Law & Ethics. Camille Ciarniello Director, Risk Management and Patient Safety Providence Health Care For the Health Care Ethics Seminar March 30, 2009. Objectives. At the end of this session, participants will be able to: describe how the law in British Columbia has evolved;
Director, Risk Management and Patient Safety
Providence Health Care
For the Health Care Ethics Seminar
March 30, 2009
At the end of this session, participants will be able to:
"The object of the common law is to solve difficulties and adjust relations in social and commercial life. It must meet, in so far as it can, sets of fact abnormal as well as usual. It must grow with the development of the nation. It must face and deal with changing or novel circumstances. Unless it can do that, it fails in its function and declines in its dignity. An expanding society demands an expanding common law.“
Prager v. Blatspiel 1924 England
“It is in my view not reasonable to infer that the doctor’s failure to give to his patient an opportunity two days earlier to elect to discontinue the dosage then being administered constituted an effective cause of the plaintiff’s ultimate misfortune”
4 Every adult who is capable of giving or refusing consent to health care has
(a)the right to give consent or to refuse consent on any grounds, including moral or religious grounds, even if the refusal will result in death,
(b)the right to select a particular form of available health care on any grounds, including moral or religious grounds,
(c)the right to revoke consent,
(d)the right to expect that a decision to give, refuse or revoke consent will be respected, and
(e)the right to be involved to the greatest degree possible in all case planning and decision making.
s 241. Every one who
whether suicide ensues or not, is guilty of an indictable offence and liable to imprisonment for a term not exceeding fourteen years.
1. The RSBC 1996, c. 181Canadian Charter of Rights and Freedoms guarantees the rights and freedoms set out in it subject only to such reasonable limits prescribed by law as can be demonstrably justified in a free and democratic society.
7. Everyone has the right to life, liberty and security of the person and the right not to be deprived thereof except in accordance with the principles of fundamental justice.
12. Everyone has the right not to be subjected to any cruel and unusual treatment or punishment.
15. (1) Every individual is equal before and under the law and has the right to the equal protection and equal benefit of the law without discrimination and, in particular, without discrimination based on race, national or ethnic origin, colour, religion, sex, age or mental or physical disability.
Dissent Lamer CJ
Majority – Sopinka J
Arthur L. Bloomfield, Professor of Medicine, Stanford University, 1888-1962
... [T]he longer she goes without, the more the risk is of her having serious oxygen deprivation to the point where [if] for argument sake she's not getting enough oxygen to her kidneys, they will shut down and cause essential poisoning of her system. If she does not get enough oxygen to her brain she can conceivably have seizures and other manifestations of the brain that will contribute to a faster demise or death.
AC’s attending physician to the Court
Declaration of Principles
The Legislative Assembly of Manitoba hereby declares that the fundamental principles guiding the provision of services to children and families are:
1. The safety, security and well-being of children and their best interests are fundamental responsibilities of society.
25(1) Where a child has been apprehended, an agency
c) may authorize the provision of medical or dental treatment for the child if
Child's consent required if 16 or over
25(2) Notwithstanding clause (1)(b) or (c), if the child is 16 years of age or older, an agency shall not authorize a medical examination under clause (1)(b) or medical or dental treatment under clause (1)(c) without the consent of the child.
Age of capacity
4(2) In the absence of evidence to the contrary, it shall be presumed for the purpose of this Act
(a) that a person who is 16 years of age or more has the capacity to make health care decisions; and
(b) that a person who is under 16 years of age does not have the capacity to make health care decisions.
Within a child protection context, the legislature has struck the balance between personal autonomy and sanctity of life differently than with respect to adults. Given the concerns over protecting the life of children in relation to essential medical treatment and the difficulty in determining capacity in these emergency situations, the choice of a best interests test for minors under 16 that takes the child’s wishes into account is not unfair or arbitrary. It represents a fair balance between the interests of the individual and those of the state
“Having someone else’s blood pumping through my veins, stressing my body, caused me to reflect on how my rights over my body had been taken away by a judge who did not care enough to talk with me”
“That day, my tears flowed non-stop. Nothing can properly describe how I was feeling and still feel today. I could liken it to being raped and violated but even those words do not express my feelings strong enough.”
Meetings with family week of February 4, 2008:
Petition for an Order that:
…this decision does not involve the consideration of whether medical advisors can be prohibited from withdrawing forms of treatment of life-support systems.
…the Petition raises the issue of whether, after certain treatment has ceased, the Court is in a position to order that the treatment resume where the medical advisors state that it is in their bona fide clinical judgment that the former treatment is contra-indicated.