End of Life Decision-making: Application of Recent Legal Decisions in Canada
Description: This one-day course, which will include both presentations, panel dicussions, and opportunities for small group discussions, will focus on the topic of informed consent for end-of-life decisions. This intensive program features a multi-disciplinary set of discussions, questions and answers involving a consent and capacity legal specialist, a clinician, an ethicist and a health economist.
The emphasis will be on the significance of two major court decisions (Rasouli and Cefarelli) and the direct implications of these cases for your hospital end-of-life policies and practices. Topics covered will include: how to draft hospital policies that are consistent with legal and ethical standards on end-of-life issues; what is best practice in terms of end-of-life counseling for family members of patients and substitute decision makers; how best to support hospitals and health care practitioners in fulfilling their fiduciary, ethical and legal obligations towards patients and substitute decision makers at the end-of-life; and how to develop/revise materials to support decision making at the end-of-life, such as proactive training, empowerment techniques, and anticipatory brochures for substitute decision makers.
The seminar will cover:
1) A legal review of the recent Cefarelli and Rasouli decisions by Mark Handelman, including:
- Withholding, withdrawing, not offering treatment: when do you or don’t you need consent?
- Health practitioner’s legal obligations regarding “due process” for patients and surrogates at end of life
- [Ontario] Consent and Capacity Board Hearings or going to court: which is appropriate?
- Suggestions for developing/revising hospital policies and other materials to support end-of-life decision making
2) Practical advice from an experienced health care ethicist, Jonathan Breslin, for preventing and resolving end-of-life disagreements, including:
- Why the term ‘futility’ should be avoided in end-of-life discussions
- Negotiating care plans and trials of therapy
- What does “best interests” really mean?
- How to focus the discussion on the patient
3) A reflective discussion facilitated by an ethicist and clergy, Glenn Brown, focusing on:
- The place of your personal reflections on end-of-life issues
- The realm of the personal vs. the professional
- How to address feelings thay you must remove yourself from current or potential responsibilities?
- How to deal with the moral residue left by difficult cases
Outcomes:
1) An in-depth understanding of professional legal obligations regarding withdrawing and withholding life-sustaining treatment;
2) Advice for developing/revising end-of-life policies and decision-making materials;
3) Strategies for preventing and resolving end-of-life disagreements;
4) An opportunity for personal and professional reflection; and
5) Ideas about estimating and realizing the cost-savings implicit in integrating policies and practices around end of life care.
Who this course is for: health care providers, especially those who work in critical care; hospital administrators and board members; other health-care workers; EMS personnel; clergy of multiple faiths; practicing health care ethicists; lawyers and estate planners.
Registrants in this course will have the option to request a “call-back” to give participants and their workplace colleagues an opportunity to benefit from second thoughts about what they found in presentations, and what they said in discussions. This follow-up can be by telephone or face to face at the organization’s corporate address. Experience shows that the second thoughts, especially when shared aloud with others in your same context, create unexpected takeaways and help you to develop a complete picture of what you will and won’t do, and how you will feel about your choices and methods in the long run.
Pricing: $CDN 999 per registrant. The fee is $CDN 899 per person if three or more persons register from one organization. This fee includes pre-read material, a course binder, a full lunch, morning and afternoon health breaks, plus an optional call back session so long as it is requested and scheduled within eight weeks. Any instructors’ travel costs associated with the optional call back would be billed at cost as an additional charge.
Instructors:
Jonathan Breslin is a qualified ethics consultant with extensive training and experience in health care ethics. He has a PhD in philosophy, with a specialization in bioethics, from McMaster University, and a Fellowship and Senior Fellowship in Clinical and Organizational Ethics from the University of Toronto Joint Centre for Bioethics. From 2005 until 2012 he served as the full time Ethicist at North York General Hospital, a large community teaching hospital in Toronto, where he built and led that organization’s first comprehensive ethics program.
Glenn is a principal in the form The Practice of Ethics, which designs ethics programs for government and government-related business. Together with associates in another company, The Ethics Group, he designed the ethics training program for the top 150 Ontario Power Generation personnel responsible for the initial restart of the Pickering A nuclear power generator, a $1.1 billion project. He is a member of the Rouge Valley Health System's Research Ethics Board.
Mark Handelman was called to the Ontario Bar in 1978. Until 2001, he practiced law in London, Ontario, including civil litigation, criminal defense and prosecution. He was one of Ontario's first members of the Official Guardian Child Representation Program. Mark was appointed to the Consent & Capacity Board in 1998 and became a Vice Chair and Senior Lawyer Member in 2000. He became Acting Toronto Regional Vice Chair and then Regional Vice Chair in 2001, for which he stopped practicing law and moved to Toronto. He was the Board's only Vice Chair for quality assurance and presided at about 2000 Board Hearings—including the majority of the Board’s “end of life” cases. Mark’s term on the Board expired in 2008 and he is now in the private practice of health care law, representing health practitioners, SDMs and patients and advising and teaching health care providers.
