A little more than a year ago, Hassan Rasouli underwent surgery to remove a benign brain tumour. Instead of recovering, he developed a serious bacterial infection and suffered a massive injury to his brain and spinal cord. He has been in a coma, kept alive by a ventilator and a feeding tube, ever since.
Mr. Rasouli?s doctors at Toronto?s Sunnybrook Health Sciences Centre agreed the 60-year-old father was in an irreversible coma known as a persistent vegetative state and believed that rather than keeping him alive on life support, Mr. Rasouli was actually slowly dying of complications from being confined to a hospital bed. They told his family they planned to take Mr. Rasouli off a ventilator and place him in palliative care until his death.
His family disagreed, saying Mr. Rasouli was making noticeable improvements and that not attempting to prolong his life was against their Muslim faith.
The doctors took their case to court, arguing that life support that didn?t benefit a patient couldn?t be considered a medical treatment under the law. By requiring doctors to get approval from Mr. Rasouli?s family to take him off of a ventilator, the court would set a dangerous precedent that would force doctors to obtain consent anytime they wanted to refuse or stop a treatment that wasn?t working. Two Ontario courts have sided with Mr. Rasouli?s family. But on Thursday, the Supreme Court of Canada agreed to hear the doctors? appeal in a case that could end the enduring legal confusion that has forced doctors and families into court battles over end-of-life health-care decisions.
It is a case that could be ?the most significant judicial examination of medical futility ever in the world,? said Thaddeus Pope, director of the health law institute at Hamline University in Minnesota and one of America?s leading academics on end-of-life issues.
The family has started a Help Hassan Rasouli Facebook page stocked with photos of Mr. Rasouli, his eyes open but unfocused, raising his fingers, grasping objects and attempting, the family says, to give a thumbs up.
?He wants to live and his family wants him to live,? the family wrote in response to questions Mr. Pope posted on his blog about medical futility issues. ?When there is hope and actual evidence for hope, as there is for Hassan, medical intervention is not futile.?
His doctors have said the movements are nothing more than the automatic reflexes of an irreversibly unconscious man.
The Supreme Court?s ruling could significantly alter Canada?s medical landscape at a time when hospitals are likely to face more such cases as the country?s aging population turns to a medical system strained for resources.
?We will have an ever-increasing number of incapacitated elderly patients who are unable to make these decisions themselves, who have not made advanced directives for these sorts of cases and where you could easily see where family members and doctors will be at loggerheads about what should happen,? said Udo Schuklenk, a Queen?s University medical ethics scholar who chaired a Royal Society of Canada expert panel on end-of-life issues.
Both doctors and family members of patients have an ethical conflict of interest in such cases, which should be left to an impartial third-party to decide, Mr. Schuklenk said. As much as families want the medical system to stop at no expense to keep their relatives alive, such decisions tie up valuable resources that could be used to help patients who could actually recover. At the same time, doctors may be equally biased in making such decisions, he said.
?It would be better if this decision was not made by doctors and not by the relatives or the family either,? he said.
?Doctors might have a conflict of interest in regards to what?s best, they might already have some other patient in mind who is also looking at using a particular resource. The families, of course, also have a conflict of interest because they also don?t see the bigger picture. So it would be much better if somebody removed from the case would look at this impartially and make that decision.?
National Post
tmcmahon@nationalpost.com
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