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Consent for ending life support would undermine MDs' authority, court hears

Forcing doctors to seek consent before terminating life-support for patients they deem irreversibly comatose would hamstring them when it comes to prescribing any treatment, a lawyer for Sunnybrook Hospital doctors argued Wednesday.

Harry Underwood argued on behalf of two doctors at the Toronto hospital taking their fight to decide what's in their patients' best interests to Ontario's highest court.

They're appealing a ruling from Madam Justice Susan Himel that if they want to end life-support for Hassan Rasouli, who has been comatose since October, they must make their case before the province's Consent and Capability Board.

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Keeping Mr. Rasouli on life support is "prolonging, not preventing, death," Mr. Underwood argued, "merely prolonging, delaying some of the effects of the patient's underlying disease."

He said Judge Himel's ruling would "result in patients being able to pick and choose their own treatment. ... This overturns established models of medical decision-making."

The doctors argue that withdrawing treatment they deem medically futile doesn't require consent - and if it were otherwise, physicians would be afraid to prescribe any treatment for fear the patient would compel them to continue even after they deemed the treatment wasn't helping.

Mr. Underwood noted that it's a doctor's responsibility to determine a patient's best medical interests, even if that doesn't dovetail with the patient's wishes.

Mr. Rasouli, 59, has been comatose at Sunnybrook since developing bacterial meningitis after surgery for a brain tumour.

His doctors have declared him in a persistent and irreversible vegetative state.

His wife, Parichehr Salasel, does not agree.

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She sat in the crowded courtroom Wednesday, flanked by her children and listening intently as lawyers argued whether pulling her husband off life support constituted treatment, and who got to decide what's in his best medical interests.

Her lawyer, Gary Hodder, argued Wednesday it makes no sense to require her consent for everything to do with her husband's care, save for the decision that would ultimately end his life.

Mr. Hodder also argued that there's still a remote possibility Mr. Rasouli's state is not as dire as his doctors suggest - that he might in fact have minimal consciousness, a "locked-in" syndrome similar to the protagonist in the film The Diving Bell and the Butterfly.

"She herself is a doctor, she knows her husband well. ... She is really willing to see this play out, to see whether he might fit with that small percentage that recovers," Mr. Hodder said.

"His doctors have given up all hope. ... She has not given up on him."

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