In a major victory for Canadians fighting against euthanasia, the Canadian Supreme Court ruled today that doctors can’t remove a patient’s life support without their consent.
The Canadian Supreme Court heard the case of stroke patient Hassan Rasouli, a 61-year-old man with severe cognitive impairments.
In October 2010, Hassan Rasouli had surgery at the Sunnybrook Health Sciences Centre (the Hospital) in Toronto to remove a benign tumor in his head. Following the procedure, Mr. Rasouli developed bacterial meningitis and ventriculitis. The infection caused a severe and widespread brain injury as well as damage to the brainstem and the spinal cord. He has been in coma since October 16, 2010 and is on a ventilator and being fed through a tube inserted in his stomach.
Doctors wanted to stop life support, but his family says that as a devout Muslim, he would want the care and filed suit. Rasouli is not unconscious, but what is often described as “minimally conscious.”
Rasouli was examined on five occasions, before his doctors, Dr. Brian Cuthbertson and Dr. Gordon Rubenfeld, decided that he is in a Persistent Vegetative State (PVS) and that they would withdraw all treatments, including ventilation.
Chief Justice Beverley McLachlin wrote the opinion for the Canadian Supreme Court, which ruled 5-2 that patient’s can’t have their life support revoked without consent.
“Rasouli is profoundly disabled. But does that mean doctors should be able to decide that his time has come to die? If the hospital and doctors seeking to impose futile care on Rasouli over his family’s objection prevail, that could be the result,” bioethics writer Wesley Smith says of the case. “Allowing doctors to unilaterally refuse wanted life-sustaining treatment would institute a profound change in the fundamental purpose of medicine.”
“Indeed, if Rasouli loses the case, maintaining life when that is what the patient wants will no longer be a fundamental purpose of medicine. Lives will only be saved if doctors believe it is worth the effort,” Smith added. “Not only that, but a Rasouli loss would allow doctors to veto a patients advance directive. In other words, if patients say they don’t want treatment, that will be sacrosanct. If patients say they do, that will be ultimately up to doctors.”
Alex Schadenberg of the Euthanasia Prevention Coalition also weighed in on the importance of the case.
“The Rasouli case is a precedent-setting case of national importance that will decide whether doctors must obtain consent before withdrawing life-sustaining medical treatment,” he said. “There have been many previous cases whereby a doctor has withdrawn life support against the previously expressed wishes of a person or without the consent of the substitute decision-maker. Many of these decisions were made based on futile care theory, cost containment, and “quality of life” evaluations by doctors. Some of these decisions result in a death by “slow euthanasia” (dehydration of a person who is not otherwise dying) and many are based on negative attitudes toward people with disabilities or other vulnerable people.”
“The Rasouli case will determine whether doctors are required to obtain the consent of the patient, the patient’s guardian, or the Consent and Capacity board before withdrawing life support. This decision will apply to all life-sustaining interventions, including the withdrawal of hydration and nutrition,” he said.
Parichehr Salasel, Mr. Rasouli’s wife, a doctor who was a doctor in Iran and who is his substitute decision-maker, met with the physicians and discussed their proposed treatment plan (non-treatment). She refused to consent to their treatment plan.
In response to the request to remove life support, the doctors attempted without success to have Mr. Rasouli transferred to another hospital in Toronto.
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Ms. Salasel applied to the court for an injunction to prevent the doctors and the hospital from withdrawing life-sustaining treatment from her husband. She believes that Mr. Rasouli is not PVS. She stated that he is moving and he has some awareness of his surroundings. She will not provide consent to withdraw the ventilator from her husband because the action is not consistent with their religious views. As Shia Muslim’s, they believe that life must be respected and upheld until all signs of life are gone.
The doctors state that they are not required to continue providing treatment which they believe lacks benefit. They stated that they are obliged to refrain from continuing such treatment even if the patient or substitute decision-maker does not consent to the withdrawal. In other words, they believe that they have the right to withdraw life-sustaining medical treatment or care without consent.