SCC to look at landmark end-of-life fight between doctors, family
Published Monday, December 10, 2012 8:22AM EST
Last Updated Monday, December 10, 2012 8:36AM EST
The Supreme Court of Canada is hearing a case today that could establish whether doctors have the right to withdraw treatment from patients who are believed to be in a persistent vegetative state -- even when doing so goes against the will of the family.
The case centres on Hassan Rasouli, 60, who has been on ventilator life support at Toronto's Sunnybrook Health Sciences Centre since October 2010 when he developed meningitis following a surgery for a brain tumour.
While Rasouli’s family believes he is conscious and can communicate with them, doctors believe he is in a vegetative state with no hope of recovery, and want to take him off life support.
Rasouli's wife, Parichehr Salasel, a family physician in her home country of Iran, has refused, saying doctors had given up too soon and there is still a chance her husband might recover.
Margaret Somerville, a medical ethicist at McGill University, said the case is not the first of its kind, but is the first to make it all the way to the Supreme Court of Canada.
The case has attracted so much attention, she said, because the court's decision could potentially give doctors the right to determine whether a person's life is worth living.
"I think people are worried that it would set a precedent that doctors all across the country could say no more treatment is necessary, regardless of what the family thought or it would seem regardless of what the patient thought because after all the family is sitting in for the person," she told CTV's Canada AM.
The disabled community is also worried about the decision, she said, because it could have repercussions for those who can't easily communicate to doctors, but are very much conscious and aware of what's going on around them.
"They don't want doctors to have that power. They're worried someone will look at them and say 'well, you don't have enough capacity to merit keeping you alive so we'll make that decision to withdraw treatment and we've got the legal right to do so.' That's why this case is very important."
In an interview at his bedside just days before the case is to be heard before the Supreme Court, Rasouli’s daughter, Mozhgan Rasouli, told CTV News that her father is now considered to be in a minimally conscious state, because of his responses to external stimulation. Within months at Sunnybrook, she said, her father was able to open his eyes when they called him, and give the thumbs-up and victory signs, she said.
“These were very significant changes and important changes,” Mozhgan Rasouli said.
Rasouli has been in intensive care at Sunnybrook for more than two years -- at a cost of up to $2,000 per day. His doctors, Dr. Brian Cuthbertson and Dr. Gordon Rubenfeld, believe he is not receiving any medical benefit from being kept on life support.
They argue that patients and their decision makers should not be able to force doctors to continue treatment in cases where the doctors see the medical care as inappropriate or ineffective.
When the doctors first took the case to court, an Ontario Superior Court judge ruled that if Rasouli’s doctors were not able to obtain consent from his family to take him off life support and begin palliative care, they’d have to leave the decision to the Consent and Capacity Board, which is a provincial tribunal that makes decisions on behalf of individuals who are unable to speak for themselves.
When the doctors appealed to the Ontario Court of Appeal, the court upheld the lower court’s decision, saying the doctors would either need consent from Salasel or the Consent and Capacity Board to end his life-sustaining care. Rather than go to the board for consent, the doctors asked the Supreme Court to decide the case.
In their submission to the Supreme Court, the doctors said that if the lower court decisions are allowed to stand, they would have serious consequences for the entire health-care system. They argued that protracted end-of-life care is a drain on the medical system and is of no benefit to Rasouli.
“Where a treatment offers no medical benefit to a patient, there can be no legal justification for requiring the treatment to be offered to the patient,” reads the physicians’ factum to the Supreme Court.
“In Mr. Rasouli’s case, there is no reversible illness from which he can or will recover, life-support serves no medical purpose. Moreover, he cannot experience any personal benefit from life-support measures in prolonging a life of which he is now unaware.”
The court is expected to hand down its ruling sometime in the next couple of months.