This document discusses culturally competent healthcare, specifically in end-of-life care and palliative care situations. It addresses how cultural competency involves understanding patients' cultural and religious beliefs, providing examples of how those beliefs influence decisions around prolonging life, pain management, and end-of-life rituals. It also summarizes how Canadian law determines how healthcare practitioners should resolve disagreements with patients or substitute decision-makers regarding treatment, considering patients' sincerely held cultural or religious beliefs. Finally, it lists several tools and principles that help ensure ethical and legal obligations are met when making end-of-life decisions for critically ill patients.

1. Omar
Ha-Redeye

2. Cultural Competent Health Care
• Focus today:
• 1) What does culturally competent health care mean?
• Specific examples in end of life care or palliative care
• 2) How disagreements between health care practitioner and
patient/SDM are resolved
• Role of patient’s faith or cultural beliefs in these disputes
• 3) Questions

3. • Omar Ha-Redeye, Ruby Latif, & Kashif
Pirzada: Integrating Religious and Cultural
Supports into Quality Care in the Last
Stages of Life in Ontario (2017)

4. Cultural
Competency is a
Journey
Australian Government Department of Education, Employment and
Workplace Relations for the Council of Australian Governments,
Educators’ Guide to the Early Years Learning Framework for Australia,
2010 (pp 25-26), available at: https://www.dese.gov.au/national-quality-
framework-early-childhood-education-and-care/resources/educators-
guide-early-years-learning-framework-australia

5. Examples in End-of-Life
Different perspectives on:
• withholding or withdrawal of therapy
• Prolonging life
• Double effect (palliative care that may
inadvertently hasten death)
• Pain alleviation
Use of specific rituals or rites
Involvement of spiritual leaders or
family members
• Challenges during COVID-19 pandemic
Access to Immediate Release Morphine
Alleviating the access abyss in palliative care and pain relief—an
imperative of universal health coverage: the Lancet Commission
report, Oct. 13, 2017,

6. How Beliefs are Understood
Test from Syndicat Northcrest v. Amselem and
s. 2(a) of Charter:
1. Sincerely-held belief
2. Whether that practice or belief is
connected to a religion
• Individualized test that does not require
authorization by religious authority
Keep in mind that the protection of “creed”
under the Ontario Human Rights Code is
broader than religion
• See OHRC’s policy on Creed

7. Checklist to Meet Ethical and Legal Obligations to
Critically Ill Patients at the End of Life (ChELO)
6 questions used to meet ethical and legal
obligations to patients at end of life
Equips healthcare professionals to guide
conversations about end-of-life care with
patients and substitute decision makers (SDMs)
Used as evidence in Consent & Capacity Board
proceedings
• NS (Re), 2017 CanLII 24872; 2017 CanLII 24872
(ON CCB)

8. Principles under HCCA
a person is presumed to be capable to consent
to treatment (s. 4(2))
SDM must provide or refuse consent in
accordance with the values and beliefs of the
incapable person (s. 21(2))
Health care practitioner may apply to Board if
they believe that SDM did not comply with s.
21
• Onus is on health care practitioner to prove their
case

9. Cuthbertson v. Rasouli, [2013] 3 SCR 341

10. Not Limited to Values and Beliefs Alone
The effect of the treatment
• Improve, prevent from deteriorating,
reduce extent of deterioration
Likelihood of improvement without
treatment
Benefit from treatment outweighs
risk of harm
Less restrictive or intrusive
treatment would be as beneficial
Speak Up Ontario, “The Substitute Decision Maker Hierarchy,”

11. Questions
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