New Case - In re S.S. - Surrogate Wins

In the past few weeks, there have been two cases of surrogate selection in medical futility cases.  First, in the ongoing high-profile Joseph Maraachli case, the Ontario CCB ruled in favor of the hospital and ordered the parents to consent to the recommended treatment.  Second, in the Albert Barnes case, the Minnesota probate court ruled in favor of the hospital.  It removed the patient's wife and appointed a new decision maker. 

In contrast to these two cases, in another recent case the CCB ruled in favor of the surrogate.  In In re S.S., the patient was a 58-year-old woman inpatient at Grand-River Hospital in Kitchener, Ontario (pictured).  She was admitted to ICU in October 2010 with catastrophic brain injuries.  "She has had a full tracheotomy and has been on full life support since that time. The patient has a history of diabetes, severe neuropathy, renal failure, hypertension, glaucoma, and is wheel chair bound. She recently suffered a multivascular stroke involving the neurocortex as well as ischemic brain lesion. A tube feeds her." 

The medical team was of the opinion that this patient would "not recover from her medical difficulties and that acute interventions such as ventilation, resuscitation, life support sustaining measures and future admission to an ICU are futile and therefore not medically indicated."  Because the patient's daughter and substitute decision maker refused to follow the team's advice, the team applied to the CCB under Section 37 of the Health Care Consent Act.

But the CCB found that the surrogate (the patient's daughter) proved that the patient was of the Muslim faith and would want "life to be sustained at all costs, even if there is pain . . . ."  Since a surrogate can be replaced only if she violates Section 21 of the HCCA, the CCB dismissed the physician's application.  This surrogate complied with Section 21, because she made her treatment decision in accordance with the patient's "values and beliefs."

This case illustrates one of the key limitations of a surrogate selection approach.  Sometimes the surrogate is a true and faithful agent for the patient.