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November 28, 2011; By: Audrey Miller
All About Estates

There has been much discussion lately regarding end of life decisions. Most recently the Court of Appeal of Ontario released its decision in June 2011 in the case of Rasouli v Sunnybrook Health Science Centre which looked at whether or not removal from a mechanical ventilator and placing the patient on palliative care would be considered treatment under the Health Care Consent Act and that the Substitute Decision Maker’s consent was required. The Globe and Mail (TGAM.CA/ENDOFLIFE) has a series being published this week exploring this difficult and emotional issue. If something happened today to you and you no longer had capacity and could not communicate your wishes, would your family know what you wanted? Even if your wishes were clearly detailed, can your instructions be legally followed? These issues are further complicated as to who can access palliative care and what hospital policies dictate.

The World Health Organization definition of palliative care is:
“Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.

Palliative care:
*provides relief from pain and other distressing symptoms;
*affirms life and regards dying as a normal process;
*intends neither to hasten or postpone death;
*integrates the psychological and spiritual aspects of patient care;
*offers a support system to help patients live as actively as possible until death;
*offers a support system to help the family cope during the patients illness and in their own bereavement;
*uses a team approach to address the needs of patients and their families, including bereavement counselling, if indicated;
*will enhance quality of life, and may also positively influence the course of illness;
*is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications.”

I know families who could not obtain a hospital palliative care consult and others who have had family members admitted only to have them discharged back to their previous ‘home’ because the ‘end date’ was not clearly imminent.

The right to choose challenges legal, moral, economic, cultural and societal issues to our fundamental core. I don’t have the answer but I can make my wishes known.

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