SHOULD DOCTORS GET PERMISSION TO PULL THE PLUG?

Hassan Rasouli has been in a coma in a Toronto hospital in a coma since October 2010.  His doctors say he is in “a permament vegetative state” and they recommend that he be taken off life support.  His wife and his substitute decision maker strongly oppose this.  Now the doctors have taken the case to the Supremne Court in hopes of disconnecting Mr. Rasouli from the medical machines that are keeping him alive.

The outcome of the case could set a national precedent on protocol for end-of-life care when physicians and families disagree.

A  lower court in Ontario has ruled that Mr. Rasoluli’s doctors would have to obtain consent from his family before adminstering palliative care.

As it now stands all provinces except New Brunswick require consent from the family or the substitue decision-maker.

A professor of medicine at Queen’S says it is of utmost importance that we get this right.  “The pendulum has swung to the family making demands that are at many levels unrealistic or illogical or even futile.”

With limited funds for health care, should we keep people alive for months or years on life support?

If you were on your death bed would you want your family’s wishes to prevail over the doctor’s diagnosis?

Should doctors get permission to pull the plug?

16 Comments »

  1. 1
    Tony Kondaks Says:

    Great question…and my response is going to try and benefit from the best of both worlds.

    Yes, the family should have the last word whether the plug is pulled…but in hopeless situations where, as in the case Neil relates in the blog, the patient is in a vegetative state with no hope of recovery, the costs must be born by the family. And if they have no money, then tough, the plug gets pulled.

  2. 2

    Take each case on its own merits. There are no one-size-fits-all answers. But, when the consensus of medical opinion is that brain death has occurred, if the family wants to “keep it going,” then they must remove their patient to a private facility and pay for its continued non-existence themselves. Hospitals are already overcrowded. Why is this even under consideration?

  3. 3

    This is a very slippery slope. More the reason for people to make a living will and express their final wishes in such an event.

    I don’t think that Doctors should have to bear the burden of the final decision.

    I agree, if there is no hope, and the family wants on-going care, the patient must be moved to a private care facility, out of hospitals and out of the “free services”.

  4. 4
    Neil McKenty Says:

    So from the above comments should I conclude that the rich can go on living but the poor die? Does that cynical viewpoint reflect the true values of this country?

  5. 5

    I don’t think that’s the point. But resources should not be prolonged long after a human has lost all viability. However, the decision should be a medical suggestion and not given to doctors to have that burden to have to argue with the family & go to court. Just because we have the technology to keep a body alive, doesn’t mean that we should.
    In this case, the family wants to prolong life, then they should pay for private care, the same as one pays for private care for elderly people. No one should be “warehoused” in a hospital. That’s an indignity!
    Personally, I would prefer to be allowed to go.

  6. 6
    Cate McB Says:

    Those with the money to do something other than that advised by medical doctors have always been able to use their money to do just that. The question now concerns publically funded Canadian medicine.

    We’ve come full circle now. With the US Quinlan case in the 70s, the family was suing to have Karen Quinlan (also in a permanent vegetative state) taken off the ventilator so that “nature could take its course.” The family won, she was taken off the ventilator, and lived unconscious for years in a nursing-home-type-place (which the family paid for presumably) until her heart finally stopped.

    Now a Canadian family — specifically an Iranian-originating, physician-wife of the patient is suing to require that physicians do not take this man off the ventilator with the claim that doing so would defy her Islamic view of preserve-life-at-all-costs.

    I’ve been wrong before, but I have a hunch that the Supreme court (if they have agreed to hear the case) will side with the physicians’ view that further artificial ventilation is futile in this case. In other words, the underlying process is irreversible and further artificial ventilation won’t change that. The patient had a brain tumour and diffuse meningitis that has caused irreversible changes in the brain.

    Yes, this will be a precedent-setting case and I hope the right precedent is set! otherwise physicians and the rest of us are doomed to provide more and more futile care.

  7. 7
    Cate McB Says:

    And yes, the Supremes have agreed to hear the case!!

  8. 8
    Barbara Says:

    No, Neil. It is not a question of the rich continuing to live. It is the rich keeping someone in a vegetative state indefinitely despite overwhelming medical opinion that recovery is impossible. I believe the family must be respected, but they must pay the cost of the care. Medicare is designed to maintain us in and return us to good health and to care for the dying in a humane fashion. There are some things Medicare does not cover because the treatment is not proven to be effective.

  9. 9

    “…the rich can go on living but the poor die?”

    No, Neil. Brain death means dead. Period. The rich merely have the option of keeping the meat fresher, is all.

  10. 10
    Neil McKenty Says:

    The ugly little fact that you all seem to ignore is that in some cases those who have been diagnosed in a permanent vegetative state have in fact partially recovered.

  11. 11
    Cate McB Says:

    If this was a case of head trauma (e.g., after an MVA) and he had only been in a permanent vegetative state (PVS) for a couple of weeks, I would be more hopeful and asking questions re: potential recovery (i.e., recovery of consciousness and/or function(s) ).

    However, this is a MUCH different scenario — more than 3 months in PVS (its been 8 months actually) and a non-traumatic cause, i.e., massive meningitis post surgery for a benign brain tumour. Irreversible is irreversible.

  12. 12
    Tony Kondaks Says:

    Neil asks:

    “So from the above comments should I conclude that the rich can go on living but the poor die?”

    Yes。

    The right to universal healthcare does not extend to enjoying your relative‘s rotting,dead carcass with no hope of revival or life。Enough is enough。

  13. 13
    Tony Kondaks Says:

    I had to make decision to pull the plug on my father。。。and he wasn’t even in a vegetative state。He was 86,had suffered a massive stroke,and all he could move was his index finger in his left hand。Certainly,it was a traumatic decision to make,but not a difficult one。My father had not only signed a living will making clear his intentions but we had discussed it countless times。。。somethingIencourage everyone todo。

  14. 14
    SUZANNE Says:

    Medical opinion is often biased. The “Vegetative State” diagnosis is often vague and used to get rid of “useless eaters”.

    If I were on my deathbed, I’d much rather have my husband decide what should happen than doctors.

  15. 15

    Death is a difficult discussion. In the vast majority of cases, it’s evident what the decision should be. In those very few cases such as the religious argument above, perhaps an Imam could shed some light. (although, in some religions, the interpretation can be skewed to suit the circumstances).
    The person is dead, and he is being kept “alive” artificially. There must be a religious argument against that!

    I guess we need to rethink and redefine death spiritually, morally and legally.
    At the same time, we need to do the same about life.

  16. 16
    Jim Says:

    I have always thought that the best way to depart this life would be for me to pass away during my sleep, in lieu of going through the pain of a heart attack whilst I’m awake. It seems to me that if I’m brought out of a quasi-vegetative state, that I would be quite angry because for the sake of a few more years of life, someone has set me up for a potentially painful ending. And besides, that someone has just torn me away from the warm arms of Bubbles Barton. Sheesh!!!


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