Human Exceptionalism

“Right to Live” Case Before Canada Supreme Court

Futile Care Theory, aka medical futility, is a bioethical theory under which doctors/ hospital bioethics committees are empowered to withdraw wanted life-sustaining treatment based on their perceptions of the patient’s quality of life and/or a cost-benefit analysis determining whether the money being spent is worth the price.

Now the Canadian Supreme Court is going to hear the case of stroke patient Hassan Rasouli, a 61-year-old man with severe cognitive impairments. Doctors want to stop life support, but his family says that as a devout Muslim, he would want the care. Litigation ensued.

Rasouli is not unconscious, but what is often described as “minimally conscious,” as described in the National Post:

As he was asked in his native Farsi to imagine performing tasks like playing tennis, Mr. Rasouli’s brain seemed to respond on an MRI scan during some tests, but not on others, says a report from Dr. Adrian Owen, a leading neuroscientist. The examinations are far from conclusive, but indicate limited brain activity, not a fully functioning mind locked in a frozen body, the report said.

In other words, Rasouli is profoundly disabled.  But does that mean doctors should be able to decide that his time has come to die?  If the hospital and doctors seeking to impose futile care on Rasouli over his family’s objection prevail, that could be the result.

Allowing doctors to unilaterally refuse wanted life-sustaining treatment would institute a profound change in the fundamental purpose of medicine. From the Globe and Mail story about the case:

A legal intervener in the case, The Canadian Critical Care Society, maintains that doctors must have the power to discontinue any treatment that is futile or even harmful to a patient. Critical care treatment should only be given when it may alleviate an illness or provide some permanent benefit, it said in a written brief. “When there is no hope of either, critical care will only result in needless suffering.”

But who decides if suffering is “needless?”  If a patient believes staying alive is worth the suffering, who are doctors and bioethicists to gainsay that decision?  Indeed, if Rasouli loses the case, maintaining life when that is what the patient wants will no longer be a fundamental purpose of medicine. Lives will only be saved if doctors believe it is worth the effort.

Not only that, but a Rasouli loss would allow doctors to veto a patients advance directive. In other words, if patients say they don’t want treatment, that will be sacrosanct. If patients say they do, that will be ultimately up to doctors.   

Futile care theory undermines universal human equality by creating a disposable caste based on “quality of life.” Anyone who doesn’t see the acute danger of allowing strangers–even if medically or bioethically trained–to decide when your life isn’t worth living doesn’t understand the nature of invidious discrimination. If Rasouli is forced to die, Canadians will have lost the right to live.

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