Keeping an unconscious person on life support is painful and undignified for the patient, and brutalizing for those rendering care, the Supreme Court of Canada was told Monday.
The seven judges presiding over a historic case involving the right to life for gravely ill patients were told that, far from being suspended in a state of benign repose, comatose patients literally wither away and suffer a cascade of worsening physical problems.
"Artificially prolonging life inflicts a terrible indignity," said Harry Underwood, a lawyer for several Sunnybrook Medical Health Centre doctors caught up in a right-to-life struggle. "These patients are not just kept alive – they are forced to be kept alive."
Life-support measures can disrupt a patient's immune system and cause organs to fail, added Andrew Faith, a lawyer for a legal intervener, the Canadian Critical Care Society.
"They can make the process of dying much worse," he said. "Doctors must weigh the medical benefits against the harm."
A seven-judge panel reserved its decision, and is expected to issue a ruling within months.
Lawyers for the family of Hassan Rasouli, a 61-year-old man who has been on life support for almost two years, argued that Mr. Rasouli's case is a classic illustration of how doctors can be far off the mark when it comes to diagnosing prospects for recovery.
Initially written off as being in a vegetative state, Mr. Rasouli was later upgraded to the status of minimally conscious state – a designation that offers substantially better prospects for recovery, said Gary Hodder, a Rasouli family lawyer.
However, Chief Justice Beverley McLachlin sharply questioned the worth of statistics that predict patient outcomes, saying: "Isn't that question for the doctor? Only the doctor knows the patient."
"In this case, the doctors were wrong," Mr. Hodder said. "The doctors were squarely wrong."
Mr. Underwood said that doctors invariably consult with colleagues on end-of-life cases and are answerable to professional regulators and the courts should they deviate from what is deemed an acceptable standard of care.
He told the court that allowing patients or their substitute decision-makers to have too much say in treatment is a slippery slope that could lead to people demanding the continuation of chemotherapy or antibiotic treatment even though when it is not working.
"Patients do not get to mandate the treatments that they believe are in their best interests," Mr. Underwood said. "As a society, we have given that responsibility to doctors."
Mr. Underwood also said that the religious beliefs of a vegetative patient on life support cannot be a determining factor in whether or not they are allowed to die.
"Wishes cannot override the standard of care," he said. "The result is the same whether it is a religious belief or a non-religious belief. All wishes deserve the same respect."
Mr. Rasouli was put on life support in late 2010 after his brain was attacked by a post-surgery infection. His family members insists their Islamic beliefs dictate that Mr. Hassan must be kept alive as long as humanly possible.