Who gets to make the decision?

[betsy]

This case is important.

Who gets to decide who lives and who dies?

On Monday, the Supreme Court of Canada will wade into that ethical minefield as two doctors from Sunnybrook hospital seek to unilaterally pull the plug on a patient they’ve decided no longer medically benefits from being on a mechanical ventilator.

No matter what the family wants.

The case surrounds Hassan Rasouli, a 60-year-old retired mechanical engineer and devout Shia Muslim. He’s been on life support at Sunnybrook since October 2010 after contracting bacterial meningitis in the hospital following successful surgery for a benign brain tumour.

The once vibrant father of two, newly arrived from Iran, slipped into a coma and after six weeks, his medical team announced to his family that there was no hope and they would be removing his ventilator and feeding tube the next day.

A doctor herself in her native Iran, his wife Parichehr Salasel stood in front of Rasouli’s bed and told them that they’d have to kill her first.

“In the view of Shia Muslims, life is sacred. A person is entitled to remain alive until all signs of life are gone. Preventable death must be prevented,” the family says in their factum.

When doctors and families can’t agree, such end-of-life disputes usually proceed to the Consent and Capacity Board (CCB) where an independent expert panel mediates on what should be done. Instead, the critical care doctors at Sunnybrook went to court to insist that they didn’t need consent to withdraw futile medical treatment.

So far, the judges have ruled against them. Last year, the Ontario Court of Appeal upheld a lower court ruling that found the physicians needed to obtain the family’s permission or refer the case to the CCB. But the Sunnybrook doctors pressed on and appealed to the Supreme Court, determined to have a definitive legal answer to a debate that will only grow as the population ages and more expensive medical machinery exists to keep people alive almost indefinitely. “If the Court of Appeal’s decision stands, patients and their surrogates will be legally entitled to insist upon receiving an array of futile treatments.”

In the meantime, Rasouli defied his doctors and actually began to improve. As his devoted family remained at his bedside, talking to him, reading to him, convinced that he was still there, he began to respond. He was able to catch balls when gently tossed into his hands, give a thumbs up or peace sign when requested, track them with their eyes. A neurologist confirmed his slight progress and upgraded him to “minimally conscious” (MCS) from his previous vegetative state. Patients in MCS have a 33% chance of making a marked recovery.

Still, the Supreme Court refused the family’s application to quash the doctors’ case.

The Sunnybrook physicians insist Rasouli is only exhibiting reflexes. “It is clear that Mr. Rasouli’s family loves him very much, and that they desperately wanted to believe that he was conscious and improving. Unfortunately, it is also clear this coloured their interpretation of his behaviour,” they say in their factum.

“The purpose of critical care medicine, including life-support measures, is to support the patient long enough to allow recovery from a reversible illness. Where, as in Mr. Rasouli’s case, there is no reversible illness from which he can or will recover, life-support serves no medical purpose.”

But it is not that clear cut or definitive. This is a family who believes there is still hope and the life of a vulnerable man hangs in the balance. And perhaps, one day, ours as well.

“It is not a matter of medical judgment that people need food, water and air,” Rasouli’s family argues. “Patients, patients’ families and the public at large are entitled to reassurance that physicians are not hastening their patients’ preventable death without consent or oversight,”

Source: Alex Schadenberg, Executive Director, Euthasania Prevention Coalition

The Euthanasia Prevention Coalition had intervener standing in the Rasouli case at the Ontario Court of Appeal and we have intervener standing in the Rasouli case at the Supreme Court of Canada. The Euthanasia Prevention Coalition hopes that the Supreme Court of Canada essentially upholds the decision of the Ontario Court of Appeal.

The Euthanasia Prevention Coalition opposes giving doctors the right to unilaterally withdraw life-sustaining treatment from patients without consent and we are concerned about how the term “medical treatment” is defined, especially since the euthanasia lobby is attempting to have euthanasia defined as a form of “medical treatment” in Canada.

http://www.realwomenofcanada.ca/sunnybrook-doctors-ability-to-cut-off-life-support-goes-to-supreme-court-of-canada-2/

This kind of power can easily be abused. How far-fetched is it that a person be sentenced to death.....simply because his organ is needed by someone willing to pay?

Would racism or any form of bigotry play a part in this decision - what with all the financial cost of keeping a person alive?

[TimG]

This kind of power can easily be abused. How far-fetched is it that a person be sentenced to death.....simply because his organ is needed by someone willing to pay?

Sorry. As long as the money to keep people alive is coming from the taxpayers then medical doctors have a duty to refuse to provide futile care. That said, if the family wants to spend their own money then the system should allow them to do so.

Any bets that the family would NOT use their own money pay to keep this guy alive?

[betsy]

Sorry. As long as the money to keep people alive is coming from the taxpayers then medical doctors have a duty to refuse to provide futile care. That said, if the family wants to spend their own money then the system should allow them to do so.

Any bets that the family would NOT use their own money pay to keep this guy alive?

That is a tough question indeed....for it means a poor person is simply out of luck. Yet on the other hand, I see your point.

It's the possibility of abusing this power that worries me more. It is easy for corruption to set in.

Of course, we've all heard of organ harvesting.

If money were no object.....and you're given the choice between two places - and organ is guaranteed by both - where will you rather have your organ transplant/surgery performed? Mexico or Canada?

[betsy]

And what about if there's just simply too many babyboomers, and not enough beds? You think it's not quite likely to happen?

The medical profession's lethal arrogance over the Liverpool Care Pathway

Step by grudging step – and led by this paper – official Britain has begun to wake up to the scandal of the Liverpool Care Pathway.

The LCP is intended to ease the final hours of patients who are close to death and to spare them the suffering associated with invasive treatment.

Numerous relatives have claimed, however, that their loved ones were put on the Pathway – which involves the withdrawal of food and fluids as well as medical treatment – without their consent. Far worse, they claimed that some of these patients were not in fact dying when they were put on the Pathway, but were then starved and dehydrated to death as a result.

On Saturday, for example, the Mail told the story of 82-year-old Patricia Greenwood, who was put on the Liverpool Care Pathway by doctors in Blackpool, who removed all her feeding tubes and drips.

But then her family defied orders and gave her water, which sparked the beginning of a remarkable recovery. Now she is planning to go on a world cruise.

The controversy over the LCP was given fresh impetus in the summer when a group of doctors, led by neurologist Professor Patrick Pullicino from the University of Kent, claimed that death on the LCP was a ‘self-fulfilling prophecy’ and a form of backdoor euthanasia, being used to get rid of difficult patients and to free hospital beds.

As such claims mounted, the reaction by the medical establishment was to dismiss them out of hand.

In the past few days, however, the story has suddenly changed. The Association for Palliative Medicine, which had hitherto said there was no problem with the LCP, abruptly turned on a sixpence and said it was launching an inquiry into it. More...

Read more: http://www.dailymail...l#ixzz2F9xP9c6f

Follow us: @MailOnline on Twitter | DailyMail on Facebook

Edited December 15, 2012 by betsy

[cybercoma]

betsy, could you revise your thread title to something that describes the topic a little better?

[TimG]

It is easy for corruption to set in.

Which is why proponents of the current model feel the courts should be able to review any individual case as a safety valve.

Of course, we've all heard of organ harvesting.

What does this have to do with this case? The issue at hand is whether further treatment is likely to be futile. If this is the case then the medical system should stop paying for it and use the money to pay for faster surgeries for people who are likely to benefit from treatment.

I realize that pro-life types get up in arms but the fact is care costs money and the only defensible position is that the family should pay for their own convictions. If they can't pay then it must be 'god's will'.

Edited December 16, 2012 by TimG

[betsy]

Which is why proponents of the current model feel the courts should be able to review any individual case as a safety valve.

And hopefully the courts will review each and every individual case.

What does this have to do with this case?

Not with this particular case. However, this case could open the door. Organ harvesting could be a lucrative enterprise, especially when it's fronted by an institution, such as a hospital. All it takes is someone with the penchant for corrupt practices ....or organized crime muscling in.

Let's face it, even if you don't sign those organ donors cards - how many of us gets to see the insides of the corpse to see if all the organs are there? How many ask the mortician of a funeral home if he found any organs missing when he was preparing the body? With cremation becoming the trend, is there a need for the mortician to open up a body?

Speaking of donor cards, there was talk a while back that instead of signing a donor card, what they're proposing to do is have you sign a non-donor card - saying you don't want to donate your organs - and without that card, they'd just go on the assumption that you wanted to donate your organs. The onus will be on you if you don't want to donate your organs. I don't know if that's already being implemented. I can understand that there's a long line up waiting for organs.....what's worrisome is those that don't want to wait, and are prepared to pay to get to an organ. Folks who can afford to pay won't have to be on a waiting list. If it's the life of a loved one - especially a son/daughter - who wouldn't want to jump the line, if the opportunity is there? They need not have to know the sordid details how that organ became available.

I'm just saying the big possibility is there.

The issue at hand is whether further treatment is likely to be futile. If this is the case then the medical system should stop paying for it and use the money to pay for faster surgeries for people who are likely to benefit from treatment.

I realize that pro-life types get up in arms but the fact is care costs money and the only defensible position is that the family should pay for their own convictions. If they can't pay then it must be 'god's will'.

I know what believers will do. They will readily leave it all in God's hands, and be at peace with it But we're not just addressing believers. People are not all believers.

The issue at hand is not simply the only issue at hand. What we've got is the proverbial can, and the Supreme court holds the proverbial can opener.

[TimG]

I know what believers will do. They will readily leave it all in God's hands, and be at peace with it But we're not just addressing believers. People are not all believers.

And the system should not care what people believe. The only factor is the prognosis and whether further treatment is likely to be futile. If, in the judgement of medical professionals, treatment is futile then it should be discontinued with the caveat that the courts can overrule the medical professionals if it can be shown that professionals in a specific case erred.

[betsy]

And the system should not care what people believe. The only factor is the prognosis and whether further treatment is likely to be futile. If, in the judgement of medical professionals, treatment is futile then it should be discontinued with the caveat that the courts can overrule the medical professionals if it can be shown that professionals in a specific case erred.

But the doctors want to bypass that, if I'm not mistaken. I think that's what they're suing for - to be able to just go ahead and unplug a person.

In a quite similar way, that's what's been happening to the elderlies in UK. The doctors were making decisions who and when a person should die. As the evidences showed, those whom they deemed ready to die managed to rally up and were fine....just providing them with the basic necessities such as food and water. (see the article)

[TimG]

But the doctors want to bypass that, if I'm not mistaken. I think that's what they're suing for - to be able to just go ahead and unplug a person.

No - what I describe is what the doctors are asking for. The case has gone to court because the family wants to ignore medical advice and force the taxpayers to keep paying for futile treatment. The court needs to rule whether these kinds of decisions to spend healthcare funding are made by the family or by medical professionals.

In a quite similar way, that's what's been happening to the elderlies in UK. The doctors were making decisions who and when a person should die.

Again, the system does not have infinite funding and it is unreasonable to expect funding for futile care. If someone has a problem with the decisions made by the medical professions then they should spend their own money.

[Guest]

Who would be better qualified to make the decision rather than Doctors? It should be made clear in a society that Doctors are going to make the decision, and anyone who doesn't agree doesn't get plugged in in the first place.

Let them get their own damn plug.

People are playing God by keeping people alive, and it should stop!

Edited December 16, 2012 by bcsapper

[Sleipnir]

That is a tough question indeed....for it means a poor person is simply out of luck. Yet on the other hand, I see your point.

It's the possibility of abusing this power that worries me more.

Something occurred to me. Since you believe in the Christian God so deeply, why not let God to decide whether you will survive or not? Simply take the person off life support and see what God decides.

In my opinion, the decision should be made by doctors and judges. When it becomes clear that the individual in a vegetative state has no sign of activity in the region of gray matter and no prospect of regaining activity - then the person should die in a dignified manner. Hence, by euthanasia.

Edited December 16, 2012 by Sleipnir

[Bonam]

I think each individual should specify what they would want done to/for them in that situation, while they are able to do so. If a patient can survive on life support, has expressed the desire to do so while lucid, and such support is paid for within the context of the medical system*, I don't think any doctor, judge, panel, or even family member should have the right to disconnect them. Similarly, if the individual has expressed the desire not to be kept alive when there is no reasonable chance of recovery, then that choice should be respected. Such a decision should exist, in writing, for every individual. Family doctors / GPs should be tasked with collecting this information from patients they see to make sure a database with this info is available.

*in Canada, you've paid taxes into it your whole life and thus have the right to the care you would need in such a situation in my opinion (you're probably less of an expense, or at least comparable, to the system as a smoker, an obese person, or someone with most any kind of cancer or chronic disease, disorder, or mental illness); in the US it would be a matter of your insurance plan or any other applicable funding sources

Edited December 17, 2012 by Bonam

[TimG]

in Canada, you've paid taxes into it your whole life and thus have the right to the care you would need in such a situation in my opinion

Taxes are the 'insurance premiums' in Canada. The more that is covered the more taxes have to be paid. In the US people can save money on insurance but find themselves unplugged when worst happens no matter what their personal beliefs. Collectively we make the same choices in Canada (e.g. you cant get some drugs or treatments because they have not been approved by the health authorities). If someone really feels strongly they should buy private insurance to cover this eventuality. They have no right to expect that futile care be covered. Edited December 17, 2012 by TimG

[Bonam]

Taxes are the 'insurance premiums' in Canada. The more that is covered the more taxes have to be paid.

What is the incremental extra cost of ensuring that people that fall into situations in which they can be kept alive but from which they are unlikely to recover, the small subset of those people that specify that they want to be kept alive no matter what, do get kept alive? Now, I don't know the numbers, and I'm not gonna be bothered to look them up, but I am gonna go out on a limb and say that extra cost is tiny. That cost is tiny compared to the extra cost of providing all the needed medical care to people that smoke, or to people that are obese, or to people that go to the doctor more often than they need to, etc. And yet people are free to make those choices and get their medical care covered. So too should they be free to make the choice to be kept alive.

If you want to ban personal choices that may lead to increased medical costs, you have much bigger fish to fry than the tiny tiny number of people that end up in these protracted life support situations.

[TimG]

What is the incremental extra cost of ensuring that people that fall into situations in which they can be kept alive but from which they are unlikely to recover

Well - the best way to answer that question is to look at what insurance policies in the US do. Are there limits that restrict futile care? If not then you are probably right that we are arguing an irrelevant point.