Death Panels, Canadian Edition

In a quest to prove Sarah Palin right, doctors at Toronto’s Sunnybrook hospital have taken to the courts to ask that they be allowed to take a man who may or may not be in a vegetative state off of life support, despite the wishes of the family. Currently, the case is before the Supreme Court of Canada:

Five months after electrical engineer Hassan Rasouli brought his family to Canada from Iran in 2010, he had routine surgery for a benign brain tumour. Bacterial meningitis infected his brain leaving him unresponsive.

 Within weeks, the surgeon wanted the family to take Rasouli off a ventilator that was keeping him alive, but his wife, a doctor in her native Iran, thought it was too soon.

In Ontario, cases such as Rasouli’s where there is no agreement are supposed to be referred to an expert tribunal called the Consent and Capacity Board.

Doctors at Sunnybrook Hospital refused to do that and instead took the case to the Ontario Superior Court in February 2011.

The court rejected the doctors’ arguments that they didn’t need consent to remove life support and ruled that Rasouli’s case had to be referred to the CCB.

The doctors’ case was rejected again by the Ontario Court of Appeal in June 2011. It was then appealed to the Supreme Court of Canada.

Actually, the case is by no means as clear as any of that. There are now conflicting diagnoses about whether Mr. Rasouli is irreversibly unconcious. He may be, in fact, be showing signs of responsiveness. Further, The Doctors (as I’m choosing to call them, if only because it’s such a horrendous TV show) may not be seeking to take the man off life support, they might just want to move him out of the ICU.

The earlier rulings are also a bit of a mess. Again, I’ve seen conflicting reports, but either they said that The Doctors had to go through the Consent and Capacity Board (read:  *uses spooky voice* Death Panel) to remove life support/move the man from the ICU; or they said that The Doctors had to provide some level care, but not necessarily the level of care that the man’s family wanted… except that they did have to provide that because they were providing some other level of care… or something like that. As I said, nothing seems particularly clear in all the reports I’ve read (and I’m not spending a sunny Friday reading court rulings).

As it turns out, with Mr. Rasouli showing signs of responsiveness, this case might not even apply to him, anymore. Nonetheless, it presents some important question.

Much of the debate (from what I’ve heard) centres around the question of who gets to decide on the proper use of life saving (or life-sustaining) medical treatment when a patient is unresponsive. I’m a pretty hard-liner on this, preferring that the next-of-kin haev the final say. However, I think reducing the debate down to this question is an over-simplification.

Moving away from the specifics of the case at hand (considering that it’s hard to confirm them), in certain situations, the general argument that The Doctors are making has merit. Not every treatment is going to be appropriate with every patient – especially when you consider the scarcity of our health care resources. As much as I want every patient to be able to demand – and receive – whatever care they desire, we cannot guarantee that we will have the necessary resources.

Our socialized health care system further complicates this matter. We set limits on the services that can be provided, thus increasing scarcity, all in the hope to offer greater universal coverage (which, I think, we often do). As our payment method converges, so does our stake in other people’s treatment.

Jonathan McLeod

Jonathan McLeod is a writer living in Ottawa, Ontario. (That means Canada.) He spends too much time following local politics and writing about zoning issues. Follow him on Twitter.


  1. There are now conflicting diagnoses about whether Mr. Rasouli is irreversibly unconcious. He may be, in fact, be showing signs of responsiveness.

    Oh, now I’ve got flashbacks.

    Anyway, when something vaguely similar came to a head here, no good came of it at all. Tell Harper to give a speech, have his voice break in the middle of it, but talk about how this isn’t an appropriate thing for the Federal Gummint to intervene in, this is an issue for the Province, may God have mercy on our souls.

    Then go back to building the multi-million dollar artistic ceilings for the temporary government offices.

    • Yeah, my first thought was “oh look, Schiavo II: Brain Deader”.

  2. I really want one of the doctors to be named Perdicaris.

  3. The problem with the Death Panels thing is that they went back on it.

    They should have said “hell yeah we’re gonna have death panels. Right now we spend three times as much per-capita on people over sixty-five as on people under forty, and the numbers only get worse as the age goes up. We want to provide a good life for everyone, but that doesn’t mean we can afford to spend all our money keeping corpses alive for another five years because kids don’t want to believe that their parents will ever die. If you want to call that Death Panels, then go ahead, because the only other choice is nothing at all.”

    • Where “Death Panel” means someone who says “You gotta come up with the money on your own”.

      • I’m not sure that’s really an option under the Canada Health Act. Also, it wouldn’t, at least in the short-run, address hospital overcrowding (if someone actually had the resources to pay for it on their own).

        • This might sound like a joke, but I actually mean it: Isn’t this what they consider the US for? Do you think that if there wasn’t the option of coming to the US, that Canada might do more to address accommodating those who want something and can pay for it? I apologize for sounding snotty, and it’s probably ignorant, but I’ve always sort of been under the impression that we provide a way for Canada to proudly proclaim equality without actually denying those with means better and comparatively convenient options unavailable to others.

          • This certainly happens, but it’s really not very common, I don’t think. First, you actually have to have the money (as you won’t have insurance), and even then, there is a fairly conventional opinion that our health care is so much better than the US’s that I don’t think many people really think of going down south.

            Now, it does happen (and there’s also been people going to India for Liberation Therapy), and when it happens, it often makes the news. There was also a case in the last 5(?) years in which the supreme court determined that OHIP (Ontario’s health insurance program) had to pay for a woman’s treatment in the US because Ontario hospitals were not providing her with the necessary care in a timely fashion. I don’t think that situation has ever been duplicated, though.

  4. Why does the Canadian Supreme Court dress like Santa Claus? Do they give gifts to all the litigants, or only to the ones on the “nice” list?

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