Wednesday, July 6, 2011

Toronto Star agrees with Rasouli decision.

The Toronto Star published an excellent editorial article on the Rasouli decision under the title: Keeping Hope Alive.

The editorial supports the position of the Euthanasia Prevention Coalition and the decision of the Appeals Court of Ontario which recognizes that withdrawing life-sustaining medical treatment is done as part of a "Treatment Plan" and therefore requires the consent of the person or the substitute decision maker.

The article even recognizes the concerns of the Euthanasia Prevention Coalition by stating:
This is wise given the pressures on hospitals to allocate scarce resources among many deserving patients. No one wants life-and-death decisions to be shaped by the need to cut corners.

The editorial states:
The family of Hassan Rasouli has been enduring a situation that any family can relate to. Their husband and father has been lying in Sunnybrook Health Sciences Centre for almost nine months, in what his doctors describe as a vegetative state. He has no hope of recovery, they say. Rasouli’s wife and children disagree: they see flickers of recognition when he blinks his eyes.

The question is: who decides? Who has the right to say whether Rasouli and patients like him be kept alive or allowed to die? Doctors or families?

Ontario’s Court of Appeal has decided that, in Rasouli’s case at least, doctors do not have the unilateral right to pull the plug — even if they believe that keeping him on life support serves no medical purpose. In the absence of comprehensive legislation governing end-of-life situations, the court’s ruling will guide the debate and tip the balance toward giving families a voice.

Rasouli has been in Sunnybrook since October, when he went in to have a benign brain tumour removed. Complications developed, leading to severe brain damage. He has been on a ventilator and feeding tubes ever since. His doctors wanted to remove life support and let nature take its course. His wife, Parichehr Salasel, who was a doctor in her native Iran, argued that giving up on him would violate his values and beliefs. “His look is full of meaning for me,” she says.

The case turned on the meaning of “treatment” under provincial law. The doctors argued that while patients have the right to refuse treatment, they do not have the right to insist on treatment that their physician believes is “medically ineffective or inappropriate.”

The judge who first considered the case decided in favour of the family, ruling that a “plan of treatment” under Ontario law includes the “withholding or withdrawal” of medical care — and therefore the family must consent to that. The appeal court agreed. Doctors may withhold treatment they believe to be useless in cases where death is not imminent, for example where more chemotherapy will do no good for a cancer patient. But withdrawing treatment (such as life support measures) that would result in a quick death is different. The family must have a voice.

This is wise given the pressures on hospitals to allocate scarce resources among many deserving patients. No one wants life-and-death decisions to be shaped by the need to cut corners.

Fortunately, sad cases like the one being lived by the Rasouli family rarely result in such sharp faceoffs with physicians. As the appeal court noted, “in most situations, life-ending decisions are worked out over time through a combination of patience, understanding, professional guidance and counselling.” When all that fails, however, patients and their families must have their voices heard.

We hope that the Rasouli decision and the support it has received, will lead to a change concerning attitudes towards health care and the need to have effective collaboration on issues that will result in the death of a person.

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