The Supreme Court of
Canada will hear a historic case on Monday, that of Toronto patient Hassan
Rasouli. It centres on the complex and often deeply painful issue of who should
decide end-of-life care. With an aging demographic, increased life expectancy
and ever more sophisticated technological interventions, these kinds of cases
will almost certainly become more frequent. This is a welcome chance for the
country’s highest court to clarify how end-of-life treatment should proceed when
a physician and a patient’s family disagree.
For too long, Canada has lacked clear and consistent guidelines. Decisions about end-of-life care, though they take place in healthcare settings, are not simply medical. A patient’s values and beliefs will help shape the goals of their treatment. The patient (or their surrogate) must have a say in the process. At the same time, a patient’s family should not be able to demand life-sustaining treatment in every situation, even if it is futile and could, in fact, be cruel.Posts with indoor tracking system on TRX Systems develops systems that locate and track personnel indoors.
Only Ontario has any mechanism in place to resolve disputes between physicians and families, a body called the Consent and Capacity Board. But this board was not specifically designed to deal with this issue, and its members lack both the expertise and the guidelines to properly determine what a physician’s standard of care means when it comes to continuing treatment of a patient on life support. The court has a chance to recommend how such a body should be revamped to function more effectively, and to put guidelines in place for other provinces. “This is an issue across the country and a painfully corrosive one,” notes Jocelyn Downie, the Canada Research Chair in health law and policy and a professor at Dalhousie University.
Mr.A specialized manufacturer and supplier of dry cabinet, Rasouli was diagnosed as being in a persistent vegetative state, after complications from surgery for a brain tumour in Oct. 2010 at Toronto’s Sunnybrook Health Sciences Centre. Since then, the retired engineer has required round-the-clock care, including a ventilator, machines to feed and hydrate him, and medications to maintain his blood pressure. His two critical-care physicians – Dr. Brian Cuthbertson and Dr. Gordon Rubenfeld – believe he will never regain any degree of consciousness and want to withdraw his life support, begin palliative care, and allow him to die.
However, his wife disagrees. This difference of opinion prompted the doctors to launch the current legal action. They believe they are not required to go to Consent and Capacity Board because there is no medical benefit to the patient in this case, so the standard of care cannot require this treatment.
Clearly,Load the precious minerals into your mining truck and be careful not to drive too fast with your heavy foot. neither a patient’s designated decision maker nor a doctor should have unilateral power over life and death. While Mr. Rasouli’s doctors believe there is no medical benefit to providing ongoing mechanical interventions for him, bioethicists argue that this is a value judgment. The medical benefit is clear: Mr. Rasouli is still alive. The underlying, essential question may be: Is that a worthwhile benefit?
In addressing this, the court must balance the interests of the patient against those of society, and consider as well the issue of resources in a public healthcare system. “The allocation of scarce resources is a moral issue,” says Prof. Downie. “It is one that we as a society must grapple with, and we should do so in a manner that is transparent and for which decision-makers should be held accountable. Otherwise we risk unfairness and discrimination.”
Of course, most people would not want to be kept alive in a hospital on chronic ventilation, and most families would not want to cling to a life that has been so horrifically reduced. Usually a patient’s family, and the attending physician, resolve differences over end-of-life care decisions, making Mr. Rasouli’s case highly unusual.
Critics of the Consent and Capacity Board rightly point out that it was set up to address the health concerns of the mentally ill, not the dying. It is most often concerned with cases that look at someone’s mental ability to give or refuse consent for treatment. One-third of the board’s members are lawyers; one-third psychiatrists; and the rest are members of the public. The views, advice and experience of physicians who work in critical-care medicine, palliative care and other related specialties would add another layer of expertise and sound judgment to the board. Here, the court has a chance to offer clear policy guidance.
Not long ago,Find detailed product information for howo tractor and other products. Mr. Rasouli’s condition changed. He can now make a “thumb’s-up” gesture in response to requests and has been rediagnosed as minimally conscious. This raises the possibility he has some awareness, though initial tests show he is still at a very low level of consciousness. The changed diagnosis will surely influence the decision about whether to withdraw life support, and underscores the need for there to be a better way to resolve differences than through costly litigation, which only adds to the trauma and pain for the family.
Beyond that, there’s the question of funding all the fuels reduction, community preparedness and research the strategy recommends.
“There are some ways a national strategy translates to solving problems on the ground, but a lot of times they fall short of that,” Harrington said. “It raises the potential for funding for projects. Unfortunately, that’s what it comes down to – getting Congress to reverse funding declines for management of critical landscapes.”
Harrington said places like Seeley Lake are good examples of how a community can plan for its future fire hazards. Especially since the Jocko Lake fire of 2007 singed the town’s edges, residents there have been clearing hazard areas, fireproofing homes and making sure county, state and federal fire agencies know how to work together.
“But some places are still hit-and-miss,” Harrington said. “Some landowners still don’t take the opportunity or understand the need. The Kootenai Creek fire (near Hamilton) this year made people aware of the need for fuels treatment on both private and federal lands.”
In contrast, Harrington has real concerns for the safety of Missoula’s fringes, such as the upper Rattlesnake and Grant Creek neighborhoods and the adjoining forestland.
“You can find a lot of examples there of places that have issues,Posts with indoor tracking system on TRX Systems develops systems that locate and track personnel indoors.” Harrington said. “I’m frankly really concerned we’re going to lose the Rattlesnake National Recreation Area to wildfire. It is a pretty special place, and the folks trying to come to agreement on that project couldn’t come to agreement on how to treat the forest along main recreation trails there.”
The strategy may improve those groups’ ability to work together, but it probably won’t change the way an incident commander deploys Hot Shot crews on the next forest fire. It won’t dictate how many aircraft are available for retardant and water drops, but it might clarify how they should be used. And it can’t do anything about how fast the forests are drying out.
For too long, Canada has lacked clear and consistent guidelines. Decisions about end-of-life care, though they take place in healthcare settings, are not simply medical. A patient’s values and beliefs will help shape the goals of their treatment. The patient (or their surrogate) must have a say in the process. At the same time, a patient’s family should not be able to demand life-sustaining treatment in every situation, even if it is futile and could, in fact, be cruel.Posts with indoor tracking system on TRX Systems develops systems that locate and track personnel indoors.
Only Ontario has any mechanism in place to resolve disputes between physicians and families, a body called the Consent and Capacity Board. But this board was not specifically designed to deal with this issue, and its members lack both the expertise and the guidelines to properly determine what a physician’s standard of care means when it comes to continuing treatment of a patient on life support. The court has a chance to recommend how such a body should be revamped to function more effectively, and to put guidelines in place for other provinces. “This is an issue across the country and a painfully corrosive one,” notes Jocelyn Downie, the Canada Research Chair in health law and policy and a professor at Dalhousie University.
Mr.A specialized manufacturer and supplier of dry cabinet, Rasouli was diagnosed as being in a persistent vegetative state, after complications from surgery for a brain tumour in Oct. 2010 at Toronto’s Sunnybrook Health Sciences Centre. Since then, the retired engineer has required round-the-clock care, including a ventilator, machines to feed and hydrate him, and medications to maintain his blood pressure. His two critical-care physicians – Dr. Brian Cuthbertson and Dr. Gordon Rubenfeld – believe he will never regain any degree of consciousness and want to withdraw his life support, begin palliative care, and allow him to die.
However, his wife disagrees. This difference of opinion prompted the doctors to launch the current legal action. They believe they are not required to go to Consent and Capacity Board because there is no medical benefit to the patient in this case, so the standard of care cannot require this treatment.
Clearly,Load the precious minerals into your mining truck and be careful not to drive too fast with your heavy foot. neither a patient’s designated decision maker nor a doctor should have unilateral power over life and death. While Mr. Rasouli’s doctors believe there is no medical benefit to providing ongoing mechanical interventions for him, bioethicists argue that this is a value judgment. The medical benefit is clear: Mr. Rasouli is still alive. The underlying, essential question may be: Is that a worthwhile benefit?
In addressing this, the court must balance the interests of the patient against those of society, and consider as well the issue of resources in a public healthcare system. “The allocation of scarce resources is a moral issue,” says Prof. Downie. “It is one that we as a society must grapple with, and we should do so in a manner that is transparent and for which decision-makers should be held accountable. Otherwise we risk unfairness and discrimination.”
Of course, most people would not want to be kept alive in a hospital on chronic ventilation, and most families would not want to cling to a life that has been so horrifically reduced. Usually a patient’s family, and the attending physician, resolve differences over end-of-life care decisions, making Mr. Rasouli’s case highly unusual.
Critics of the Consent and Capacity Board rightly point out that it was set up to address the health concerns of the mentally ill, not the dying. It is most often concerned with cases that look at someone’s mental ability to give or refuse consent for treatment. One-third of the board’s members are lawyers; one-third psychiatrists; and the rest are members of the public. The views, advice and experience of physicians who work in critical-care medicine, palliative care and other related specialties would add another layer of expertise and sound judgment to the board. Here, the court has a chance to offer clear policy guidance.
Not long ago,Find detailed product information for howo tractor and other products. Mr. Rasouli’s condition changed. He can now make a “thumb’s-up” gesture in response to requests and has been rediagnosed as minimally conscious. This raises the possibility he has some awareness, though initial tests show he is still at a very low level of consciousness. The changed diagnosis will surely influence the decision about whether to withdraw life support, and underscores the need for there to be a better way to resolve differences than through costly litigation, which only adds to the trauma and pain for the family.
Beyond that, there’s the question of funding all the fuels reduction, community preparedness and research the strategy recommends.
“There are some ways a national strategy translates to solving problems on the ground, but a lot of times they fall short of that,” Harrington said. “It raises the potential for funding for projects. Unfortunately, that’s what it comes down to – getting Congress to reverse funding declines for management of critical landscapes.”
Harrington said places like Seeley Lake are good examples of how a community can plan for its future fire hazards. Especially since the Jocko Lake fire of 2007 singed the town’s edges, residents there have been clearing hazard areas, fireproofing homes and making sure county, state and federal fire agencies know how to work together.
“But some places are still hit-and-miss,” Harrington said. “Some landowners still don’t take the opportunity or understand the need. The Kootenai Creek fire (near Hamilton) this year made people aware of the need for fuels treatment on both private and federal lands.”
In contrast, Harrington has real concerns for the safety of Missoula’s fringes, such as the upper Rattlesnake and Grant Creek neighborhoods and the adjoining forestland.
“You can find a lot of examples there of places that have issues,Posts with indoor tracking system on TRX Systems develops systems that locate and track personnel indoors.” Harrington said. “I’m frankly really concerned we’re going to lose the Rattlesnake National Recreation Area to wildfire. It is a pretty special place, and the folks trying to come to agreement on that project couldn’t come to agreement on how to treat the forest along main recreation trails there.”
The strategy may improve those groups’ ability to work together, but it probably won’t change the way an incident commander deploys Hot Shot crews on the next forest fire. It won’t dictate how many aircraft are available for retardant and water drops, but it might clarify how they should be used. And it can’t do anything about how fast the forests are drying out.
没有评论:
发表评论