"Thank You Canada"

"Thank you Canada. My father's life has changed, but he's there. He's human like any other human."
Mojgan Rasouli

"I am happy for Hassan, so much, but I am happy for all of us, for all humans."
Parichehr Salaselam

Mojgan Rasouli, left, kisses the hand of her father Hassan Rasouli as his wife, Parichehr Salasel tries to keep him comfortable in Sunnybrook Hospital's cardiac intensive care unit in Toronto last year. Photo: Tim Fraser/For Postmedia News

"The Supreme court has spoken and ignoring their opinions is something one does at one's own peril. Every hospital needs to re-review their end-of-life policies."
Rasouli lawyer, Mark Handelman

"This case presents us with a tragic yet increasingly common conflict. A patient is unconscious. He is on life support -- support that may keep him alive for a very long time, given the resources of modern medicine. His physicians, who see no prospect of recovery and only a long progression of complications as his body deteriorates, wish to withdraw life support. His wife, believing that he would wish to be kept alive, opposes withdrawal of life support. How should the impasse be resolved? 
"By removing medical services that are keeping a patient alive, withdrawal of life support impacts patient autonomy in the most fundamental way. The physicians' attempt to exclude withdrawal of life support from the definition of 'treatment' ... cannot succeed."
Excerpts from Supreme Court of Canada majority decision, Chief Justice Beverley McLachlin

Hassan Rasouli, a recent Iranian immigrant to Canada was slated for surgery to remove a benign brain tumour at Sunnybrook Hospital in Toronto in 2010. A seemingly routine procedure on an otherwise healthy man. But of course any surgery is potentially fraught with danger of the unexpected, and Mr. Rasouli contracted meningitis, eventually was diagnosed in a persistent vegetative state, and his doctors, convinced consciousness would never return, have advised the removal of the ventilator and feeding tube keeping him alive.

Devout Shiite Muslims, his family insists that he is conscious, however minimally. They would not agree to removing life support. In their turn the doctors informed the family that they would have to resort to legal means to prevent having their husband/father removed from life support. Which is precisely what occurred; Mr. Rasouli's wife won rulings at two lower courts. The Sunnybrook doctors appealed those rulings to the Supreme Court of Canada.

In the interim the hospital changed the diagnosis of the man's condition from alive but unresponsive and utterly immobile, to minimally conscious. Patients considered to be minimally conscious are capable sometimes of moving their fingers slightly, of watching others, following their movements with their eyes; appearing to be aware of what is occurring around them. The family released a video of Mr. Rasouli clutching a ball that was thrown into his hand, raising fingers responding to spoken numbers, and holding a pen.

Little wonder under those circumstances that they believe their loved one remains aware and conscious and is entitled to continued life. It is virtually impossible to imagine that family members, seeing a loved one still alive, with all the hope that their condition still offers them in visions of a possible partial recovery, agreeing to remove life support. "This is something that has haunted me throughout this process, that someone in a minimally conscious state may be lying in a hospital bed, listening to people talking about him", observed the family's lawyer.

All the more so in light of a new discovery through research and experiments carried out by Dr. Adrian Owen, a Western University neuroscientist who insists his functional MRI scans of vegetative patients demonstrated a small percentage retain a level of consciousness. He carried out a fascinating experiment last year engaging with a seemingly comatose patient, asking him to respond to yes-and-no queries. The responses were picked up by brain activity on the MRI, indicating whether or not he was experiencing pain.

Mr. Rasouli was analyzed by Dr. Owen's team, who came to the conclusion that he presented at a "very low level" of consciousness. Writing for the five-judge majority of the Supreme Court, Chief Justice McLachlin claimed that removing a ventilator and feeding tube -- requiring physical interference and risking death - represented a form of treatment. "Withdrawal of life support impacts patient autonomy in the most fundamental way", she concluded.

If doctors, therefore, consider it time to withdraw life-support -- usually taking away a mechanical ventilator breathing for the patient, or a feeding tube --  patients or their representatives must first be consulted and consent sought, before any action may be taken, the court announced, in a 5-2 ruling.