Daily BrewSupreme Court rules doctors can’t end life support, but debate not over
The Supreme Court of Canada issued a split decision on Friday that found doctors could not remove a patient from life support without consent, it a ruling widely seen to be the heaviest gavel swung in relation to Canada's "right to die" debate.
In a 5-2 ruling that the Court stated had no bearing on the ongoing "philosophical debate," the Supreme Court declared a comatose Ontario man could not be removed from life support without his wife's consent.
The case involves Hassan Rasouli, 61, who has been kept alive for years by a ventilator at Toronto's Sunnybrook hospital.
Rasouli has been unconscious and on life support since 2010, in what his physicians believe is a "persistend vegetative state" with no reasonable hope of recovery.
They sought to remove him from life support, but his wife has refused to provide her consent, setting up this legal battle widely considered to be a referendum on Canada's "right to die" laws.
In its Friday ruling, however, the Supreme Court said its ruling was not a final word on the philisophical debate. "The Court’s task is simply to determine what the statute requires," the ruling stated.
[ Related: Supreme Court upholds right to demand life support ]
Cases like these are heartbreaking, and both sides are doing what they believe is best for Rasouli. The physicians believe keeping him on life support will lead to further health problems and would prefer providing him with palliative care until his eventual death. His wife, Parichehr Salasel, can't bear to give up hope that he will miraculously recover, and cites the couple's Muslim religion as a reason for not giving consent.
She moved to block the physicians in court, they moved to secure the right to move forward without consent and, in the end, both the Superior Court of Justice and the Ontario Court of Appeal sided with Salasel. Now, in a 5-2 split decision, the Supreme Court has agreed.
"The (Health Care Consent Act) sets out clear rules requiring consent before treatment can occur, identifying who can consent for an incapable patient, stating the criteria on which consent must be granted or refused, and creating a specialized body to settle disputes, including those between SDMs (substitute decision‑makers) and physicians over consent regarding life support," Chief Justice Beverley McLachlin wrote for the majority.
The physicians had argued that life support in this case did not serve a medical purpose, but the argument was rejected.
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Those who ruled in the minority were more sympathetic to the plight of the doctors, finding that the Health Care Consent Act did give patients a right do decide what treatment option physicians must follow. 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," Justice Andromache Karakatsanis wrote.
In cases like these, doctors face an ethical dilemma not easily surpassed. It's hard to pull the plug and, when it is our loved one, it could be nearly impossible. But doctors see the same drama play out again and again, and when they say continuing life support is doing more harm than good, we should take heed.
McLachlin, however, does not exactly agree. “Wherever one draws the line, it is inevitable that physicians will face ethical conflicts regarding the withdrawal of life support,” he wrote. “No legal principle can avoid every ethical dilemma.”
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