Terrible decision by Ontario court in food and fluids case.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Several weeks ago the Euthanasia Prevention Coalition announced our intention to intervene in the Cement case, which was being heard by the Ontario Consent and Capacity Board. The Consent and Capacity Board is a judicial body that was established under the Ontario Health Care Consent Act to determine the course of treatment when a substitute decision maker disagrees with a proposed course of treatment that is being proposed by a hospital/doctors.

The Cement case concerns Hannah Cement, a 62 year-old woman with Down Syndrome and dementia, who is a life-long member of an Orthodox Jewish community and family. The substitute decision makers for Hannah, her family, refused to consent to a course of treatment that was comprised of the withdrawal of all treatment and care, including food and fluids and providing only comfort care.
 
John Campion, was the lawyer who represented the Euthanasia Prevention Coalition. EPC was granted a limited intervention standing based on our concerns related to the physicians defining food and fluid as medical treatment.

Donate toward the cost of the Euthanasia Prevention Coalition court intervention. (Link).

The substitute decision makers were willing to negotiate the level of care for Hannah but they were not willing to consent to the withdrawal of nutrition, hydration or ventilation.

The decision by Lora Patton, the Judge in this case, stating the following:

• No further antibiotics will be offered in the event of and for the treatment of aspirations although these may be offered as required for comfort measures to relieve discomfort; 
• No dialysis will be offered;
•  No vasopressors will be offered; 
• No CPR and no mechanical ventilation will be offered; 
• Feeding will cease if any of the above treatments are required but for the operation of this order. 
• All investigations and other interventions will cease. 
• Comfort measures consisting of the administration of medications to ease suffering, pain, shortness of breath, anxiety, nausea, or any other symptoms, including bacterial infections, will be provided.

Patton ordered that the decision must be implemented by April 5, 2019.

This decision undermines the clear and unified wishes of the substitute decision makers (her family), it ignores the position of her life-long faith tradition, it will result in her dying by dehydration, and it is based on a discriminatory premise that Hannah's clear wishes cannot be ascertained because she has Down Syndrome.

I hope that this decision will be appealed and I hope that the Euthanasia Prevention Coalition will once again be given intervention standing in this case to argue why nutrition and hydration does not constitute a form of medical treatment, but rather normal care.

The significance of the Cement case.

This is a precedent setting case in Canada concerning the definition and provision of assisted feeding.

In 2014, the Euthanasia Prevention Coalition intervened in the Bentley spoon feeding case. In February 2015, the BC Supreme court, in the Bentley case, decided that:

Oral nutrition – like spoon feeding – should not be considered health care or medical treatment, but rather seen as basic personal care and support.

The British Columbia Court of Appeal decided not to hear an appeal of the Bentley decision establishing the precedent that spoon feeding is not medical treatment.
 
If food and fluids are defined as medical treatment, then food and fluids can be withdrawn in the same manner as withdrawing or withholding any type of medical treatment.

For Hannah Cement, the withdrawal of fluids will cause her to die by dehydration.