November 6, 2013

Terminally-ill Canadians have given a lot of thought to the kind of treatment they want at the end of their lives. I wonder what Hassan Rasouli thinks? More to the point, does Mr. Rasouli think?

Even after three years of being hooked up to life support and in a nearly vegetative state, Rasouli's daughter and wife are convinced that he does think.

His doctors have a different view. They say that Rasouli's family are mistaking reflexive actions for mental awareness. Such patients engage in activities such as opening and moving eyes, crying, smiling, frowning, grunting, yawning, chewing, swallowing, and moving limbs - - all which produce the illusion of conscious acts.

His case is hopeless and unethical as far as his doctors are concerned. They swear an oath to do no harm but the surgical and technical interventions performed on Mr. Rasouli amount to torture; keeping him alive biologically but in a state of living death.

Rasouli's doctors were so convinced of their case that they took it to the Supreme Court of Canada. Last month the court ruled that doctors can't unilaterally remove a patient from life support without the family's consent. The ruling is specific to Ontario which is the only province with a board to review such disagreements.

Chief Justice McLachlin spoke for the majority of justices: “Over the past 17 years, the Board has developed a strong track record in handling precisely the issue raised in this case.”

A minority of justices disagreed. “Such an extension of patient autonomy to permit a patient to insist on the continuation of treatment that is medically futile would have a detrimental impact on the standard of care and legal, ethical, and professional duties in the practice of medicine.” And these patients tie up a ICU bed worth about $1 million a year.

The illusion of life is persuasive with modern health care. Dr. Anand Kumar, a physician with experience in end-of-life treatment has a frank assessment.

“I can take a guy’s heart out and keep it beating on a stick. And if you put a gun to my head, I could even take a person who has been dead for 20 minutes and reanimate him. But when people say that they want everything to be done, at some point you have to say: Literally, everything? Or, do you mean, everything reasonable?”

What would Hassan Rasouli have wanted? We can only guess since he didn't give any directions as to medical intervention. As a retired engineer, I would think that Rasouli's rational choice would not to be kept artificially alive. But his family's wishes are clear: they want God to decide. But God has left the room and left Mr. Rasouli suspended by the too-clever devices of man.

In B.C., we don't have to leave the vagaries up to poorly written "living wills" or well-meaning family members. The Ministry of Health in cooperation with Interior Health and others have come up with a clearly written directive that specifies end-of-life care called My Voice -- Expressing My Wishes for Future Health Care Treatment.

I plan to fill mine out mine soon.

David Charbonneau is the owner of Thompson Studio
He can be reached at dcharbonneau13@shaw.ca