application to the Consent and Capacity Board. Physicians must allow the patient or substitute decision-maker a reasonable amount of time to disagree before a no-CPR order can be written.”

While the conflict resolution process is underway, if an event requiring CPR occurs, physicians must provide CPR. In so doing, physicians must act in good faith and use their professional judgment to determine how long to continue providing CPR.”

Over at the Healthcare Consent Quality Collaborative, they are “scratching their heads trying to make sense of the actions that are now required of Ontario physicians.”  In particular, the final paragraph instructs physicians to “begin CPR (i.e.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.