Supreme Court of Canada begins hearings in end-of-life case
OTTAWA, December 11, 2012 (LifeSiteNews.com) - Seven justices of the Supreme Court of Canada began hearings Monday in a case that could have profound implications for end-of-life decision-making in Canada.
The so-called 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 ventilation, hydration and nutrition.
“This is a precedent-setting case of national importance in Canada that will decide who has the right to decide to withdraw medical treatment,” said Alex Schadenberg of the Euthanasia Prevention Coalition.
“It is important to note that this case is not related to end-of-life treatment decisions, but rather life-sustaining treatment decisions. Some people are dependent on medical treatment, but not otherwise dying.”
The EPC is an intervener in the Supreme Court of Canada hearings.
The case concerns Hassan Rasouli who, in October 2010, had minor surgery at the Sunnybrook Health Sciences Centre 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.
Rasouli’s doctors, Dr. Brian Cuthbertson and Dr. Gordon Rubenfeld, decided that he was in a Persistent Vegetative State (PVS) and concluded that he had no hope of recovery. They therefore decided to withdraw all treatments, including ventilation.
However, Rasouli’s family, including his wife Parichehr Salasel, who was a doctor in Iran and who is his substitute decision-maker, disagreed with the diagnosis and sought an injunction to prevent the doctors and the hospital from withdrawing life-sustaining treatment.
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Ms. Salasel said she believes that her husband is not PVS. She stated that he is moving and he has some awareness of his surroundings. She said she will not provide consent to withdraw the ventilator from her husband because the action is not consistent with their religious views. As a Shia Muslim, she stated that life must be respected and upheld until all signs of life are gone.
The Ontario courts that originally heard the case ruled that doctors must obtain consent, either from the patient or his substitute decision makers, prior to withdrawing medical treatment. If consent is not obtained, the courts concluded that the doctors should have brought the case to the Consent and Capacity Board for a decision.
The doctors subsequently appealed to the Supreme Court, arguing that doctors should have the unilateral right to decide when medical treatment can be withdrawn.
The Evangelical Fellowship of Canada, also an intervener in the case, argues that a patient’s wishes and religious beliefs must be considered in decisions on withdrawal of treatment.
“This decision will impact not only how we treat seriously ill Canadians, but also whether we as a society value their wishes and their sincerely held religious beliefs,” said EFC Vice-President and General Legal Counsel Don Hutchinson.
“Patient wishes must be considered in regard to their medical care,” added Hutchinson. “In this case, Mr. Rasouli and his family also hold religious beliefs about life. The family wants Mr. Rasouli’s beliefs considered and are satisfied that the matter be heard by the Consent and Capacity Board.”
EFC Legal Counsel Faye Sonier pointed out that doctors have the faculty to provide a medical opinion but do not have the prerogative to make treatment withdrawal decisions based on medical diagnosis alone.
“The right of the patient to decide to accept or reject medical treatment [is] based on a decision made from the perspective of his worldview or framework of reference about life,” Sonier said.
“Physicians are not equipped to consider non-medical factors such as sincerely held religious beliefs and philosophical values of patients. When disagreement arises, the Consent and Capacity Board is the legislated venue to consider these factors and make these decisions.”
Alex Schadenberg said that giving doctors control over withdrawal of treatment decisions would not be in the best interest of patients.
“This is not simply a scientific decision,” Schadenberg said, “it deals with people’s values and beliefs. Moreover, doctors have their own biases which would influence their judgement, and sometimes, doctors make mistakes - they are simply wrong. So this unilateral power given to doctors would not be protecting vulnerable people.”