Tag Archives: Court Intervention in Medical Decision Making

Withdrawing Life Sustaining Treatment – Terminal Extubation: Hassan Rasouli Part II Terminal Extubation

Hassan Rasouli, previously diagnosed as being in a permanent vegetative state, has now been diagnosed to be in a minimally conscious state. The reason for the change – his physicians noted that he is able to give a thumbs-up when asked by his wife and able to track with his eyes. His physicians are Drs. Brian Cuthbertson and Gordon Rubenfeld, two critical care specialists at Sunnybrook Health Science Center in Toronto Canada, one of the largest trauma centers in Canada, who have petitioned the Canadian Supreme Court for the authority to withholding life sustaining treatment without the consent or approval…

Withdrawing Life Sustaining Treatment – Rasouli Decision: We don’t need permission to withdraw life sustaining care Court Intervention in Medical Decision Making

On December 22, 2011, the Supreme Court of Canada agreed to hear the case of Cuthbertson and Rubenfeld versus Hassan Rasouli. The appellants, Drs. Brian Cuthbertson and Gordon Rubenfeld) are Mr. Rasouli’s physicians.    . The question before the court is whether physicians must seek approval from a legislatively created board of review before withdrawing a patient from life sustaining treatment. The statue was passed for a variety of reasons, including establishing a uniform standard of practice for the protection of patients across the country. The review by the Consent and Capacity Board is only required if there is some objection…

Withdrawing Life Sustaining Treatment -From Conscious, Non Terminal, Incompetent Part II Withdrawal/Withholding of Care

Physician Liability: Withdrawing and Withholding Life Sustaining Care From  Conscious, Non Terminal, Incompetent Patients – Part II There are different standards that must be appreciated and respected before a physician can support a decision to withdraw life sustaining treatment from a non terminal and incompetent patient. This scenario requires the highest degree of protection for the patient. Our fundamental rights are the most important when we are the most vulnerable. Patients in this category are weak, often confused and subject to the effect of bias and undue influence. When illness requires life sustaining treatment family members may experience sympathy for…

Letting the Conscious Non-Terminal, Incompetent, Patient Die: Hold On a Minute – Not So Fast – Part I Withdrawal/Withholding of Care

It is an injustice to cause patients to unnecessarily prolong the process of dying. Actual futile care must be avoided. But it is equally an injustice to easily acquiesce to patient’s demands that my result in unnecessary death. On August 17, 2010 the Supreme Court of Pennsylvania decided a case involving a non-terminal, profoundly mentally retarded patient. The patient was conscious and non-terminal. David is 53 years old. David’s parents were the guardians. His parents argued that putting him on the ventilator was not in his best interest and requested terminal extubation. The hospital refused. After several weeks his condition…

Withdrawing Life Sustaining Treatment – Betancourt v Trinitas – Appellate Court Decision Bioethics Conflicts

The New Jersey Superior Court–Appellate Division dismissed the appeal in Betancourt v Trinitas finding the appeal moot. The court stressed it’s concern over the  “sparse record” presented at the time of  the original hearing in the trial court as well as on appeal and found that the evidence was not “conclusive in several areas necessary to fully adjudicate the substantial issues raised.” This is sometimes referred to as insufficiency of evidence. If the person or entity bringing the case does not provide sufficient evidence the court will dismiss the claim. In this case Tinitas Hospital’s request to withdraw the ventilator….

Withdrawing Life Sustaining Treatment – Betancourt v Trinitas – Life, Not Policy Withdrawal/Withholding of Care

Ruben Betancourt, 72 years old, was unconscious following the dislodging of a ventilator breathing tube after surgery at Trinitas Medical Center, which resulted in anoxic encephalopathy. He was readmitted to Trinitas in July 2008 with a diagnosis of renal failure. He received dialysis treatments, remained on a ventilator, and feeding tube. The physicians at Trinitas diagnosed Mr. Betancourt as being in a persistent vegetative state and told the family of their intention to stop dialysis and allow him to die. The Superior Court in New Jersey held a two day hearing and thereafter enjoined the hospital from withdrawing life support without the consent…

The Case of Baby RM – Court Intervention in Bioethics Court Intervention in Bioethics

This is the kind of case that courts dread. Baby RM has congenital myasthenic syndrome (CMS) and is on a respirator. The physician supports the mother’s request to terminally extubate. The father implores to the contrary. To make a decision the court must hear evidence, the kind of that will provide a clear picture of this child’s diagnosis and most importantly prognosis – short term and long term. Before the court can make a ruling this dilemma is best brought before the hospital ethics committee to review this case in detail, hearing from any physicians who are most familiar with this…

A Staged Approach to Withdrawing Life Support Withdrawal/Withholding of Care

A South Korean Ethics Committee uses a staged approach to Withdrawing Life Support In follow up to this blog’s April 23, 2009 post: “Letting the Conscious But Incompetent, Non Terminally Ill, Patient Die.” A South Korean hospital used a staged approach to consider the withdrawal of artificial life support based upon the condition of the patient. On June 11, 2009 an Ethics Committee at the Yonsei University Severance Hospital in Seoul Korea decided to remove a 77-year-old woman in a vegetative state from a respirator in accordance with a Supreme Court ruling.  Severance Hospital President Park Chang-il said:     “Though we…

Daniel Hauser – and Medical Confidentiality Dilemmas in Clinical Bioethics

I agree with the court’s rulings in the case of Daniel Hauser, highlighted in the media recently. In this case there is as absolute need to continue chemotherapy. It should however be pointed out that the Court ignored Mrs. Hauser’s demand for confidentiality and contributed to this case becoming a spectacle in the media and making Mrs. Hauser the focus of overwhelming media attention, pitting her beliefs against most of the country’s. This injudicious conduct may have contributed to the panic of the mother to leave the jurisdiction and hide herself and her son. The legal issues in this case…

Life, for some in Texas, is Cheap Abandonment

HEALTH AND SAFETY CODE CHAPTER 166.039. PROCEDURE WHEN PERSON HAS NOT EXECUTED OR ISSUED A DIRECTIVE AND IS INCOMPETENT OR INCAPABLE OF COMMUNICATION For the most vulnerable patients, without friends or family, life for some medical patients in Texas, is cheap.  On vague and specious grounds and without proper oversight or transparency, physicians may withdraw life sustaining treatment from a patient, even if the patient is conscious, talking, and aware of his or her surroundings. This statute allows this to occur if a physician treating the patient concludes that the patient will die within six months and there is no…