Plain Speaking at the End of Life

Over at the NYT New Old Age Blog, Paula Span interviews Stephen Workman on appropriate language at the end of life.  Here is just one example:

I don’t switch to comfort care. I discontinue any treatments that don’t contribute to comfort. Because if this is the day you’re switching to comfort, what kind of care are you switching from? A patient’s symptoms, like pain or shortness of breath — weren’t those important yesterday

There is no switch. We are always providing comfort care. We’re going to stop the things that don’t help you be more comfortable. Once you acknowledge that a patient is dying, nobody says, “Continue doing the things that hurt.”

This is precisely the error that the Ontario Court of Appeal made in Rasouli.  That court very heavily relied upon the "switch" to comfort care to support its conclusion that consent was needed.  The court assumed that palliative care was "new" treatment for which consent would be required.  While serious, the error is a simple, factual one.  If the court were to correct this false assumption, yet changed nothing else in its analysis, the court would reach an opposite conclusion:  that consent is NOT required.