UK Decision Overrules Doctors' Request to Remove Life Support

A new decision in the UK courts has over-ridden doctors' recommendation that a "permanent vegetative state patient" be removed from life support. Hassan Rasouli, according to the wishes of his wife, Parichehr Salasel, is currently being kept alive by a ventilator and a feeding tube.

The doctors contend that they need permission to place a patient in palliative care but not to remove life support. The court ruled otherwise.

From the article at Globe & Mail:

“I think it will reopen the debate Canada-wide about how to effectively and efficiently adjudicate end-of-life disputes,” said Mark Handelman, a lawyer for the Euthanasia Prevention Coalition, an intervenor in the appeal. “...The public at large needs to learn a lesson from this. You have to have discussions about end-of-life care with your loved ones.”

The two doctors, Brian Cuthbertson and Gordon Rubenfeld, had argued that although they required consent to provide palliative care to Mr. Rasouli, they did not need it to withdraw life-sustaining measures that are no longer medically useful. The Ontario Court of Appeal on Wednesday upheld a lower court ruling that said that they do need consent, and that if they don’t get it, they must refer the case to a tribunal.

Ms. Salasel said she was pleased with the decision, adding: “I have my husband and he is still alive ... He’s getting better, absolutely. He is alive and with medication, with modern medicine, he will be better.”

The dilemma raised in the case is of society’s own making and increasingly an issue with Canada’s aging population: medical technology can now keep the sickest patients biologically alive, even though some doctors feel this does more harm than good. Distraught family members, meanwhile, often do not know their family member’s wishes, or refuse to give up hope, and choose every intervention available to sustain life.

Keeping Them Alive Because You Love Them.

Michael Vitez writes for the Philadelphia Inquirer's online site, philly.com, about the legal and emotional challenges of end of life care that often looks like undue pain and stress for the dying. It's a shocking article about futile care and medical proxies. I suggest you read the entire thing at the link above but here's a clip, below.

I ask, in all sincerity, what the difference is between Prince and Terri Schiavo's family who wished to keep Schiavo alive because she was "completely vulnerable" to them? Not only does the conundrum of futile care and proxy decision-making cause us to think about the economics of health care but, more importantly, about how we love.

And how, as Vitez rightly asks, do we as a culture determine what is best for the patient?

Prince Pulido loved his mother. She named him Prince, after all.

And he couldn't let her go.

It didn't matter to him that nurses at Abington Memorial Hospital thought he was harming her by keeping her alive, or felt he was unrealistic - believing that stem cells could regenerate her brain.

This was his mother, she wanted to live, and she had always bounced back.

For more than a year, Maria Pulido was kept alive on a ventilator. She had respiratory failure, heart disease, dementia, and diabetes, and had both legs amputated, one after gangrene. By last winter, medical records show, she was in or near a coma - unresponsive, couldn't follow commands, would react only to pain.

Prince knew different. She smiled at him. He saw the gleam in her eye.

On May 14, the breathing tube in her throat got clogged and fell out during suctioning at a nursing home. She went without oxygen for 10 minutes and suffered brain damage. Even Prince could see her stare was blank. Still, he continued life support.

He believes in God and in miracles. He's a Philadelphia fireman who races into burning buildings. There's always hope.

Ten times between June 2009 and July 2010, Maria Pulido went by ambulance from a nursing home for ventilator-dependent patients to Abington's intensive care unit, where she spent 69 days and accumulated charges of $1.2 million.

What, if anything, should America do when families insist on continuing life support even though doctors and nurses believe it just prolongs dying?

(h/t Carla Axtman)

Gary Coleman, Terri Schiavo and the Definition of Death.

Jill Stanek's apparently an immortal doctor.

Baby Jada.

From Thaddeus Pope at Medical Futility Blog:

Summit County, Ohio Probate Judge Bill Spicer recently determined that he has jurisdiction to hear the medical treatment dispute concerning Baby Jada Ruiz. A trial is set for later this month. (Plain Dealer)




5-month-old Jada suffered, apparently as a result of child abuse, fractures as well as brain damage "as severe as it can get without actual death." She is "on life support with . . . no hope of recovery." Jada's father, who has been criminally charged, wants life-sustaining treatment to continue. On the other hand, Jada's mother, Deja, believes that her daughter is already gone and should be allowed to die.


The Plain Dealer says the dispute concerns this question: "What happens when parents don't agree on whether to take their child off life support?" One might be tempted to think the question is actually simpler than that because the father's decision making rights are compromised. Therefore, the mother's decision should be dispositive. But Ohio law apparently supports parental decision-making rights until after a final adjudication terminating parental rights. That has not yet happened to the father.

Love's Demand.

From Thaddeus Pope at Medical Futility Blog: "Hastening Death Can Be Love's Demand."

Here is an abstract of a presentation that I will make at the 2010 Film and History Conference, this November, in Milwaukee.

For several years, I have been writing about the mechanisms for resolving medical futility disputes. One of the primary causes for such disputes is the firm conviction of family members that love demands continued life support for the patient. Love requires not “giving up” on the patient.

More than four decades after the introduction of technology (such as dialysis, ventilators, artificial nutrition & hydration) that can prolong life but not cure or reverse disease, many individuals still hold unrealistically optimistic notions about what medicine can offer chronically critically ill patients. And even those who believe and understand the prognosis often cannot let go.

Hospital clergy, ethics consultants, and social workers spend significant time counseling families, and help them appreciate that consenting to palliative care or hospice is not only consistent with love but even required by love. Three movies beautifully exemplify this re-conceptualization of love: The Event (2003), It’s My Party (1996), and My Life (1993). In each, family members oppose the patient’s decision to forgo therapy or to hasten death. They feel that love demands biological life be prolonged as long as possible. But as the ongoing or inevitable decline becomes increasingly obvious, the family realizes that love demands supporting (and even helping) the patient make a peaceful exit.