Err on the side of life
Medical case poses hard questions for Supreme Court
The Supreme Court of Canada has an unenviable task before it in the case of Hassan Rasouli, a 60-year-old Ontario man whose very life hangs on the court’s decision. At issue is whether the wish of Rasouli’s family to keep him alive should prevail over doctors’ assessments that his case is hopeless and he should have only palliative care, which would likely mean withdrawing food and water from him.
Rasouli is diagnosed as minimally conscious — an upgrade from his previous persistent vegetative state, which he fell into due to an infection after doctors operated to remove a benign brain tumour.
Rasouli’s wife, who was a doctor in the family’s native Iran, says Islam dictates that everything must be done to save Rasouli’s life. The family believes he is capable of making certain movements in response to them.
It will be interesting to see the results of the court’s deliberations. A blanket verdict is impossible to deliver because there is no one-size-fitsall answer to this incredibly nuanced issue. Each patient is unique and a decision that specifically addresses Rasouli’s case will not work in other cases, because of the multitude of complex factors that must be taken into consideration for a wide variety of patients and medical conditions.
It’s tempting to think that these kinds of cases could be avoided entirely if only people left living wills or otherwise made their wishes known while they are still in good health. Sadly, that’s not entirely a solution. For example, the American Hospice Foundation, in a publication entitled Medical Issues to be Considered in Advance Care Planning, lists a dizzying array of interventions that are possible, who they will help, who they won’t help, and what their side-effects and permanent burdens are. They include cardiopulmonary resuscitation — among whose side-effects in elderly people is rib fractures; other effects include pneumonia from aspirating vomit into the lungs and brain damage from lack of oxygen.
Still other interventions listed include intravenous medications, ventilator support, two varieties of positive airway pressure, dialysis, total parenteral nutrition — nutrients delivered through a catheter in a vein, which can cause sepsis and heart rhythm disturbances, among other problems — and feeding tubes (inserted through the nose or directly through the abdomen).
It would be extremely difficult for people in the best of health to choose from among these, with no knowledge of the illness or illnesses they will be suffering one day that could necessitate such a decision.
Moreover, healthy individuals in their 50s who are contemplating making a living will have no idea how advances in medical technology may affect treatments and the management of disease 30 years down the road.
Cases like Rasouli’s are further complicated by the knowledge that doctors can be wrong about a patient’s chances of recovery. The Rasouli family’s Muslim values mean they want doctors to err on the side of life. We hope the Supreme Court will do the same.