Resolving Medical Futility Disputes - Alberta follows Ontario in Chalifoux v. Alberta Health Services

This month, the Court of Queen's Bench of Alberta released an eleven-page opinion in Chalifoux v. Alberta Health Services.  This is a rather typical medical futility case resolved in a typical fashion.



The Patient

Ava Alayla Chalifoux-Campiou was born in May 2014 with thanatophotic dysplasia.  This condition prevents her chest from being able to grow to accommodate her lungs.  Sun Hudson, the subject of one of the most high-profile U.S. futility cases, had the same genetic condition.



The Clinicians

The treating clinicians unanimously agreed that it was in Ava's best interests to have comfort measures only.  They, the facility ethicist, and even the mother's independent expert all agreed it was "ethically inappropriate" to continue intensive care interventions, because:  

• Ava's condition was "terminal" with "no known cure"  


• ICU interventions were "painful and distressing" 


• ICU interventions placed Ava at risk of "distressing complications"  

Unable to reach consensus in family conferences, Ava's treating clinicians sent her mother a letter advising that they would remove Ava from mechanical ventilation 48 hours later.



The Mother

Ava's mother sought an injunction to prevent the clinicians from removing mechanical ventilation.  But she did not explain why she thought it was in Ava's best interests to be maintained on mechanical ventilation.



The Court

The Court determined that Ava's mother was unable to appreciate Ava's best interests, because:

• she was not very involved with Ava's care


• she was not well engaged with the medical team  


• she had other personal circumstances that impeded her ability to make a decision   

In short, the Court held that the "ability" of Ava's mother "to make decisions that are in Ava's best interests" was "compromised."  


Notably, the Court specifically refused to hold that "physicians do not require the consent of the family or the approval of a Court."  Instead, much like the Ontario CCB, the Court found that Ava's parents were not acting consistent with the applicable standards for substitute decision makers.  The court provided the authorization that it held Ava's mother should have provided.