Ontario Appeal Court Rules No Consent Required for DNAR Order (Cefarelli v. Hamilton Health)

This week, the Court of Appeal for Ontario issued an opinion that, at first glance, seems to directly contradict its June 2011 ruling in Cuthbertson v. Rasouli (the appeal of which is still pending before the Supreme Court of Canada).  But Cefarelli v. Hamilton Health Services is consistent with Rasouli, which held that consent is always required to stop life-sustaining treatment.  

The Cefarelli case concerns end-of-life decisions affecting Antonio Costantini.  Clinicians apparently placed a "no-CPR order" without consent.  A family member sued.  The trial court ruled that consent was not required, and that the appellant was effectively making a request to impose CPR treatment which carries no possibility of medical benefit, but would only inflict harm.  The appellate court affirmed.  

The Court explained that clinicians did not need consent for the "no CPR order," because "the November 2012 treatment plan (which was consented to) gives the responsible physician discretion regarding which components of cardiopulmonary resuscitation are to be used and which are not."  Therefore, the "no CPR order" was "simply one available to the doctor within that plan.  It cannot be said to be a withdrawal of treatment from that treatment plan.  No question therefore arises of the need for consent."