Friday, August 20, 2010

Brampton Civic hospital imposes euthanasia by dehydration through pressure tactics.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Alex Schadenberg
esterday, I received a phone call and then an email from Bernard Stephenson, concerning Joshua (Kulendran Mayandi) the pastor of a small christian Church in Brampton Ontario. The email outlined several significant concerns for the Euthanasia Prevention Coalition.

First: Joshua (48), who is not otherwise dying, is being dehydrated to death (euthanasia by omission). This is not a case when hydration and nutrition need to be withdrawn because he is actually dying and nearing death, but rather the decision appears to have been made to intentionally cause his death by withdrawing IV hydration and nutrition probably because he is unlikely to recover from his disability.

Joshua has otherwise stabilized and would likely live for many years in this condition. Society cannot condone intentionally dehydrating a person to death because of their disability or the potential cost of long-term care. Article 25 (f) of the Convention on the Rights of Persons with Disabilities states: Prevent discriminatory denial of health care or health services or food and fluids on the basis of disability.

Second: It is deplorable that the Consent and Capacity Board in Ontario, the hospital and the lawyer for the hospital, who are all paid by the government and have nearly unlimited resources to pressure people to consent to their will, appeared to appoint a Substitute Decision Maker (SDM) to make decisions on behalf of Joshua, based on that persons willingness to agree to a non-treatment plan, even though there is no proof that the plan of non-treatment represented the values of the person.

The Consent and Capacity Board was established to ensure that consent to treatment is based on the prior wishes or values of a person, before that person became incapacitated to make decisions for themselves. The fact that Joshua did not write down his personal wishes or assign a person to make legal and health care decisions on his behalf in these circumstances, does not negate the fact based on his religious convictions it is unlikely that he would have agreed to death by dehydration.

To pressure a person to agree to intentionally dehydrate a person to death, (euthanasia by omission) based on the cost of continuing the legal battle to defend the values of a person, is unconstitutional and inconsistent with Ontario law.

Everyone needs to strongly respond by sending letters and emails to:
Brampton Civic Hospital - email: or call the Communications Hotline at: 905-494-2120, ext. 22505.

Consent and Capacity Board of Ontario - email:, Phone: 416-327-4142, Fax: 416-924-8873

The letter should state:
I am disgusted with the decision by the Brampton Civic Hospital, its lawyer, and the physician for (Joshua) Kulendran Mayandi, to intentionally cause his death by removing his IV hydration and nutrition even though he is not otherwise dying (euthanasia by omission). If this decision is not reversed, it will create fear among the citizens of Brampton that if they experience a disability that they too would be killed by dehydration and starvation. 
For the sake of justice and equality, I demand that you change your policy and once again continue feeding.
The following is the email from Bernard Stephenson:

Joshua is a 48 year old pastor of a small Brampton Church. He was admitted to the Brampton Civic Hospital (William Osler Health Centre), after collapsing in front of the ER on May 29, 2010.

He was revived but not before sustaining a significant cognitive disability.

He remained in the ICU, but after regaining the ability to breathe on his own, he was transferred to the respirology ward, where he remains.

He has regained some ability to communicate despite the fact that he has a significant cognitive disability.

He has progressed from being in a deep coma with signs of decerebration and decortication to almost full movement of his arms and legs and coherent use of mostly one-word answers and occasionally multi-word sentences with his sister over the phone.

He recognizes the family he was living with for the past 10 years, who have been at his bedside from morning to evening, 7 days a week.

From the beginning of his stay in the ICU until now, the doctors have repeatedly asserted that there is no hope of recovery, from a medical point of view, and they have strongly suggested that all life-sustaining treatment be removed.

His family, who live in Sri Lanka, and his supporters here have rejected these suggestions.

Nevertheless, the fact is that he had assigned no Substitute Decision Maker (SDM), and he has no immediate family living in Canada.

His first physician in the ward, removed his feeding tube, without consent, leaving him only IV fluids.

He was in this situation for over three weeks until his supporters appealed to the Ethics Committee adn the Consent and Capacity Board through a lawyer and forced the hospital to restart feeding through a nasogastric (NG) tube. Even though he was entitled to a long term gastric (G) tube the physicians refused the latter option, even though they had initially suggested it, citing that it is 'artificial' and possibly 'harmful'.

Currently, the only option the hospital and his current physician is offering is to withhold all life-sustaining treatment and care including IV fluids, food and medication.

The court first rejected Joshua's sister, Mallika Arumugan, as his (SDM) because they did not consider her capable of making medical decisions for Joshua, but she also did not agree to the demands of the hospital.

After the court rejected Joshua's sister as his SDM, a friend for 25 years became the next option. We were told that this friend would only be accepted as the SDM if he agreed to the preconditions – palliative care with the removal of all medications, IV hydration and nutrition. The alternative was a continuation of the costly legal battle before the Consent and Capacity Board or allowing the Public Guardian to take over. Since we were not able to sustain the costly legal battle and the family did not want Joshua to fall into the hands of the Public Guardian, this friend decided to accept the terms. He was subsequently granted SDM status with those limiting conditions.

Personally, I disagreed with the decision as it was immoral, unethical, inappropriate and wrong besides being totally useless.

Brampton Civic hospital on August 17 withdrew all life-sustaining treatment and care, including fluids and food, based on the forced agreement between the hospital and the SDM.

I deplore what the hospital and doctors are doing. They have a duty to inform people about quality of life and treatment options in a given situation, such as Joshua's, but they do not have the right to impose their preference for death or to assume that Joshua would not want to live the rest of his life in this condition. The Hospital and doctor's actions are both unethical and inappropriate.

Bernard Stephenson, M.D., M.Div.

To contact Alex Schadenberg at the Euthanasia Prevention Coalition call: 519-851-1434 (cell phone)

To order the Life-Protecting Power of Attorney for Personal Care:


Anonymous said...

ON law requires that decisions be made in a patients best interest when there is no known prior wish. Sometimes, there are things worse than death. In this case, I presume 'cognitive disability' actually refers to something closer to a permanent vegetative state. The interventions required to keep a patient alive in this state are invasive and usually lead to other issues requiring increasing levels of intervention. The question of where to draw the line is not about when it becomes too much for the hospital, but rather when it becomes too burdensome for the patient.

Anonymous said...

Anonymous above states: "Sometimes, there are things worse than death....The question of where to draw the line is not about when it becomes too much for the hospital, but rather when it becomes too burdensome for the patient."

If the patient can't speak for himself, then WHO is deciding whether something is too burdensome for said patient? And who makes the determination as to whether something is worse than death? It is not up to us to judge that, especially if we believe in God.

There is much at the core of this problem, and the root is the lack of dignity for the human person. Who are we to judge the worth of another! Isn't this what happened in the days of slavery?

In the end, isn't it better to err on the side of LIFE than to make a mistake and cause death?

Anonymous said...

There are so many cases where doctors have declared a patient's case 'hopeless' only to have the patient later revive. There is no proper scientific agreement on what 'brain death' is, yet this is often presented to families as being certain and irreversible.

In this case, 'persistent vegetative state' certainly doesn't sound likely if he's talking on the phone to his sister.

How quick we are to consign people to dustbin, to rush on with our valuable lives sitting in traffic jams, rather than look after those that need our care.

If half this story is true, I can't believe the police have not been called. I didn't think open euthanasia was legal here (I know lots of doctors do it anyway).

Anonymous said...

The crux of this particular case is that the patient, unable to acess water and food due to his condition, will die from dehydration--just as would any and every other person, healthy or ill, who was likewise unable to access water and food.

An apparent "disability discount" on the perceived value of the lives of folks like Joshua has brought us to a time when such deadly deprivations have become first thinkable in the minds of some who would impose them, and now an awful reality, imposed on defenseless, dependent, disabled people like Joshua.

Several years ago, I had a patient whose political prisoner father had died from starvation in his native N. Korea. To think that N. American members of a humanitarian profession like medicine would now treat a person--their own patient no less--in similar callous fashion to my patient's father is both shocking and sobering.

Anonymous said...

Is there a reason the suggested letter is only addressed to the hospital and CCB? Why not the local members of federal and/or provincial parliament? Why not the provincial Minister of Health and Long-Term Care or the federal Minister of Health?

Unknown said...

This is a very interesting and difficult case indeed.