A unanimous June 29 ruling by the Ontario Court of Appeal will require doctors to go before the Ontario Consent and Capacity Board-a tribunal unique to Ontario-before taking patients off life support if their families disagree. The decision supports a broader April ruling in the province’s Superior Court and could have major implications for near-death patients in medical facilities across Canada-if other jurisdictions follow suit.
The ruling was triggered by the case of Hassan Rasouli, a 60-year-old Shia Muslim man who has been in a persistent vegetative state since October 2010 when he contracted meningitis after brain tumour surgery. His treatment team at Toronto’s Sunnybrook Health Sciences Centre felt that since Rasouli had no hope of recovery, it was in his best interest to remove him from his ventilator and give palliative care only.
His wife, also his substitute decision maker, objected, saying that her husband was showing some responsiveness and that removal from life support was against the family’s religious beliefs. She started injunction proceedings, which the doctors appealed. Rasouli remains on life support.
This decision, although more narrowly defined than the Superior Court decision, may awaken doctors in other jurisdictions to the advantages of having a consent and capacity tribunal to resolve such disputes, says Toronto health-care lawyer Mark Handelman, a former vice-chair of the Ontario Consent and Capacity Board and co-counsel for the Euthanasia Prevention Coalition, an intervener in the case.
The case highlights the double-edged sword of modern life-support technology, which some believe succeeds in helping terminal patients not to live longer but to take longer to die. The doctors are expected to appeal the decision to the Supreme Court of Canada.