Cuthbertson v. Rasouli -- Consent Is Not Static

The Ontario Courts in Rasouli held that once a life-sustaining intervention is ever offered to a surrogate, it cannot be withdrawn unless and until there is consent.  While the language of the HCCA seems to force the courts into this ridiculous corner, there are good reasons to read the statute to not require this result.  

If I were a small plane pilot in clear, smooth sky, I might hand the controls over to my less-experienced brother to get some flying practice.  But if there were increased air traffic or turbulence or if it were time to land, then I would take the controls back.  Just because I offered him a chance to fly, does not mean I meant the offer to be permanent and irrevocable.  There were obvious implied conditions to the offer.  

So too in medicine.  Consent is an ongoing process.  As the patient's condition changes, the physician has a duty to redo the informed consent and present new options.  So, the consent based on the original options is conditioned on the then-current conditions.  If implied conditions are eliminated by the rulings in Rasouli, then physicians may never offer certain interventions (a time trial of therapy), if they might be concerned they could never withdraw it once it became clear the therapy was not effective.  Alternatively, physicians would be forced to be ultra-explicit and make the original consent patently conditional.