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Doctors want the right to pull the plug

The battle between doctors and patients’ families over end-of-life care has just begun


 

Photo illustration by Andrew Tolson / Levi Nicholson

On the morning of Oct. 18, Mojgan Rasouli and her mother, Parichehr Salasel, left their home in Toronto’s north end and boarded the subway for downtown. This was a day they’d anticipated for years, yet Rasouli, a self-possessed 30-year-old, felt calm.

Approaching the offices of their lawyer, Gary Hodder, they took note of the news vans parked outside. About half an hour before, the Supreme Court of Canada had announced its ruling in a case that will have life-and-death implications for every Canadian—and, most immediately, for Mojgan’s father and Salasel’s husband, Hassan Rasouli. As the two women rode the elevator to the 22nd floor, the Supreme Court decision was already dominating headlines. Yet Rasouli and Salasel still had no idea which way the verdict had gone.

In 2010, Hassan Rasouli, an Iranian engineer, emigrated to Canada with his wife and two children (Mojgan’s brother, Mehran, is 26). That October, he underwent surgery at Toronto’s Sunnybrook Health Sciences Centre to have a benign brain tumour removed and contracted an infection that left him profoundly brain-damaged. For the last three years, the 61-year-old has been kept alive by a mechanical respirator inserted into his trachea; he’s fed and hydrated through another tube, in his stomach. His doctors, who say Rasouli will not recover, wanted to “unplug” him. His family said no. Devout Shia Muslims, they believe that every human life is sacred, and they’re convinced that Hassan’s health could improve. Salasel, a physician in Iran, is at her husband’s bedside daily, and reports that he shows signs of consciousness, like giving the thumbs-up, or opening his mouth and sticking out his tongue on command. In a five-to-two ruling, the Supreme Court sided with the Rasoulis. When mother and daughter stepped off the elevator into Hodder’s office, and learned the result, cries of joy echoed down the hall.

Death is the stark reality of life. Yet, with the tools of modern medicine, we can now postpone it for a startlingly long time. In the case of patients such as Rasouli, who can no longer speak for themselves, some family members insist that everything medically possible be done to keep them alive. Doctors argue that aggressive interventions can prolong a patient’s suffering—that this puts the doctors themselves in an untenable ethical position. They want the right to decide when it’s time to end life support, and let the patient die. “Physicians often feel like torturers,” says Arthur Schafer, director of the Centre for Professional and Applied Ethics at the University of Manitoba. Patients who can’t swallow must have fluid suctioned from their lungs. “It’s like having a hot poker put down your throat. Bedsores are inevitable. They get infected, and must be surgically scraped.”

The Supreme Court ruling does little to bring closure to this debate. On the contrary, it’s expected to embolden more families to challenge physicians over end-of-life care. Given Canada’s aging population, and advances in medical technology, the battle between doctors, patients and their families over whether or not to “pull the plug” is only beginning. It’s still rare for doctors and patients, or their substitute decision-makers, to disagree over end-of-life care, but it’s happening more often. Ontario’s Consent and Capacity Board, an independent tribunal created 17 years ago to deal with such situations, has heard a number of gut-wrenching cases dealing with the elderly, the infirm, even babies. Since 2009 there’s been a “dramatic increase” in the use of the board to resolve end-of-life cases, according to a 2013 study in the Journal of Critical Care.

In attempting to stop Rasouli’s life support, his doctors didn’t go to the Consent and Capacity Board—they skipped that step. Drs. Brian Cuthbertson and Gordon Rubenfeld, intensive-care physicians at Sunnybrook, have argued that they don’t need a patient’s consent (or that of his substitute decision-maker, in this case, his wife, Salasel) to end a treatment that has no medical benefit, as they see it, and may even be causing the patient harm. The Supreme Court disagreed and said they should have gone to the board. So now, Ontario’s Consent and Capacity Board has the seal of approval of the highest court in the land. And the Rasouli family’s legal battle may not be over. If the doctors wish, they can now take the case to the Consent and Capacity Board, which could step in and have Hassan Rasouli taken off life support, once and for all.

Despite this possibility, Mojgan Rasouli was composed after the Supreme Court ruling. “Any other decision would have surprised me,” she says. “Nobody can draw a line for the end of life. Not even doctors.”

In July 2007, the Consent and Capacity Board heard the case of a patient identified as “Mr. C.D.” He was an 81-year-old man from St. Catharines, Ont., and a Second World War veteran who’d come to Canada “with nothing,” as his family explained, working hard to become a successful businessman. He was suffering from dementia and was being fed through a tube into his stomach. He had bedsores and infections his body could no longer heal. Mr. C.D.’s doctor believed her patient should be taken off life support and put on palliative care. It would hasten his death, she said, but give him a better quality of life at the end. His wife adamantly disagreed, refusing to consent.

As Mr. C.D. could no longer speak for himself, Mrs. M.D. was his “substitute decision-maker,” a legal term defining who can give consent to medical treatment when the patient himself cannot. Both were devout members of the Greek Orthodox Church. Mrs. M.D. testified that her husband was a “fighter,” and would wish to stay alive for as long as possible. (This was his daily philosophy, she said, although the two had never discussed life support.) Mrs. M.D. even refused the doctor’s requests to increase her husband’s pain medication, worrying it would render him unconscious and unable to recognize her and their daughters. When Mr. C.D.’s family members visited him, they believed they could still detect “joy in his eyes.”

In the past decade, Ontario’s Consent and Capacity Board has heard about 25 such cases, “more than all the courts in the country combined,” according to Mark Handelman, a Toronto health-law lawyer, who has served as its vice-chair and senior lawyer member. (Only the Yukon has a similar system, called the Capability and Consent Board.) The Consent and Capacity Board has about 150 appointed members, one-third of them psychiatrists, another third lawyers and the rest laypeople, says Handelman, who served there for a decade. Hearings are held by three-person panels as close as possible to where the patient is being treated, within a week of the initial application. Decisions are rendered within one day.

In the case of Mr. C.D., the board ruled with his doctor. The written decision acknowledges his wish never to give up the fight. “But, he did not. He fought dementia for as long as humanly possible, perhaps longer than humanely possible.” It directed Mrs. M.D. to: consent to removing her husband’s nutrition and hydration; boost his pain medication; and start palliative care. The board’s decision does not state whether Mrs. M.D. complied, but in cases where substitute decision-makers don’t consent following a ruling, they are no longer considered fit for the role. (Parties can appeal to the Superior Court of Justice.)

In January 2011, when Hassan Rasouli’s doctors found themselves at loggerheads with Salasel, they decided not to go to the Consent and Capacity Board. In an active challenge to the way these cases are handled, they said they would unplug him unless Salasel got a court order to stop them. She and her children, who’d been in Canada mere months at this point, were at a loss. They found Hodder, their lawyer, through a friend in Toronto’s expatriate Iranian community. After two lower courts stopped doctors from unilaterally withdrawing life support without Salasel’s consent, the Supreme Court weighed in.

Hassan Rasouli's daughter Mojgan (left) and his wife Parichehr Salasel speak with him during a visit. (Carlos Osorio/Toronto Star/Getty Images)

It found that ending life support does in fact constitute a “treatment” that requires consent: It has the “health-related purpose” of preventing a patient’s suffering and indignity; it can entail “physical interference” with the patient’s body; and it’s closely tied to palliative care, which clearly requires consent. As Chief Justice Beverley McLachlin wrote in the ruling: “By removing medical services that are keeping a patient alive, withdrawal of life support impacts patient autonomy in the most fundamental way.” The chief justice also noted that Ontario’s Consent and Capacity Board has handled these cases for many years, and that they shouldn’t be sent back to the courts. Given the ruling, Handelman believes we could start seeing similar tribunals pop up across Canada.

Schafer, the ethicist at the University of Manitoba, calls the Supreme Court decision “disappointing, muddled and incoherent.” With this ruling, “the right to refuse treatment becomes the right to demand treatment,” he says, even when doctors feel it’s pointless or harmful to the patient. (The two dissenting justices felt these end-of-life cases should be decided by the courts, not by the Consent and Capacity Board.) The verdict touches upon doctors’ ethical dilemmas in these cases, yet it does little to soothe them. In 2008, three doctors resigned from a Winnipeg hospital rather than continue to treat Samuel Golubchuk, an elderly patient with minimal brain function. Doctors wanted to remove Golubchuk from life support; his family sought a court order to stop them, believing this would violate his beliefs as an Orthodox Jew. (Golubchuk died after almost eight months on life support, and the family later dropped its lawsuit against the hospital.)

The Supreme Court also didn’t address one of the most pressing issues in our health care system. To treat just one patient in a bed in the intensive care unit (ICU) costs an estimated $1 million per year. The Sunnybrook doctors, however, chose not to raise this in their legal battle. “Physicians don’t make decisions for patients based on resource allocation issues,” says their lawyer, Erica Baron of McCarthy Tétrault. In the Rasouli case, “it wasn’t factored into the decision-making.” Even so, it’s a reality Canadians must consider. As Handelman notes, “It comes down to: Are we going to keep your grandfather alive in a vegetative state in an ICU bed that I need for three days after bypass surgery?”

Cutting-edge research is making the line between life and death ever blurrier. After falling into a coma, Rasouli was diagnosed as being in a persistent vegetative state, meaning he was completely unconscious and unaware. Yet, in 2012, his diagnosis was upgraded slightly, to “minimally conscious.” The work of Adrian Owen, a neuroscientist at the University of Western Ontario, suggests that some vegetative patients show signs of consciousness when their brains are scanned—and that a few can even answer questions by modulating brain activity. Rasouli’s family are certain he is awake, despite what the doctors say. “I see from his eyes, he understands everything that happens around him, but cannot respond,” Salasel says.

“As lawyer to this man, this is something that’s haunted me,” Hodder says. “He may be lying there in his hospital bed, listening to people talk about him. He may be completely aware. Medical science doesn’t always get it right,” the lawyer adds and, for that reason, “decisions are not exclusively the province of [doctors].”

The legal floodgates are opening as more newly empowered patients and their families fight for a say in treatment. Joy Wawrzyniak, a nurse in Oshawa, Ont., filed a lawsuit against Sunnybrook and two of its doctors, Donald Livingstone and Martin Chapman, over the 2008 death of her father. Douglas DeGuerre, then 88, was a Second World War veteran living in the hospital’s K Wing, a care facility for vets. On Sept. 17, DeGuerre had both legs amputated above the knee. Before the surgery, Wawrzyniak—her father’s substitute decision-maker—told the doctor that if her father went into cardiac arrest, they should do everything possible to revive him. DeGuerre got through the surgery and was sent to the ICU. Wawrzyniak’s statement of claim alleges that, although she instructed several times that her father was to be treated as “full code,” meaning all life-saving measures be taken, doctors changed his status to “do not resuscitate,” unbeknownst to her. On Sept. 22, she came to the hospital to visit her father and found him struggling to breathe. DeGuerre went into respiratory arrest and died.

Now that the Supreme Court ruling has come, Wawrzyniak’s lawyer, Barry Swadron, says, “We intend to move forward very quickly. Whenever there’s a disagreement between the family and doctors, they have to go to the Consent and Capacity Board. Joy didn’t have that opportunity.” Lawyer Daphne Jarvis, who’s representing Sunnybrook, says this recent ruling won’t have an impact on the Wawrzyniak lawsuit. “The Court decided only that withdrawal of life support in a situation like Mr. Rasouli’s constitutes treatment for which consent is required,” she wrote in an email. “The DeGuerre case is totally different. It remains the case that medical judgment determines whether a treatment such as CPR is to be offered.” The doctors’ legal team would not comment.

Sunnybrook has earned a reputation as a hotbed for physician-activists. “The Rasouli case is not unique out of Sunnybrook,” says Handelman, who’s been involved in a handful of other disputes there. But Dr. Andy Smith, executive vice-president and chief medical executive, says any perception that Sunnybrook doctors are aggressively taking aim at end-of-life laws is simply a matter of sample size. With around 90 ICU beds, Sunnybrook has the biggest ICU in Canada, he says. “Over 4,000 people each year come in as new admissions to these high-end critical-care beds,” Smith notes. “This is not a Sunnybrook-specific issue. It’s arising across the country, all the time.”

And not just over the elderly. One case heard by the Consent and Capacity Board in September 2007 concerned a patient identified as “EJG,” an eight-month-old baby who suffered oxygen deprivation before birth, leaving him in a vegetative state. He didn’t respond to pain, sound or discomfort. He couldn’t eat or drink and was fed through a tube. His eyes could not blink and needed special ointment to keep them from drying out. He was the size of a child of 2½ months. While this baby might survive many years, kept alive by increasingly invasive medical procedures, he would not improve. EJG’s doctors wanted to wean him from the ventilator; if he could not survive, they proposed letting him die, supporting him with comfort care. The baby’s parents wouldn’t consent, saying that God would heal their son, or that medical science would one day find a cure. The board sided with the doctor.

Handelman hopes the Rasouli verdict will convince more people to discuss their end-of-life wishes. “You sometimes have family members who believe they’re doing the right thing by fighting to keep a loved one alive,” he says, “when the loved one would not have wanted it.” As for Rasouli, it’s impossible to say at this point whether he wishes to live in such a state. His daughter, who describes him as a creative, charming and ambitious man, with a lively sense of humour and a love of Persian music, says the Muslim faith is the foundation of their family. “Our religious beliefs are very personal,” she says. “The life of the human is precious.”

After an emotional press conference at Hodder’s office, wife and daughter went to visit Hassan Rasouli, as they do each day. “In the evening, my mother-in-law, my husband and our friends all came to the hospital,” says Mojgan Rasouli, who was married earlier this year. That day, she told her father of the Supreme Court verdict. She squeezed her father’s hands. She says “his eyes were very bright.”


 

Doctors want the right to pull the plug

  1. Ten more years before Aktion T4 is rehabilitated by the new establishment… tops. We never ever learn.

  2. One of the most offensive waste of resources in our medical system is the use of intensive care to prolong an elderly patient’s life by a few weeks. The medical staff can tell that these patients are going to die imminently. If the patient is lucky, they’re unconscious for the treatment. If not, they’re in a lot of pain, are usually terribly confused and frightened. Why does this happen? It’s a combination of family expectations and poor medical practice on the part of doctors. Some doctors cannot or will not deal with the prognosis, and don’t communicate the reality of the situation to the family. Some families can’t cope with the situation, and emotion or cultural belief drive them to push for every potential treatment. The net result is that we blow a few hundred thousand dollars while asking the medical staff to torture a dying person for a couple of weeks.

    • So the alternative is to ignore the wishes of patients and their families?

      You have a lot more trust in the medical profession than I do.

      • I think doctors need to do a better job of explaining end of life situations to patients and their families than they currently do. Good doctors already do this, they avoid a lot of pointless treatment, and help everybody deal with the situation. Some doctors are cowards, and they shy away from having an unpleasant or confrontational conversation. Some doctors are arrogant, and think that they have an answer for everything.

        Finally, decisions need to be made rationally, not emotionally. Medicine is a science despite all the unknowns and variables. It’s a bit much to spend hundreds of thousands of dollars because family members can’t accept the imminent demise of a loved one.

        • Yet in this case, the family was in the right about his chances for recovering consciousness and improvement. There is no question of them ending his life now. If they had listened to the doctor, that man would be dead now.

          • So the family claims. Families have a tendency to want to see things that may or may not be there. Rasouli’s condition was changed to “minimally conscious” some time ago, but that’s a subjective call. It’s been 3 years, any improvements are equivocal – I’d say the doctors were probably right.

          • Yes, but changed to minimally conscious after the doctors wanted to pull the plug.

            But largely we have a difference of opinion of where life is worth living, and that will happen. But I think that this should be left to those nearest and dearest to decide, because of those differences of opinion.

          • How do you feel about the “nearest and dearest” deciding that their next of kin shouldn’t get life saving blood transfusions? Should physicians go to court to get permission to give these life saving treatments to children against the wishes of their parents or should they leave that to the family and let the kids die?

          • How about we choose life in both cases eh?

            Listen, I know you work for the health care system, but I did as well. In a palliative care ward with dementia patients. I saw families lied to about whether their parents were restrained. I saw how patients were handled who were overweight or had mental difficulties that bordered on abuse. I saw patients being drugged without their knowledge. I saw nurses who did other unethical things, not maliciously, but because they were trying to get through the day without too much hassle.

            I don’t think I was in a particularly bad ward, and I don’t think the nurses and doctors there were bad people. Heck, some of it was even necessary. But forgive me if I don’t give you carte blanche to decide my care absolutely and give you guys all the power.

          • Is it really life if a person is not aware of their surroundings but has a body that is breaking down and is continually needing active treatment that the patient can never consent to receiving in order to survive?
            Yani, you said the patients were restrained and received medication they didn’t agree to take. How do you think these patients in a coma who are attached to a ventilator are being treated? They are experiencing infections related to their respiratory and urinary tract systems on a regular basis, necessitating the constant pumping of antibiotics through their systems. They are experiencing bed sores that raw and likely being packed with gauze because they are so deep. Do you think they are comfortable or do you think they require just a bit of restraining and medication when they start getting restless?
            I would in no way ever defend anyone in the healthcare system that acts unethically. It is in the best interest of the system that anyone who does so exits the system so that the reputations of those of us who remain are unsullied by their presence. The doctors are wise to take their case to court when they feel they must speak up on behalf of patients and what they feel serves their best interests.

          • Maybe you need to read it again….THE DOCTORS upgraded his medical status!

          • Yes, it is awfully subjective. So forgive me if I don’t want to give Doctor A final say, when Doctor B could give a different diagnosis.

      • The paitents families wishes are not the doctors overall objective, rather what is best for the patient themselves. Families in most cases will do whatever it takes to keep their family member alive even when it is hopeless. The doctor should not be biased by these issues but in some cases can be.

  3. What benefit is it to the doctors to pull the plug? Their pay doesn’t change…and if they’re worried about a bed shortage…then get more beds.

    Plug-pulling decisions should be left to the patient and/or the family.

    • Families are not medical professionals and often have no clue about how much suffering and pain prolonged medical ‘experiments’ are having on a person.
      If we left the decisions up to families, our health care system would collapse in no time, especially with the coming tsunami. How much money do you think it’s costing to keep these people living on machines? Do you not think some families would be more interested in keeping the disability or government checks flowing in while we’re all paying for a person to be kept artificially alive?
      Don’t you think that money would be better used for someone who actually has a chance of recovery?

      Ridiculous.

      • Neither do doctors. In fact doctors make the worst patients.

        Doctors are quite happy to do ‘medical experiments’ amounting to torture, on any number of people who want assisted suicide. Doesn’t bother them in the least when they know how to help within minutes, yet don’t. We are kinder to injured dogs than that.

        Doctors aren’t saints and families aren’t evil….and shame on you for implying otherwise.

        Someone who has worked hard, and paid taxes all his/her life expects better than a pulled plug, and a body bag at the end of it to ‘free up’ a bed.

        PS….there is no tsunami. The youngest boomer is 48.

        • So all families have the best interest of their family members at heart? You are delusional.
          Did you even read the article?
          I hope one of your young relatives aren’t one of the ones waiting for heart surgery because some religious wingnut wants to keep their 90 year old vegetative grandpa in diapers.

          • I’ve already dealt with my parents deaths thank you, and my instructions are in writing with my lawyer. I’m very familiar with such situations.

            So take your snippiness elsewhere.

          • Apparently, No Jo was right – you didn’t actually read the article.

            By the looks of things, you seem to just enjoy arguing with people.

          • Or maybe I’m dealing with people who don’t understand the concept of universal medical care

            The ‘why should I pay for your accident’ kind of people

          • I’m with EmilyOne. What I haven’t experienced first hand I have heard first hand accounts from friends. I will file an appeal to any Court ruling that gives Doctors the right to pull the plug.

          • Just remember that physicians are also taking families to court that are refusing treatment on behalf of their family members. You might see it as wanting to end a life but physicians see this as a humane approach.

          • Thank you.

            Last thing I’d want is a doctor making decisions for me.

          • This isn’t all about 90 year old vegetative grandpas. That’s just what they are showing you to help garner the support needed for what will ultimately be signing your rights away. I agree that doctors and hospitals need to set some guidelines but the family should also have some power here.

        • Families are complicated. The people demanding the most treatment are usually the ones who’ve spent the least time with their loved one before the medical event. The nearby family members normally have come to grips with the situation and are willing to let go. Emotional issues are projected onto an end-of-life care situation, and that leads to some warped decision making.

          • Yeah, complicated and dysfunctional….but it should be the patient’s choice. No one else’s.

            Most people have a horror of tubes and wires and will want to go peaceably…..but we have enough room, or should make enough….for the fighters.

          • Well, since the article deals largely with patients who are incapable of choosing, how do you propose to let them?

        • “Someone who has worked hard, and paid taxes all his/her life”???

          Apparently, you missed the part about the Rasouli’s being in Canada for 3 months.

          Do you really think they paid enough taxes into this country to warrant the $1 million per year that ICU bed will cost to keep the dude alive on machines?

          Feel free to contribute to the medical expenses of all the accommodated religious families who think ‘god’ will find a cure or ‘life is precious’ no matter how much you’re suffering.

          Hope you have deep pockets.

          • The principle is what’s at issue here…..we’ll have people here for a short time, and people who’s families have been here for generations.

            We’re supposed to be treating them all like Canadians.

            Why are you so cheap anyway?

          • Becky Breeder;
            Come back to reality. This situation isn’t limited to religious families by any means.

          • You’re right Betty, but based on the “article” above, the cases were all based on religion. There would be no other sane reason why someone would want a relative to suffer and be kept alive artificially – except, of course, that they want the family member’s cheques to keep rolling in. I’ve seen it.

          • The Country is going to go broke because so many people are artificially keeping their half-dead loved ones alive just to collect their cheques? If you have seen it, report it! I am sure that it’s illegal.

          • No, the religious and irrational masochists (although irrational masochism is probably a necessary condition for religion)

          • Nothing like putting a Muslim family in the picture to stir up a bit of anger. That could be any family, including yours, and you have no idea how you would feel in their situation. He is not a “dude.” He is a person.
            As for accommodating religious beliefs I admit I am a little befuddled. When my parents had to face this decision with my 3-month old sister it was heart-breaking but they told them to go ahead and pull the plug. We put our entire faith in God and huddled around her little hospital bed and prayed and prayed for a miracle. When that didn’t happen, we accepted God’s will. Everyone’s situation is different but a little common sense and some genuine faith in God can help so many through this difficult process.
            Having said all that, I still would NEVER AGREE to giving doctors the ultimate control or “right” to make those tough decisions. It scares me how many people are so willing to do so.

        • “Someone who has worked hard and paid taxes all his/her life”….hopes like everyone else to die in their sleep at home and avoid the ICU at all costs. Cut the BS and try for some honesty here. No elderly person wants to spend the end of their life hooked up to any machines. For that matter, no young person does either. As for the body bag, who cares you will be dead. We all end up in the body bag whether we die in hospital or at home but we don’t know the difference.
          As for doctors, they are just like everyone else. They are human beings. They want a good death like everyone else. If family members are willing to sue because they didn’t resusitate an 88 year old man who had no pulse and wasn’t breathing, think what those same family members would do if they assisted the old guy to commit suicide.

          • Some elderly people want all measures taken to survive…and young people definitely do

            Patients should have the ONLY say in any of this….doctors are just being fussy on when they assist death

          • What old people or young people want to survive if they are completely incapacitated in a bed for years and years with no way to communicate to their family and no way to breathe on their own?

          • Survival is the biggest urge humans have.

          • Survival with zero quality of life is worse than death and if you have a conversation with any person, I challenge you to find one person above the age of 21 who would chose to live a life in a bed with a ventilator breathing for them and with no way to communicate with the world; no way to taste food; no way of ever getting of out of that bed let alone the hospital and tell me that they would chose that “life” over death.

          • We are not talking about the Christopher Reeves of the world or this lady in your article who obviously led a very fulfilling life because she was awake, Emily but rather the patients featured in the article. Please read it, Emily. It deal with people who are in apparent vegetative states. Believe it or not they are NOT hosting dinner parties. They aren’t communicating with anyone. They are lying in their beds; eating no food but getting bed sores and suffering from regular bouts of pneumonia. They have no hope to communicate their desires. Now kindly Emily, stay on the topic that the article is about. You would sentence a baby born who at birth was so short of oxygen that she has no chance for any life outside a crib where she will lay day after day never communicating her needs or wants to her parents. She will never leave the hospital. Would you want that kind of life for your child, your grandchild, yourself?

          • Oh….you mean the ‘locked-in’ people that they’ve discovered are alive and functioning?

            So you’re saying medicine will never find a cure?

            Or are you advocating infanticide?

          • Emily, do you have any idea what a severe lack of oxygen to the brain does? We are not talking about a “locked-in” person who had a trauma during a car accident. As for infanticide, the baby was being sustained on artificial ventilation…kept alive by artificial means because the brain stem is damaged to the point it doesn’t even tell the respiratory center to breathe. We aren’t talking about paralysis here. Read the article. As soon as the artificial means are removed, nature took its course. There is such a thing as a good death. I am sure you are aware of it given your constant championship for assisted suicide. I guess you only champion it for a certain subset of the population….the one you belong to. Meanwhile, you believe infants should be poked and operated upon, having feeding tubes inserted and countless IV’s etc. as though they can’t experience any discomfort, all to appease some sick notion that we are doing everything to ensure they “survive”. Medical ethics is about asking not what can we do but rather should we do what we can do just because we can do it? Pumping a lot of medications into a small infant just so the body maintains a pulse isn’t necessary ethical medical care.

          • Then it’s assisted suicide innit….something that’s illegal in Canada.

            You want it 6 ways from Sunday….but it’s all the same thing.

          • Emily, that comment suggests you have no understanding of physician assisted suicide.
            Assisted suicide involves the active participation of the assistant (the physician) in ending the life of the patient who has requested the assistant’s aid either by providing medication or actually injecting the medication and other activities.

            A person on life-support who has little or no brain function cannot live without the aid of a ventilator and isn’t able to request that nature be allowed to take its course. The physicians are simply arguing that nature should be allowed to take its course because there is very little hope of recovery and mere survival when you are going to spend the remainder of your life in a bleak situation is not a worthy goal.

          • HI…everybody understands it. Other places already have it.

            This isn’t rocket science you know.

          • Yes, I saw how well it is working out in Belgium. One physician assisted a relatively young man with a sex change operation that went bad to kill himself, saying he met all the criteria. Hmmm…..no wonder the Canadian physicians aren’t eager to jump of the bandwagon.

          • Working better there than it is here HI….and many countries have it.

            Again, this isn’t rocket science.

          • Really? Obviously you ignored my example without giving it any thought. You complain about physicians wanting to let nature take its course in severely brain injured individuals yet you want physicians to actively participate in assisting anyone who wants to die in committing suicide. If you don’t trust physicians to care about what is best for any of their patients, why would you trust them to assist people who are vulnerable and believe they have no choice but to end their lives?

          • The guy chose to die. It was….I repeat…his choice.

            If someone wants to remain alive, or die, or die with help….it is their choice.

          • The guy was likely severely depressed and perhaps mentally incompetent to make that choice. I don’t believe that Canadians want our healthcare system having physicians assisting the depressed to commit suicide. I would love to hear your opinion on it though. Is that what you believe that physicians should do? Should they help depressed people commit suicide?

          • I’ve said repeatedly HI that it’s up to the patient…..and other countries have regulated systems for it that work just fine.

            Keep the religion, your morality and your judgements to yourself and let the patient decide. Don’t second-guess grown adults.

          • Really? “Keep your morality and your judgments to yourself.” Religion has very little to do with it when it comes to mental health and depression as even the atheists tend to accept that the severely mentally ill are a vulnerable group that require protection from themselves most of all. As such, we as a society see a lot of value in keeping otherwise healthy people from committing suicide. You, Emily should write to your provincial government and get them to re-write the mental health act for your province given that you don’t seem to share that value. I can see it now…”Don’t second-guess grown adults. If the guy chose to die. It was..I repeat…his choice. Let the patient decide.” Awesome, Em. You could recommend Wynne just de-fund all mental health programs focused on those suffering from major depression and schizophrenia (which has a suicide rate of 10 percent among those afflicted) and instead send the funding over to the physicians willing to assist the mentally ill with suicide. Do you realize that the suicidal are the one group of adults who do not have that “urge to survive” you were talking about earlier? Do you think we as citizens are in way beholden to protect those among us who because they do not have this urge are vulnerable?

          • Do you need this written in electric blue ink….or in Olde English font or what?

            I’ve said ‘let the patient decide’ about 20 different ways now…I’ve run out of ways to print 4 simple words.

            Other people in the world have figured this out with no problems….are you saying Canadians are too stupid to make decisions on their own? Or we can’t trust grown Canadian adults to know what’s best for them?

            Suicidal people…for whatever reason….can just jump out a window….end of story. When clinics and doctors are involved, forms are filled out, conversations are held, waiting periods are involved…..before anything else happens. Then the patient makes the decision.

          • “Let the patient decide” is great, but doesn’t really solve the problem here. These patients are not able to make any decisions for themselves, and in most cases people haven’t left useful care directives. To get “let the patient decide” to be useful, we need to 1) get every person to complete a detailed set of health directives in the case of incapacitation, and 2) ensure that they really understand the implications, consequences, and probable outcomes of all those different treatment options. Considering the number of people who think you can treat a virus with antibiotics, or who subscribe to naturopathic therapy, I suspect we’re talking more about an aspirational goal than a realistic one.

          • Doctors already tell patients….in detail…about serious procedures. You even sign a contract.

            If the patient is beyond asking, then the next-of-kin makes the decisions….like always

            If you want to be even more formal there is Power of Attorney for personal care. Done every day.

            Why is it suddenly so difficult to do what we’ve BEEN doing all along?

          • Ta da! Thus the subject of the article. In some cases the next of kin are making decisions that physicians feel are NOT in the best interests of the patients. This isn’t a particularly new thing. Physicians have gone to court in order to treat some patients against the wishes of their next of kin who belong to religions that don’t believe in blood transfusions. Physicians went to court to “pull the plug” on baby M when her parents didn’t want her artificial life support ended. In that case, baby M’s parents were standing trial for starving her to death and had selfish reasons for not wanting her to completely succumb to her injuries. Believe it or not, sustaining life by artificial means is not always the ‘kind” thing to do. It can be harmful to a patient as the person’s skin integrity is constantly breaking down with horrendous bed sores that are excruciatingly painful.

          • I like how emily one comments so much its so easy to find he contradicting herself between articals. Its almost ammusing

          • It IS amusing – she just blabs and argues without even realizing what’s coming out of her mouth.

          • “What old people or young people want to survive if they are completely incapacitated in a bed for years and years with no way to communicate to their family and no way to breathe on their own?”

            Me.

          • Would you feel that way if you were in pain from bed sores?

          • Fine – then wallow in your suffering. Just don’t take the option to “NOT” wallow in suffering from everyone else.

            The point is choice. What don’t you get about that?

    • “if they’re worried about a bed shortage…then get more beds.”

      With what? Magic beans? Have Harry Potter conjure a new wing?

      A bed shortage means the bed is unavailable for other patients who may have a better prognosis but whose treatment has to be delayed… possibly to that other patient’s detriment (worsened health or even death).

      At some point this selfishness literally hurts others. If there are only so many resources available, it is stupidity to waste the resources “treating” the incurable while those who can be cured go without.

    • There is no benefit currently, at least we hope, but give them full power and that could change in the future. Everything is corrupted in this world, governments, police, lawyers and I am sure doctors are not immune. Government workers were already given quotas for the number of people they are expected to kick off the EI system per year. Who knows what they would do if they have all the power to pull the plug on your life. The decision needs to be made by the individual/family based on medical opinions provided by their doctors. If in disagreement, an independent body must make the final decision.

      • Well doctors are supposed to care for patients that request care. We have money for F-35s but not enough for more beds supposedly, so doctors want to be able to ‘pull the plug’

        Then when a patient chooses to forego treatment….doctors don’t want to help. None of it makes sense.

        Patients better hope they can make a doctor at least understand their wishes….or better yet they should give power of attorney to a relative with their wishes stated in writing.

    • You do realize that it isn’t a literal problem of beds do you not? There are plenty of actual beds. What there are not is plenty of knowledgeable trained RN’s at a rate of fifty per hour to care for the patients in the beds in ICU and there are not plenty of respirators and other life-saving equipment to keep people alive indefinitely. In fact a few years ago when the H1N1 flu outbreak occurred many hospitals were unable to provide respirators for the number of people who required them.
      Now, if the families could take the patients home to care for them themselves, there would be no issue because frankly, on one is really saying that families don’t have the right to care for their own family member as long as they wish to do so. The issue is when they demand that others provide that care in a way that involves artificial means to accomplish the task.

      • If we can afford F-35s, we can afford proper medical care in this country.

        • Provincial jurisdiction Emily….if we can afford to tear down gas plants, we can afford to “afford proper medial care.”

          • Fed money is in provincial healthcare, so they get to set the standards. Have done so all this time.

        • Oh are they offering the provinces more money and are they going to build bigger hospitals to house all of these people who will be on ventilators? Meanwhile, is keeping people alive on ventilators “proper medical care” and in whose opinion is that?

        • Well, the F-35 program is $16 billion over 40 years. That amortizes to about $400 million per year, which could theoretically pay for another 400 critical care beds in Canada. Except that medical care costs escalate at between 6 and 15% per year, so by year 40, that $400 million pays for between 1 and 38 beds. Then we have to ask ourselves what we’ve accomplished by spending that money, and it’s to have kept a limited number of dying people alive for a relatively brief period of time.

          • Let’s not exaggerate, eh?

            It’s for national health care….not just a few people with unpulled plugs

          • It’s not exaggeration. Total spending on health care in Canada hit $192 billion last year. Diverting that $400 million per year from the F-35 would increase that budget by 0.2%, which would get swamped by the annual cost increases in no time.

          • Have it your way then….we scrap tanks, ships and troops as well.

            Happy now?

    • You are absolutely right, Emily. The doctors get NO benefit. No change in pay. The shortage of beds isn’t even really their problem. So given that, I guess they should leave all treatment decisions up to the patients and their families. Those families that deny their children life-saving treatment and opt for prayer instead, should be left in peace to do so. I guess physicians in Canada should no longer go to court to get injunctions to treat these children. Canadian physicians shouldn’t bother phoning social services when they recognize the signs of abuse in one of their patients….be it a child or a senior citizen. Why should physicians bother to go out of their way to do anything that might be in any way uncomfortable because let’s face it, their pay won’t change. Just let the families and the patients decide. So what if many patients are anti-vaccine and pro-cigarette smoking. So what if everyone wants anti-biotics to treat everything? What benefit is it to the doctors to try to intervene? Decisions for treatment should be left to the patient and/or the family.

      • Is there some reason why Cons can’t distinguish between children and adults, and between religion and science? Or between assisted suicide and child abuse and between one person and society?

        The phrase ‘dim-witted hick’ comes to mind here.

        • You are rambling….

          • No, you are playing dumb.

            At least I’ll be nice and assume you’re playing

          • dumb as in mute?

          • How refreshing. At least you will not be giving me a lecture on manners today, unless it is one of those “do as I say and not as I do” lessons you often extoll. Now I do know you like to present yourself as the victim in every situation and in order to do so, your enemies have to be ‘Cons’ and if at all possible, Albertans so go ahead and let your put-downs fly. Feel free to give me a “Ciao” in your next comment as well so we can end this most unpleasant little tete a tete and you can get back to you vitally important job.

          • Good work on this topic Emily, thanks!

          • She tends to do that. A lot.

          • Funny thing is shortly after this exchange, she went on another thread and accused someone of being “rude” to her.

  4. Slimy lawyers looking for millions from the taxpayers with their frivolous lawsuits. Performing CPR on an 88 year old man? If he didn’t die of respiratory failure, he would die of a crushed rib cage.
    Frankly, I’m tired of these religious fanatics taking advantage of the taxpayers.

  5. So, Doctors want the ” RIGHT ” to pull the plug on people that they can not save, and in their opinion are Terminal, against the wishes of the relatives ; yet these same Doctors will not agree to Euthanasia, when it is the express wish of the Patient who is also beyond help by the Doctors, and possibly in dire pain.

    Physician, give yer collective heads a shake, Physician heal thyself.

    • Some doctors would be quite willing to participate in assisted suicide, if it wasn’t for the fact it would land them in jail.

      In some ways it is the flip side of the same coin.

        • LOL! Posting an article on assisted suicide from the catholic register is equal to posting a story from Fox news praising Obama.

          Do you really think watching a family torture a loved one who has bed sores and tubes and wires and is being kept alive artificially is “caring for a patient”.

          You need to give your head a shake.

          • Yes- much more humane to starve them and then have them die of thirst. Much more humane than having to treat their bedsores.

          • Do you realize that some bedsores are so large you can insert your fist into them? Please accept that the pain related to them is excruciating and they are often almost impossible to “treat”.

          • Guess your apparent “tolerant” liberal attitude is intolerant to another view.

            Wait until they want your hospital bed and call you a “bed blocker” or other high minded euphemisms.

            Have a nice day.

          • Hey, the “bed blockers” are those waiting for nursing home beds. They are waiting for the beds because your provincial government hasn’t seen fit to build enough nursing homes. These patients do not belong in hospital.

          • I think that you have not understood my posts…roflmso.

            I would NEVER take advice form the Roman Catholic Church lol.

            IT, needs to give it’s head a shake and get it’s own house in order, before giving it’s advice to the World.

            I posted the link from the Catholic Register, only to show the CMA view on Euthanasia, which seems rather contradictory considering their wish to ” Pull the Plug ” on patients against the wishes of relatives.

            EVERYONE should have control over their own body, and should have a Living Will stating the conditions under which Euthanasia or Pulling the Plug should happen. ( which should be honoured by Doctors and Relatives )

            I have been caring enough to apply this to my dogs when they came to the end of their lives, to stop their needless suffering; surely any caring person should do the same for their ” Loved Ones ” is that not The Christian thing to do ??

          • I believe you are misunderstanding the stance that many physicians are taking. They of course want what is in the best interest of their patients. In the case of a severe brain injury where the brain no longer functions in any capacity and the body can only be kept functional by technology, of course a physician would be in favor of nature being allowed to take its course as it would if the technology were not available. In the case of dying patients, physicians provide opiates to provide pain relief even though they know these depress the respiratory center in the brain and liken hasten death. Many families might not want their dying family member to have these opiates knowing this however, a physician makes a promise to care for their patient and so they accept the side effects of the medications. They also talk to families about not providing treatments that prolong life and therefore suffering. A lot of family members demand every possible life extending intervention, perhaps not realizing that they what they are demanding will in no way extend their family member’s life by an appreciable amount but will likely create increased suffering for the amount of time the person does remain alive. You are asking physicians who know that this is the reality to actively participate in providing medication and or injecting medication and thereby causing the death of patients who aren’t in any imminent danger of death and you think these physicians shouldn’t be afraid of family members trying to sue them or have them arrested for murder?

          • I think this addresses your concerns —

            ” EVERYONE should have control over their own body, and should have a Living Will stating the conditions under which Euthanasia or Pulling the Plug should happen. ( which should be honoured by Doctors and Relatives ) ”

            With emphasis on — ( which should be honoured by Doctors and Relatives )

            NO ONE except the Patient, should be ” Playing GOD ”

            The LIVING WILL spells out the wishes of the Patient, what the Doctor or Relatives wish is superfluous.

            A good friend of mine was dying in Hospital, and given a week to live.

            A couple of days later his heart stopped, and they paddled him

            back to life, only to finally allow him to die a couple of days

            later—- WTF.

          • Not everyone can have control over their own body due to their age or mental capacity.
            Playing God is keeping the body of a person who is mentally unaware and has little hope of ever becoming mentally aware alive by artificial means for an indefinite period of time.
            Everyone should have a living will but unfortunately that is not even close to being the case.
            Your friend who died did not have a “do not resuscitate” (DNR) order which is very strange for someone who was dying. Typically if your friend was incapacitated the physicians would speak to the family and request the DNR and would also ask to change the level of care to “comfort measures only”. No healthcare team wants to resuscitate dying people.

  6. First, do no harm; I am guessing modern “doctors” do not go by that “old fashioned” principle.

    • “Modern doctors?” Really? If you relied on “old fashioned methods”, they would be no debate. There would be no ventilators and people would pass away because they are being artificially sustained.

      • How is technological progress invalidating the ‘first do no harm’ principle? Oh, I forgot, you liberals can’t think… never mind then.

        • Sometimes it is less painful and certainly less harmful for a physician to do less rather than more interventions and that is guiding principle behind palliative care. It is inhumane to keep poking and prodding people, causing them unnecessary suffering when there is no hope of a cure or at least a great reduction in symptoms such as pain. To use a ventilator long term to provide oxygen to a human body when the mind has little or no hope of ever becoming cognitively aware is not a decision make in the best interest of a patient because it exposes the patient to pain and suffering related to continuous breakdown of skin integrity and infectious process to many of their body’s systems including the respiratory and urinary system.

          • My, my, that’s a lot of nonsense that proves, rather conclusively, wouldn’t you say, that you have no clue, and really, really cannot think rationally.

          • As apposed to you who is all rational, all the time except that you haven’t offered ANYTHING that explains or substantiates your argument. You say my argument is nonsense but you haven’t offered one thing to repudiate anything I have said. All you have done is call anyone who disagrees with you stupid, ill-informed, irrational or a Liberal. Did your high-school debate coach not inform that that is not a proper strategy for an adult conversation? Come-on, explain your stance if you think you have a legitimate one. If you are going to claim that that I “don’t have a clue and cannot think rationally”, prove to me through your argument that you do have a clue and are rational otherwise, you are just rude.

          • Hmmm, have you noticed, that whenever you liberals cannot produce a coherent, rational argument ([cough] always [cough]), you start complaining that your adversaries are “rude” and “extremist”?
            Glad I could help.

          • I am a conservative from Alberta for gawd’s sake. What I have noticed is YOU HAVE NO ARGUMENT PERIOD. Now go away.

          • “Conservative”? “from Alberta”? And “for gawd’s sake”? Is that how “conservatives from Alberta” refer to the Good Lord?
            Dude, that’s just; sad. I weep for your country.

          • Thanks for the offer of “weeping for our country” dude. I am sure you are really upset by the moral decay you imagine is happening here based on that terrible blasphemy. Might be a good idea not to visit this country either because they won’t let you bring your gun with you to protect yourself from all of us quasi-conservative Canadian atheists and our upstart ideas.

          • Alas, you ideas are not “upstart”. Socialism, as you practice it in Canada, admittedly in somewhat milder form under the “human rights lawyer” Red Alice Redford (sp?), Alberta, is an idea as old as tyranny. Socialism itself being nothing more than neo-feudal reaction to capitalism.

          • You are a coward, moderate guy. You hide behind a political philosophy and “your God” to excuse the fact that some of those patients who you have hooked up to life support might be living in excruciating pain but you don’t want to reflect on that because you are willing to let a human being suffer in a state that can in no way be described as living just so you can look down your sanctimonious nose at those of us who dare to wonder if these people are stuck in a living hell, and accuse us of wanting to ‘harm’ them.
            Now you are taking a swipe at Canada’s brand of capitalism. It is really funny that you are bemoaning the state of capitalism in Alberta, because I will tell you right now, it flourishes here in Calgary. The rich here aren’t suffering from any tyranny. They are living a great life in a great city. There are more rich people in Calgary per capita than in most in other cities on the planet. Does it really offend your sensibilities that both rich and poor in such a wealthy city and province get to walk into the hospital and get treated for free no matter how ill or expensive the treatments are? You prefer it when people lose their homes and everything they own because they had the bad luck to get cancer. Again, I suggest you never visit here. One of your compatriots wrote a letter to our newspaper complaining he was accosted in a public park by two young men who approached he and his wife and asked if they had attended the stampede. Your compatriot said he felt threatened and told them to leave, which they did. Your compatriot was very upset he didn’t have his gun to protect himself. As it turned out, the Calgary Chamber of Commerce hired a few young men to hand out free tickets to the stampede that afternoon in the park. Your compatriot would have shot one of our citizens just for being friendly.

          • I doubt that the rich and poor in your city all get the same treatment when they visit the hospital – or their family Dr. They don’t here in Ontario. If your Dr doesn’t think you’re worth it, you don’t get what you need.

          • Oh please…I work in the hospital. They are all getting the same treatment here. It isn’t great but it is equal.

          • Except for those, for instance, who can afford Avastin to lengthen their time here on earth and those who cant?

          • I am not a cancer nurse but I do not that their are many psychiatric medications that are “off formulary” due to high expense and we find ways to fund them so no patients (especially those who are poor) are going without. You might want to look up Avastin, it was just reported that it was possibly linked to two cases of flesh-eating disease. If that it true, it might not be available much longer.

          • The only thing I know about it is that there is a woman in the papers who is seeking funding for it. But there are always some people who get what they need and then the rest of us who don’t. Why my Dr would want to mess with my Rxs that he knows nothing about is beyond me.

            The trouble with moving and living abroad is that one gains life experience. The downfall is that unless you have lots of money and a husband and family, no one trusts you or cares.

          • Yes, I read about the woman.

          • Good thing you did or you probably wouldn’t have believed me.

          • Of course I believe it. There are many medications that are non-formulary (not available in hospital) due to the high cost of the individual meds.

          • So why on earth do people like Mike Duffy need to keep their employee health care plan (from the gov’t) even though their salary has been taken from them and in his case, he is retired and his benefits will come to him even if he has no income.

            So why did he get to keep the health plan?

          • I really hit the little liberal nerve there in your “conservative from Alberta for gawd’s sake” body, didn’t I. And don’t say you are not a liberal. Only liberal scum resort to name calling when their idiot argument fail to win the discussion ([cough] always [cough]).
            And yeah, I worked in Calgary last year, indeed during the election, when the dipsh##t I was working with was gleeful that the “Alberta Tea Party” (that would be Wild Rose) lost. I didn’t ask his idiot political views, but that was another POS “conservative from Alberta for gawd’s sake” no doubt. Oh well, made good money.

          • No, you did not hit a nerve but rather my funny bone. With regard to all your coughing…if you can afford it, you might want to see a doctor. Your symptoms suggest you might be in need of treatment.
            So glad you made a few bucks in Calgary….but should a good christian like you be calling his fellow man nasty names just because his political views don’t match yours. Shouldn’t you be turning the other cheek? Oh and dipsh*t, I voted Wild Rose so I am a “for gawd sake real live conservative…yee haw!”

          • Funny, every time you liberals call somebody nasty name, you start kvetching when you get a taste of their own medicine.
            And considering your warped view, you will understand, I trust, that I will not believe you are a Wild Riose supporter.

          • Hahaha! Who cares what you believe when it comes to my voting record coward dude although you could just look it up on Discus. It truly has never been a secret.
            I am wondering though what is YOUR stance on those people in your country who can’t afford to keep their family members on life support plugged in in your hospitals. Do you advocate the “socialist solution” of paying for them to be kept alive or does so capitalist greed overcome your so-called love of Jesus Christ and are you all for pulling the plug so you can save those poor souls from the tyranny of socialism?

          • Yeees, because naturally you have been so honest about everything that your few pathetic posts on Disqus definitely prove what your voting record is.
            And of course being such an honest “conservative” you have an actual proof of those people who’s families couldn’t keep them on life support, right?
            Note: opinion piece on CBC does not really count, as even you might realize.

          • My posts might have been pathetic but few? 2500 plus is not a few. Given that I actually “stumped” online for for the Wildrose before the last election, you might get an indication what the record is. Besides really, who brags about voting conservative on a liberal blog like this…most the time I am trying to live it down.
            Now you are going to claim there are not people in your country who haven’t been bankrupted by illness and kicked off by their medical coverage by insurers because of the costs of their lengthy illnesses and expensive treatments? I don’t have to count on the CBC for THAT information, your beloved Democrats got elected to two terms in the White House under Obama because of it, not to mention the recent government shutdown. Hey we live in the north, not in a news free zone.

          • So, just ranting, no facts. How…ah, liberal.

  7. Welcome to Canada. We have now decided its time for you to die.

    • No, we have decided to let nature take its course as intended and that sometimes it is cruel to allow technology to give false hope of a recovery when there is none. It is not always the right thing to intervene to keep a body alive when the mind is gone, just because we have the technology to do so.

    • Critical care technology means that we have machines that can replace the function of your heart, lungs, kidneys, liver, and digestive system. We can’t fix a failed brain, though, so the best those machines can do is keep a body going until it dies of some sort of infection or wears out so totally that the machines can no longer compensate.

  8. The requirement of going to a tribunal that acts quickly when there is a disagreement between doctor and next-of-kin seems entirely reasonable to me. These doctors were arrogant. If they felt their patient was suffering needlessly they should have applied to the tribunal as soon as the next of kin challenged their decision.

    I think the idea that the doctor should be able to make the decision unilaterally appalling. I personally would not want to live in that state but my family knows it. If there is a disagreement I want a tribunal to weigh in.

    • Probably didn’t want to go through the nonsense that London did when they went to the tribunal about Baby Joseph who was suffering and his parents brought in the wacko religious troops from the US…Death threats against the doctors and staff at the hospital soon followed.

    • They go to court with the belief they are acting in the best interest of the patients. It isn’t exactly arrogance but likely frustration. To the physicians it is common sense but to families it is very emotional. I encountered one lady who was very, very angry that physicians had “let” her 91 year old mother die without intervening in every possible way, even though her mother was ready to die.

      • How did you know her mother was ready to die? Did the lady – the daughter – realize this? Was she given time to come to terms with it?

        • The lady told me her mother asked her to let her go. The mother was in ICU for at least one week asking her daughter to let her die. How long should a daughter take to come to terms with her mother’s wishes when her mother’s body is worn out and there is nothing science or medicine can do to change that?

          • And why couldn’t the daughter let her go? Did you ask? Perhaps there needs to be grief counsellors available in such situations.

            Obviously, this woman had power of attorney or she wouldn’t have been able to hold up the process to such a degree, requesting medical intervention “in every possible way.”

            I don’t know if a near-death 91 year old would have the ability to know her own mind. If she did, could she not tell the staff what she wanted?

            This situation seems so one-sided that it is clearly a case where the old lady should be let die – if we are getting the whole story.

            It is not, as you say, a case of the mother’s body being worn out because if it was worn out the solution would be to let her die naturally, receiving palliative care. So it was more a case of the body NOT being worn out, wasn’t it, and some people wanting to hasten death, and one person not.

          • Sue, I have no idea. The facts are that the woman was dying. She lived 91 years. It was over for her. Her daughter was an acquaintance I met because our children were on the same sports team.
            When I said the physicians didn’t do every medical intervention possible, I meant they didn’t put her dead mother on life support. Her mother died of natural causes. The woman couldn’t accept the death. She wanted all kinds of surgeries and investigations that weren’t in anyway appropriate or even possible for a 91 year old woman to be exposed to. Of course of the woman should be let to die because she died of OLD AGE.

          • There is a difference between putting someone on life support and for instance, rescucitating them if their heart fails, or giving them other kinds of treatment. She was very old to be put on life support. But I can see that it might have come as a shock to the daughter, I can see also that she told you in retrospect, not as it was happening.

            So she wasn’t on life support after all. And the mother asking the daughter to “let her go” was probably more of an emotional plea not one meant to get her daughter to take her off life support. So her daughter’s saying, buck up, you’ll be better soon, and the mother’s saying Let me go. There should have been a grief counsellor

          • Sue, how can the death of a 91 year old person come as a shock to anyone? Resuscitating a person who has died of old age is a very bad idea. Their bones are very brittle and their ribs tend to break during CPR. The entire act of CPR is very violent and not a pleasant procedure. A person who is resuscitated it not apt to be very comfortable upon awakening especially if all their ribs are broken.
            This example of a daughter who showed incredible selfishness in denying her mother a peaceful death, perhaps even in the comfort of her home shows us the extend of emotional immaturity exists in some of the adult family members who are involved in the decision making when it comes to the welfare of dying patients. Despite the advanced age of her mother and the fact that she herself was now a supposedly mature woman and mother, this daughter never prepared herself for her mother’s passing. This woman definitely needed counselling but the counselling should have come before she burdened her mother with her demands that her mother survive at all costs. A parent should at the very least be rewarded by their children with a good death. An adult child should not be hanging on their parent, wailing for their parent to stay with them, while their parent is dying as though their parent is failing them rather than doing what is inevitable according to nature’s plan.

          • You were talking about life support, were you not? Isn’t that what you decided, that she must have meant life support, ie to put the mother on a machine that would breathe for her? Like the man who is the subject of this article.

            I can see that the daughter might have wanted that, but didn’t have the cooperation of the hospital, so simply had the week with her until she died.

            What they had decided to do if the mother had a heart attack is another issue. No doubt, nothing.

            The daughter didn’t appear to be asking for rescusitation, just to keep her alive on life support. This is waht you said:

            “When I said the physicians didn’t do every medical intervention possible, I meant they didn’t put her dead mother on life support. Her mother died of natural causes.”

            You know that you can’t know how you will react to your parent;’s death until it happens., No one can prepare completely for the end of someone they were close to.

            I don’t know what your acquanitance told you about the death of her mother. I think maybe you made up a bit to fill in the gaps.

          • I think the daughter thought life support was an option. It never was. Her mother was old. Her mother’s organs were old. Her mother’s body was worn out and likely she had kidney failure and heart failure. The daughter had UNREALISTIC expectations.
            I know I will not ask my parents who are 86 to live longer than they are capable of to suit me. I will hope they fall asleep and don’t wake up. My father-in-law and mother-in-law both were living at their own home when they died and my husband and I are grateful for that. You don’t get to chose when your parents die but if you do, pick what is best for them and hope when you go, that you will have a nice death too.
            Of course I didn’t fill in gaps, Sue. I am a nurse and she was venting at me about the crappy health care system in Canada that let her 91 year old mother die without doing everything possible to save her. Are you sure you aren’t doing some projecting of your own here?

          • I gather the daughter not only thought life support was an option but kept on thinking it was, even when told it was not.

            There’s a difference between asking your mother to live longer for your benefit and asking her to sign an agreement to accept no more treatment, when treatment is available – and I don’t mean life support.

            And by the way, death can be hastened, I’m sure in a multitude of ways.

          • No, life support was not offered and really there were no options for more treatments but the daughter wanted the doctors to keep on poking and prodding her mother to find a cure despite the fact that her mother was very aged and was ready to die and there was no cure. Death of course is inevitable and at 91 years old I think a person has earned it on their own terms. It is very sad because her daughter will never likely be at peace with her mother’s passing but always be bitter about it. I am sure that is something her mother would never have wanted.

          • I don’t know what good life support would be, at that age, if there was no treatment available. The daughter seemed to still be hoping that her mother could make a recovery.

            I think sometimes when a person has a chance to read about what others go through they can come to a different understanding of it.

          • Yes, she did think her mother could recover. I have known others who have not prepared for their elderly parents passing or becoming disabled (with dementia, etc.) Those people too have had a very hard time accepting what has happened. It is almost as though their parents were in their 50’s instead of their late 80’s or early 90’s. They just didn’t let themselves think about what was likely going to happen in the not too far future.

          • Each situation is different. When my mother died I accepted that it was the inevitable result, and that my mother had exercised choice. Then when my father was 90, my brother had him moved 150 miles for convenience sake – his – my brother’s. He put on weight, became bloated and was dead within a few weeks.

            I started thinking about my mother’s death, and my brother’s attitude – even before that. My brother never had anyone’s interest at heart except his own. It must have been a nuisance for him having my mother in ICU. And he had bullied her before to get his own way. She could have gone on dialysis but presumably chose not to. She was 86, but I am no longer sure that she made the choice of her own free will not to accept treatment.

            Well, my brother succeeded in isolating me from my parents and people I knew. My mother died too soon for me to attend the funeral (I was in England), and for my father’s death, my brother put a notice in the paper saying there would be a private graveside ceremony for family only, except he and my daughter didn’t bother going. Google Dennis Fulham Woodstock for his military record.

          • Sue, I hate to say it but your comment makes it clear why physicians need to concentrate ONLY on what is best for their elderly patients without getting into the politics of the family.

          • We’re talking about dialysis, not life support, in the case of my mother. She only ended up at the end of her life because of decisions my brother and daughter were involved in making.

            As for the patient’s doctor, in the case of my mother her family physician had already exited the role, leaving the responsibility to the hospital doctor. I guess that made it easier to make ‘objective’ decisions.

            There has been talk of death panels, but I don’t know that that applied to my mother’s case. Hers was a case of deciding, with help from the family, to not accept treatment that was available.

            Who knows what’s best for the patient. My mother was coherent enough, apparently, to make the decision, while ill, having been admitted to hospital, under stress, but capable enough of making the life-changing (ending) decision to not accept treatment while not even having more than a day to consider it, and, while my brother hovered over her. And we have already experienced the power he had over her, time and time again, to get her to do his will.

          • I’m sorry for your loss Sue. I would like to comment that I am a nephrologist and work in the ICU, and I consider dialysis “life-support.” End-of-life is very individualized, and the more we talk about our end-of-life goals with our families, the more we can avoid conflicts within family members and between health care staff, and go with the wishes of the patient.

          • Very well stated.

          • I don’t even know why you would think that was well-stated when all he did was twist the meaning of “life-support” as it was meant to be understood in this article.

          • Praeludium gave you the honest assessment of what dialysis means for an 86 year old woman who isn’t getting the dialysis as a life saving treatment while waiting for a kidney transplant but rather as a life-prolonging therapy for someone who is dying from kidney failure and isn’t well enough to be a transplant recepient due to extreme age and other health care issues. What this physician told you is exactly what a physician would have told your mother. Her time on earth could have possibly been extended but that time might not have been especially pleasant.

          • Praeludium didn’t explain the difference, only that dialysis was “life-support”, same as respiratory machine taking over for the patient’s breathing being “life support” but the kind that means the chances the patient will get better are next to nil.

            No one can assume what a physician would have told my mother. I’d rather not dwell on this any more, as this topic is not about me or my mother. You can keep trying to interpret her experience but doctors are not all of the same mind. And not all patient experiences are the same. I’m sure someone did try to convince her it was her time to go, and it was probably my brother’s idea. It was another way of isolating me, by giving him time to clear out the house of anything that belonged to her before I arrived home.

          • I’m pretty sure dialysis was a viable option in my mother’s case. So, even though it is also considered to be “life-support,” and the patient will die if treatment is withdrawn, it isn’t the kind of life support that always means the patient will be in ICU until the machine is turned off, which is the kind mentioned in this article, about the man on life-support.

            Not all families talk about death. It was me who suggested to my mother several years she died that perhaps she’d like to purchase a plot for the two of them. She hadn’t thought of that, nor thought of updating her will until I encouraged her, and gave her the name of my previous lawyer before I left the area. It was always my mother who took charge and dominated, which is why I refer to her only and not to my father. She couldn’t have known, but he did remarkably well after she died. But my brother talked my mother into making him power of attorney, along with my daughter, because, she said, he would be able to work with her. Dominate, he meant.

            So no, I did not get much information. But it was interesting that he felt the need to be so formal about getting my mother’s consent not to accept further treatment. It didn’t make it any more believable that he had only his own interests at heart. I didn’t realize that until my father died, after having been moved 150 miles at age 90, away from his second intimate partner, for the sake of convenience, or something like that. He gained a lot of weight very quickly in the retirement home in Southampton and then died of a heart attack.

          • Sue, having 86 year old parents I can just about guarantee you that they have reflected on the what if’s for sometime now and are just waiting for the day to arrive when they will be faced with “treatment decisions.” Your mother probably spent that day thinking about how you and your brother would cope when she passed away but she likely knew exactly what she wanted for herself. As a student who met elderly who were dying, they almost always were solely concerned with the effect their death would have on their family and usually completely accepting of their fate for themselves. They have lived long lives and most are ready to go when the time comes. Their fear is usually not that they are dying but rather that they will suffer by lingering in pain or that they will leave family behind how can’t cope in the world.

          • Don’t assume you know what my mother was like. She wasn’t good at facing decisions like that, or dealing with her own health issues.

            We don’t know what she was thinking, for sure. As I said, she had a tendency to do what my brother told her to.

            Once she made the decision she would have stuck with it, just like she stuck with her marriage. But I doubt that she completely accepted the decision she had made. Most people would have mixed feelings, I should think, and possibly regrets and momentary thoughts of Well maybe I shouldn’t have – possibly a reason for the restless sleep she had later in the week which were counteracted by more morphine. One day is not long enough to make such a decision.

            I know she didn’t fear dying but I don’t think she was too concerned about what would happen to her family – her husband, for example. They just weren’t those kind of people. You shouldn’t project your own experience on mine or my mother’s and the rest of my family because it probably doesn’t apply too accurately.

          • Sue, how old are you? Have you never given any thought to end of life decisions and the inevitability of your own mortality?

          • You have a way about you that is insulting.

          • No living will I guess.

          • I think it’s actually you that has this issue with blaming everyone else for everything that has happened around you. It was your husband that left you, then your poor choices in choosing a bad course of study in university, then you couldn’t find employment so you’re poor but it’s someone else’s fault. Then you complain that doctors aren’t treating your pain and treating you like a second class patient. Now it’s your mother who at 86 should have stayed on dialysis because your brother wanted to kill her. You need to read your life story woman, it’s always about other people having a problem and never you.

          • I may not have been explicit enough. I left my husband. I had had enough, and he was getting even more domineering, especially in matters of sex. Unfortunately, I had thought university was about merit, not about the competition among women with merit (and without) who were willing to use any power they had, including their sexual power. That’s something I wasn’t comfortable with. People in power tend to hire people with similar values, and that mean men and women willing to engage with one another in ways I wasn’t comfortable with.

            I don’t know for sure what happened with my mother because I was in a different country and the only think I know for sure was that my brother, my daughter, and someone else made sure her consent was given “freely.” Yeah, right. She should have had someone else asking her if she was willing to forgo life-giving measures and not her family, at least, not them.

            Actually, I have been left holding all these problems, while the ones who don’t mind using what power they have to get ahead in life, do so, while trying to crush me for writing about it.

            See Anne Kneale and Bill Mates: age, gender, and sexual
            exploitation Apr 14, 2013:
            http://suemcpherson.blogspot.ca/2013/04/anne-kneale-and-bill-mates-age-gender.html

  9. If history has taught us anything it’s that human life has not been treated as “precious” in reality. What this article points up is that a lot of people have a superstitious fear of death and that the medical system is mostly centred around money.

    • Could you give an example of the things you think in this article represent “fear”?

  10. This case of Hassan Rasouli has nothing to do with “assisted suicide” whereby the patient decides he doesn’t want to live in pain anymore, or with a terminal illness that leaves him incapacitated.

    This situation is related, as your note indicates, on the “related” article about suicide: RELATED: Right To Die: Why Quebec will likely become the first province to legalize assisted suicide. However, including that subject here, within the body of this article, only makes it appear that these are more closely related than they really are.

    If you – Macleans, for instance – want to turn people onto euthanasia, and against growing old and living with chronic illness, then by all means keep pushing this case of this man whose life will never get any better, and which couldn’t be all that great anyway.

    This is a cultural and religious matter, and the last thing Canada needs is hoards of foreigners with customs and norms that are not at all traditionally Canadian insisting on their rights. They are not only being a financial burden, they are also turning people away from a compassionate view of the issues related to assisted suicide, in which the patient himself has a say in what happens to him (or her).

    The man in this case probably didn’t see this coming, at his fairly youthful age of 61. So it does bring to our attention the necessity of arranging for consent before anything bad happens. But don’t mix this in with the idea of euthanasia and patients wanting the right to end their lives before they get to that state.

  11. In cases like this I believe the physicians and the procedure to ‘pull the plug’ are ethically motivated as is assisted suicide.
    Dr.Donald Low’s comments a few weeks ago on the right to die and extraordinary measures to keep a person who is in a ‘vegetative state’, horrendous pain or the like should be allowed to die. It is an act of mercy!
    And yes we will be hearing a lot about this–in fact we’ve only just begun.
    Canadians by the thousands do it for their pets out of mostly a deep sense of love and mercy. Surely we can do the same for our fellow brother/sister for all the right reasons.
    Please people; technology will just increase these horrid situations of artificially keeping a dead person alive.
    I believe the vast majority of Canadians would support this as the vast minority will always be against this. Have a heart people; don’t let your fear,guilt and religious views get in the way of your compassion for a peaceful quiet death.

    • Whatever the ethics, the main difference is that Dr Low wished for his own life to end. This article is about end of life scenarios, by choice and by relatives’ choice when the situation is right.

      Dr Low may have thought he was standing up for others, but he was in a situation, more than likely where he had the money to buy the solution he wanted, if he were willing to go out of the country for it. His kind of request could do harm to those who are under the power of people (nurses, attendants, Drs, receptionists, etc )who don’t care if they live or die.

      I imagine that one more reason why thousands of pet-owners do it for/to their pets is because the cost of keeping them alive can get to be a burden. As for whether it is done for the right reason, that’s up to the pet-owner.

      As far as human beings are concerned, ending the life of another human is or should be more of a responsibility than doing it to a pet.

      And it isn’t a fear of any type, necessarily, that gets in the way of people saying No to this. Any death can only be peaceful if the recipient is ready for it. Having someone make the decision that my time on this earth is over is not something I want, not when I still have work that I want to finish – or indeed, other reasons for sticking around. We don’t always get to choose when to leave this world, but worse than not getting to choose because of an accident is not getting to choose because some other person decides it’s time.

      • Hi Sue;
        I tend to agree with much of what you say except the last paragraph in your response to me seems to contradict the 1st sentence of your letter where you agree to turn the life support system of this man off.
        This puts the whole question back to square one.
        Saying that; I do like your contribution to this ever more growing popular debate (discussion)–we’ll see a ton of this stuff in the coming months and years and it’s important that Canadians of all backgrounds pay close attention.
        Technology it seems always surges well ahead of ethics and newer and better life support systems will continually be upon us and well ahead of the ethical curve. We all have to keep talking about it.

        • I think you’re claiming fear is the reason why this family, and many others perhaps, don’t want to see the person’s life end. But that is so vague, and doesn’t really explain what’s going on in that family. It’s more likely that it is their culture that’s the problem, or certain religious beliefs.

          I doubt very much that fear of death is the issue, which I think is what you meant. It might be fear of being alone, fear of not having the man of the house to protect them, or whatever. If you’re going to claim it’s about fear, then explain what you mean, If you think it’s about guilt, say why. If you think it’s their religious beliefs, inform us what you know about the Muslim view of death.

      • Do you really believe pet owners euthanize their pets because of the cost of keeping them alive? I believe you are wrong. People pay extravagant amounts of money to look after their pets. They euthanize them when they feel they are suffering. I am not sure if you have owned a beloved pet but to see it go from an active family member to a point when it is struggling to breathe and is having regular seizures, is incontinent and falling down stairs, is very heartbreaking. When the medications provide don’t ease of the symptoms, euthanasia, which costs hundreds of dollars, seems like a very humane last gift to an old friend who has meant the world to your family.

        • Is that “heartbreaking” as in seeing someone you love dying, or “heartbreaking” in a different way?

          • It is heartbreaking in the way that so many people love their pets as though they are children. For me, my children grew up with their pets and were devastated when the pets got sick and were dying. If we could have thrown money and the situation and cured the pets, we would have but congestive heart failure has no cure and the medication only works for a short period of time. Taking your pet to the vet and putting them to sleep is a much kinder thing to do than watching them struggle to breathe.

          • It would be impossible to make palliative care available for all pets, though there are probably some owners who have it for them. For humans solutions such as morphine keeps people settled, though doing that for animals would be another expense and not one they would understand. Unlike humans, no one really cares what you do with your pets. It’s up to you if you want to shorten their life.

          • Palliative care for pets likely wouldn’t work for one important reason…pets can’t tell you when they are in pain.
            Cost in terms of old drugs like morphine isn’t a big deal because morphine is very inexpensive. I am not sure you can use it on pets though.

          • My girlfriend was allergic to morphine, have you ever seen someone die of cancer without proper pain treatment? Report back when you do. Palliative care is a joke, you basically starve to death.

          • There will always be exceptions. You can’t make a law that will cover everyone’s needs. But we hear time and time again about how some people in society – generally the ones with less power – get stomped on. and that’s just asking for trouble to make a law giving Drs and their confidants the power over life and death.

  12. I do agree with those who say this man should have his life support turned off. Anyone who is having brain surgery or other surgery that might have complications should state their wishes beforehand. It seems to me that his family has been left fighting for his life, while he himself did nothing to make things clear. Perhaps that’s the way they like it over there, that the wife stand by hubby regardless of the situation. That way, he isn’t obliged to state it for himself that, no matter what, he wishes to remain alive if he ends up on life support. We have a difference in culture here, one that needs to be resolved, before many hundreds of thousands more immigrants arrive on our doorstep from countries that hold these strict beliefs.

    As for euthanasia, on behalf of oneself, that’s a different matter. Let’s not hand over complete power over life and death to the receptionists who have done favours, to nurses, attendants and Drs too quick to sign off on a patient. This is a political issue, in ways not even beginning to be dealt with. Too many people don’t like to be associated with older people, are too ready to be insulting towards them, sometimes treating them like children, and doing what they can to make life harder for them – especially those who don’t obey in ways they think they should, being from a different generation, and perhaps speaking out against social injustice. The same people who would refuse needed treatment or medications to patients are likely going to be the same ones only too willing to sign the papers to stop life-giving treatment – and without telling the patient.

  13. The doctors should have the right to pull the plug. They have no vested interest – no financial benefits to be gained – no personal vendettas to settle – and the condition of the person involved would be very critical without hope of recovery. Keeping someone alive on a machine, especially for that family at the core of the article, often means financial payments that end on death. CPP, disability, etc. etc. It is hard to understand how anyone could watch someone they claim to care about suffer with a tube stuck in their stomach or shoved down their throat while they do drama for the media.

    • You don’t know that any given Dr has no vested interest in getting rid of someone. That’s just asking for trouble – yes, let’s get rid of the patients who don’t have families, or don’t have money. Or how about getting rid of Muslims, or people of a particular race? Or how about getting rid of people who hold particular political views that are generally unwelcome – for instance, on things sexual.

      Once you give that permission – to Drs, (and that means their nurses and admin staff too) , you will run into all sorts of problems with abuse of their power. We already see that, when some people don’t get as good treatment as others. Drs make wrong decisions sometimes. Giving them power would not be good for our society.

  14. I just want to point out that the kind of life support that is of concern here is the kind which involves the patient staying in hospital, on a machine. this is not a typical case.

    It is different if a patient might be able to go home again to live, using some other form of life-support, such as a new heart, or dialysis treatments. The big problem here are patients who cannot breathe on their own and need constant care in a hospital.

  15. This case of Hassan Raouli is a red herring. It is an exception, leading readers to think that this could happen to any one of use, or our families. Rather, this is one of those cases that got the media’s attention, just like Tarek Loubani’s and Greyson’s did over their ordeal in jail in Egypt, while thousand of others have experienced the same fate and not received attention.

    Don’t worry. Most people who are in that state, of not standing a chance of getting better, will gradually (or suddenly) be deprived of gentle care and will sooner rather than later meet their maker. Their won’t be hoards of people in the same situation in hospital who so clearly need to be set free. Usually, older people on their last legs will be put in another kind of car home, cheaper than the accommodation of this man – Sunnybrook Hospital, as far as I can see.

    The doctor who recently made his own life an example for the assisted suicide movement is also an exception. He also would be getting the best of care and could have afforded to go abroad to end his life.

    The people this movement will really affect are the ones whose families can’t afford to keep them alive at home, whose doctors don’t have the right to end them, much as they might like to. Convince these people that letting go is the right answer leaves far more resources for those already with money to make use of, to get them healthy again. Doctors will be less encumbered with citizens who are becoming a burden, and freer to help those who, in their view, probably deserve it more – the middle classes.

    In the UK, a few years ago, in the 90s, Dr Harold Shipman started killing his elderly patients – over 200 of them. Nobody noticed, for several years. An overdose of morphine was convenient and quick. And we have people here who want to make it legal for doctors here to make the decision when a sickly old person should exit this world? What do you want when you are old? Do you have someone you can trust who won’t just be trying to get rid of you so they can inherit your belongings and property, and worse, so they can take their place as the new patriarch or matriarch of the family.

    Instead of so much emphasis on assisted suicide and ending respiratory life support (pulling the plug) more needs to be done on keeping people out of hospital for as long as they are able to remain at home, and in the area of palliative care. This talk of how to make it easier to end people’s lives doesn’t sound as though it’s going to be much better than the holocaust, when unwanted people were rounded up and put in camps, except this time it will be the poorer people, not the Jews.

  16. they should have the right if they are suffering put them out of their misery

    • Yes, they should. That’s what we have been discussing here, how to allow that to happen without those in authority – hospitals, etc, and family members, abusing the power they have over these vulnerable members of society.

  17. During my 16 years in England, I spent three years (1995-98) working as a caregiver – living with and caring for several elderly people suffering from advanced dementia. I saw first-hand how this disease leaves its victims trapped in a truly terrifying, living hell – with no way out except fading slowly and somewhat agonizingly into a merciful death. I often felt my charges were closer to anxious zombies than human beings – and did often wonder about the ethics of prolonging life as long as possible under those circumstances.

    My time as a carer left me decidedly unwilling to experience that kind of ‘life’ myself. As such, I can say hand on heart that the day I’m diagnosed with dementia is the day I start making moves to check out. When it comes that kind of illness, I’m going to quit while I’m ahead.

    In fact, maybe we should be a little more like Latin America – where people appear to embrace and celebrate death rather than attempting to ignore it and lock it away behind closed doors, as westerners seem inclined to do?

    Raising awareness
    This year, I self-published The Carer, a short e-novel based on my time as a live-in geriatric nurse. Described as a “gritty urban thriller with a social conscience”, The Carer offers a “Faustian tale of elder abuse, patricide by proxy and the corrosive effects of power.” You can buy The Carer for USD0.99 from Amazon and all other major ebook retailers.

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