Ecclesiastes 8:6 For there is a proper time and procedure for every matter, though a man's misery weighs heavily upon him.

 A modern translation of a biblical edict will do.  It expresses the need to consider the appropriateness of an action at a time and place when reality reflects the need.  And in the case of an elderly man who became a victim of a personally cataclysmic car crash, a 90-year-old man who has been 20 months in a coma, it is due time to consider the usefulness of refraining from heroic medical actions to prolong his life which is now utterly devoid of anything resembling quality.

The car accident that occurred in November 2010 left this elderly man with serious head and spinal cord injuries.  He was brain damaged.  His long stay in intensive care or alternately the trauma unit of the Ottawa Hospital when required, has been replete with many infections and bouts of pneumonia.  His condition has deteriorated at times to the extent that he has required tracheotomies and suctioning.  A tube connected to his stomach is how he is given sustenance.

Internal medicine specialist Dr. Carl van Walraven at the Ottawa Hospital is of the belief given his specialized knowledge as a medical practitioner that it is not in this man's best interests to undertake aggressive, life-sustaining measures.  The man's daughter, however, who has been empowered to make decisions on his behalf believes the hospital must do anything possible to treat her father for the purpose of extending his life.

Her father, she insists, a Holocaust survivor, would wish to have any steps possible initiated that would keep him alive.  This difference of opinion was unresolvable between the two principals involved; the doctor and the daughter; they were unable to reach an acceptable agreement on a plan of treatment.  The doctor approached the Consent and Capacity Board of the province to weigh the details of the dispute and to reach an informed conclusion.

Their conclusion - after Dr. Van Walraven appeared before a three-member panel to explain it was not his intention to remove life-support systems, merely to rule out heroic measures such as cardiopulmonary resuscitation, if the man's condition continued to deteriorate, which it most surely must, and will, given the circumstances, his condition and his age - was to agree with him.

He explained that the man has been in a persistent vegetative state since his involvement in the car crash, incapable of speaking, or to react to his environment.  He has a "zero-percent" chance of achieving anything remotely resembling a recovery since his baseline health is poor and cannot be improved.  Dr. van Walraven is in support of eliminating any aggressive procedures and tests leading to pain and discomfort.

The elderly, comatose man's daughter and three grandsons all spoke before the panel as well, testifying that although their father and grandfather was incapable of speaking, he still communicated by a means only they were privileged to witness, exhibiting what was to them signs of recognition and happiness.  Emotions that he withheld, according to his daughter, from health professions for fear they were attempting to take his life.

The existence of a power of attorney was made clear to the board of enquiry.  It was signed by the elderly man himself in April 2010.  The man had expressed his desire not to have his life prolonged under certain circumstances: should he ever be in an irreversible coma; should he be terminally ill and life-sustaining procedures could only be expected to delay his death; finally, should the burden of treatment outweigh anticipated benefits.

The board returned their verdict: "Nothing in evidence suggested that, in these circumstances, GS (identifying initials; name withheld) would want to be subject to unnecessary medical interventions...  All of the evidence made plain that GS had a very poor quality of life and that the situation would not improve.  GS was subjected to daily indignities through invasive medical procedures without increasing the likelihood that he would recover any awareness or consciousness."

It was the panel's impression that the man's daughter did not adequately balance his pain and suffering, while passionately advocating on his behalf.  Dr. Jose Pereira, medical chief of the palliative care programs at Bruyere Continuing Care and The Ottawa Hospital, points to this case as representative of the need to make end-of-life discussions before emergencies arise.

"As a society, and as patients, families and physicians, we need to be having these discussions much more openly than we do now.  We need to address the elephant in the room so that we can avoid these crisis situations at the end of life."