After surgery to remove a brain tumor last October in Toronto, Rasouli, 59, contracted bacterial meningitis. The infection spread to his brain, leaving him in a coma. His doctors say he is in a permanent vegetative state, and are calling for removal of his ventilator and feeding tube, after which he would die.
Rasouli’s family disagrees. They say the Iranian mechanical engineer is getting better and will recover. “He was a very strong man. He went into the surgery thinking he would come out alive,” Rasouli’s daughter, Mozhgan, 27, said in an interview with The Globe and Mail, Canada’s main national newspaper. “I appreciate all the doctors’ efforts through these miserable months. But we want my father alive.”
In a case that recalls American Terri Schiavo, Mozghan, her 23-year-old brother Mehran and mother Parichehr Salasel, are now fighting a legal battle against the doctors of Sunnybrook Health Sciences Center over who gets to make the final decision regarding Rasouli’s life. At the core of this life-or-death case is the question of what is considered medical treatment.
“Doctors are obliged to offer treatment that can benefit the patient, and they are obliged not to offer treatment that is futile,” was the statement from Rasouli’s physicians to the court. Since the doctors, Brian Cuthbertson and Gordon Rubenfeld, believe Rasouli’s ventilator and feeding tube are part of a treatment plan that is not of medical benefit to the patient, they should be able to terminate it regardless of family opinion, their lawyer argues.
“If medicine can achieve nothing for the patient, it is not in the patient’s best interests,” said their lawyer, Harry Underwood. “How are patients’ best interests to be protected?”
Gardner Hodder, a lawyer representing Rasouli’s family, countered by saying, “Deciding whether someone should or should not have rights is not the purview of a doctor.” Rasouli’s wife, Parichehr Salasel, a family physician from Esfahan, is “willing to see this play out and keep him alive a bit longer to see if he fits in the small percentage that recovers.”
“His life is a gift from God,” says Salasel, a devout Shiite. “God wants him to be alive.”
Her son, Mehran, says his father’s condition is improving. “When I speak to him, he opens his eyes. He knows me,” Mehran said.
Nevertheless, the doctors in the case told the court, “It is as certain as anything ever is in medicine that he will never recover any degree of consciousness.” As a result, they are trying to appeal a previous court decision that requires them to seek approval from Ontario’s Consent and Capacity Board to stop life support without the family’s consent.
The Consent and Capacity Board, a decision-making body only in Ontario, provides quicker and end-of-life treatment decisions than the courts. In other Canadian provinces, families must go to court to challenge doctors’ wishes. If the court rules that the Rasouli physicians decide to end life support without first getting the board’s approval, it would set a precedent for all Ontario doctors to make unilateral decisions about such treatments.
“There should be a review of these decisions,” said Mark Handelman, a Toronto lawyer and representative for the Euthanasia Prevention Coalition. “At stake is the autonomy of individuals at the end of life to contribute to the definition of their own best interests.”
“At least there [at the Consent and Capacity Board], there is some sense that a fair hearing can be made and decisions can be made quickly for the best interests of everybody,” says Alex Schadenberg, also of the Euthanasia Prevention Coalition.
On the other hand, Underwood says an opposite ruling would “box in” doctors, forcing them to continue even useless treatments. The result would be “patients being able to pick and choose their own treatment… This overturns established models of medical decision making,” he argued. Doctors decide the best interests of a patient based on medical benefit.
The three-judge panel of the Ontario Court of Appeal was set to make a decision thisn Wednesday while the Iran Times was in the mail.
One of the judges, Justice Michael Moldaver, asked Underwood, “Are we that impoverished a society that we’ll say, ‘We’ll just let him go?’ Why wouldn’t we look at it the other way and say, ‘Let this person keep going?’” Some medical ethicists and physicians agree, saying the patient’s values must be considered when deciding “best interests.”
“It may be in the patients’ best interests to carry on because the patient believes it is what he has got to do to get his eternal reward,” said Justice David Doherty.
The question of “patients’ best interests” and the ultimate decision-maker received a lot of attention in the United States in the fight between Teresa Marie “Terri” Schiavo’s parents and husband from 1998 to 2005. After a cardiac arrest in 1990 left her in what doctors called a vegetative state, doctors tried to bring her back to consciousness with physical therapy and experimental therapy.
After a few unsuccessful years, Terri’s husband, Michael, sought in 1998 to remove her feeding tube, inciting protests from Terri’s parents, community members, lawmakers and even US President George W. Bush. After numerous appeals and despite attempts by some legislators, Michael Schiavo’s decision was honored in 2005. Terri Schiavo died March 31, 2005.
