OTTAWA – The Supreme Court of Canada is set to rule today on a case that grapples with some of the thorniest end-of-life issues in a health care system strapped for cash and facing an aging population.
But unlike high-profile, assisted-suicide pleas that have dominated the news, this one involves forcing doctors to keep a patient alive on life support indefinitely.
Hassan Rasouli, a 61-year-old Iranian emigre, remains on a ventilator in a profoundly brain-damaged state following surgery for a brain tumour in 2010.
The doctors treating Rasouli at Toronto’s Sunnybrook Health Sciences Centre believe it is in their patient’s best interest to end the current treatment regime — effectively ending his life.
Rasouli’s wife, a licensed physician in Iran, has refused consent, citing the couple’s Shia Muslim religion and a belief that her brain-damaged husband’s movements indicate some level of consciousness.
Two lower Ontario courts both sided with Rasouli’s wife, but disagreed on the interpretation of the law, leaving it to the Supreme Court to sort out the legal complexities.
Interveners have high hopes the top court will look beyond the individual circumstances of Rasouli and his family and help interpret legal questions regarding the obligation to provide medical care that doctors and hospitals deem futile and not in a patient’s best interest.
The ruling could help sort out who gets to decide when medical treatments are no longer worth pursuing, and whether discontinuing treatment equates to hastening death or allowing a patient beyond hope of recovery to die.
“There is a difference between killing and letting die. This is letting die. It’s the natural conclusion of life,” Bernard Dickens, professor emeritus of health law and policy at the University of Toronto, said in an interview last year.
“And in that sense, there is nothing unnatural or nothing wrong about it. The difficulty is the family members — sometimes patients themselves — are sometimes not willing to accept that.”
The Rasouli case, in some respects, comprises a mirror image of the assisted suicide debate that has once again become the focus of public attention.
Last week, British Columbia’s Court of Appeal overturned a lower court and upheld a ban on physician-assisted suicide, likely meaning the Supreme Court of Canada will again be grappling with the issue in the near future.
And last month, a video by renowned microbiologist Dr. Donald Low put a poignant human face on the issue.
Low, who became known across Canada for his work during the 2003 SARS crisis in Toronto, appealed from death’s doorstep for terminally ill patients in pain to be able to die with dignity.
He died from a brain tumour just days after appearing in the video.