A Framework for Resolving Disagreement during End of Life Care in the Critical Care Unit

In the August 2010 issue of Clinical and Investigative Medicine, Karen Choong and colleagues provide "A Framework for Resolving Disagreement during End of Life Care in the Critical Care Unit."  They provide a 10-step approach for resolving disagreement.  The final step in the process, at least in the Canadian provinces Ontario and Yukon, culminates in submitting an application to the CCB (respectively, Consent and Capacity Board and Capability and Consent Board) on the grounds that the substitute decision maker is not acting in the patient's best interests.  



These Boards can act very quickly and are more expert than a regular court to adjudicate medical futility disputes.  One drawback, however, is that their decisions can be appealed to a regular provincial court.  Even on an expedited schedule that judicial review often takes so long that the underlying dispute often becomes moot in the meantime.