Ontario Doctors prohibited from “Pulling Plug” Without Consent



The Ontario Court of Appeal recently dealt with the issue of whether consent is required from a patient or his/her substitute decision maker for the withdrawal of treatment in an end of life situation.


The Facts:

This case involves Mr. Rasouli, a patient who has been kept alive since October 2010 on a mechanical ventilator while being fed through a feeding tube inserted into his stomach. He developed bacterial meningitis and ventricultitis following surgery, which caused a severe and widespread brain injury as well as damage to the brainstem and the spinal cord.

The treating physicians formed the opinion that Mr. Rasouli is in a persistent vegetative state with no realistic hope of recovery and that ongoing mechanical intervention will provide no medical benefit or improvement. As such, they would like to “pull the plug” without obtaining consent of the family.

In the absence of Mr. Rasouli’s true wishes having been expressed when he was mentally capable, his wife opposes the withdrawal of her husband’s life support and takes the view consistent with the religious beliefs of Mr. Rasouli that his life be continued and that preventable death be prevented. In addition, the family points to situations where patients may be misdiagnosed and subsequently recover from their conditions. As such, she demands that consent from the patient and/or family of the patient be obtained before the physicians can “pull the plug”.


The Decision

The court acknowledged that the Health Care Consent Act requires that medical  treatment requires the consent of either the patient or his/her substitute decision maker. However, the question was whether or not the “withdrawal of life support” constitutes treatment. After a lengthy analysis, the court was satisfied that “Withdrawal of Life Support” falls within the definition of treatment and therefore requires consent.

In addition, the court pointed out the unclear case law in Canada on the issue of whether physicians must obtain consent in the withdrawal or withholding of medical treatment .

However, it did state that in certain cases involving end of life situations, Canadian courts have prevented doctors from acting unilaterally and it adopted this positon.



The precedent set by this case means that doctors require consent when withdrawing life support in Ontario.

In this case, consent was referred to the Consent and Capacity Board, which will determine what is in the best interest of the Mr. Rasouli. Pending the decision of the Consent and Capacity Board, the physicians are not permitted to withdraw Mr. Rasouli’s life support.


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