Court of Appeal of Quebec

A.P. c. Centre hospitalier universitaire Sainte-Justine

Marcotte, Moore, Baudouin

Appeal from a judgment of the Superior Court granting an application for authorization of care. Dismissed.

In June 2022, the appellants’ 5-year-old child drowned in a pool. He has been hospitalized in the intensive care unit of the respondent hospital since the accident.

The child is suffering serious sequelae, including significant diffuse brain ischemia that has placed him in an irreversible vegetative state. His prognosis is very grim: He will be on a feeding tube for the rest of his life, he will be unable to speak or see, he will have no awareness of what surrounds him, and he will depend on others for all of his everyday activities. Episodes of spastic quadriparesis also cause him great discomfort, even pain. His life expectancy is five years at the most.

Although the child can breathe on his own, he is connected to a mechanical ventilator by an endotracheal tube.

The respondent wants to remove the tube. Doing so presents a risk of death, not because the child depends on the machine to breathe, but because he might be unable to control his secretions, given his neurological condition.

The parents understand that extubation is necessary and beneficial for their child, but they refuse to accept that it could be fatal. They demand that he be reintubated in the event of failure.

The trial judge concluded that the parents’ refusal is neither reasonable nor justified, since they consider the best interests of their child only from the perspective of keeping him alive, regardless of his condition. Their position is influenced by their distrust of the treatment team and their religious beliefs. Subject to modifications to prepare for temporary and transitional reintubation in the event of surgery, the judge authorized the care plan, and he allowed the respondent to remove the tube without otherwise providing for the child’s intubation in the event of failure.

The evidence supports the judge’s conclusions that the parents’ refusal to consent to the care plan proposed by the respondent is not justified in the circumstances.

The judge properly weighed the evidence submitted and did not err in concluding that the requirements in article 12 of the Civil Code of Québec (S.Q. 1991, c. 64) are met. Extubation followed by reintubation in the event of failure is neither beneficial nor advisable for the child, and the potential risks of the procedure outweigh the expected benefits to the child.

Finally, the treatment plan proposed, as modified by the judge at the hearing, is in the best interests of the child and is consistent with good medical practice, even if it risks indirectly leading to his death.

Text of the decision: http://citoyens.soquij.qc.ca

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