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Thursday, September 11, 2014

Doctors impose DNR order, ignore family's pleas, leading to patient's death

You might be aware that recently doctors in Toronto did not assist Douglas DeGuerre, an elderly man who was having a heart attack, with the result that Mr. DeGuerre died. He was very sick with heart disease, diabetes, and other conditions, and had just undergone double leg amputation. Although Mr. DeGuerre's daughter was present and begged the medical staff at the hospital to save her father, they said that a Do Not Resuscitate (DNR) order had been put in place for her father and refused to take action.

If you would like more facts and background than the brief summary I've provided, click here to go to the article in the National Post that originally reported the story.

The story is causing quite a stir among doctors, but also among lawyers who prepare health care directives for their clients. It's my understanding from reading this story that the man's daughter was properly appointed as his substitute decision-maker (otherwise known as health care proxy, power of attorney for personal care, or health care agent). Therefore she was authorized and empowered to give directions regarding her father's health care. The doctors' failure to provide emergency care to Mr. DeGuerre appears to be directly contradictory to current law.

As lawyers, we need to know that when we describe to a client the legal effect of a document they are signing, we are telling them accurately what to expect. It's concerning to us that a medical board would impose a DNR order that directly opposes the instructions given by a substitute decision-maker. We cannot assist our clients to meet upcoming challenges if we don't have confidence that the legal system is being upheld.

The question at the core of all of the controversy is who gets to decide whether life-saving measures are taken with respect to any given patient - the doctors or the substitute decision-maker. The doctors are not the enemy; we all just need to know how to work together on these issues.

Now the daughter is seeking disciplinary action against the doctors. Her initial complaints to the College of Physicians and Surgeons, the regulatory body that oversees doctors, were dismissed. She appealed this to the Health Professions Review and Appeal Board, who, in a rare move, disagreed with the College and ordered that disciplinary hearings be re-opened.It has also instructed the College to ensure that its policies are updated and fine-tuned to accord with current law and court rulings.

My heart goes out to Mr. DeGuerre's family, but also my thanks, as this sad case might be the catalyst for positive change for all of us.

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