Mozhgan and Mehran Rasouli, wtih mother Parichehr Salasel, leave Ontario appeal court in Toronto on May 18, 2011.Fernando Morales/The Globe and Mail
Sitting on a courtroom bench, son and daughter on either side, Parichehr Salasel listened to lawyers argue over who has the final say on her husband's life - his doctors or his family.
She and her family have been in Canada just over a year; for most of that, 59-year-old Hassan Rasouli has been in what his doctors call a persistent vegetative state.
Multiple neurologists say the outlook isn't good. Since coming down with bacterial meningitis after brain surgery in October, Mr. Rasouli has been comatose - irreversibly, they say. And as his doctors, they argue, it's their responsibility to end treatment that would lead only to a protracted, bedridden death.
His family begs to differ. They insist he is responsive and can recover.
"He was a very strong man. He went into the surgery thinking he would come out alive," Mr. Rasouli's daughter, Mozhgan, said in an interview. The 27-year-old University of Waterloo urban planning student has taken on the role of family spokeswoman.
"I appreciate all the doctors' efforts through these miserable months. But we want my father alive," she said, her voice wavering, her eyes filling.
As devout Shia Muslims, Ms. Rasouli said, it's impossible for her family to countenance cutting her husband off from life.
"His life is a gift from God to us. … God wants him to be alive."
Those emotional and spiritual imperatives have launched the family, and Mr. Rasouli's doctors, headlong into one of the thorniest issues of medicine. Now judges in Ontario's Court of Appeal will have to determine who can decide whether to terminate care keeping a patient alive. What constitutes treatment, and is there ever an obligation to continue it against doctors' advice? When is it in someone's best medical interest to go against their loved ones' wishes if that means death?
Doctors from Toronto's Sunnybrook Hospital were in court on Wednesday seeking to overturn a ruling from Madam Justice Susan Himel of the Ontario Superior Court of Justice that would oblige them to seek consent from the province's Consent and Capacity Board to stop life support without Ms. Salasel's permission.
Letting the ruling stand would set a dangerous precedent, the doctors' lawyer, Harry Underwood, argued in court. It would force doctors to continue treatment as long as a patient or a patient's surrogates desire, even if it has become useless.
Doctors would be "boxed in," Mr. Underwood said, adding that it would cast a chill on treatment decisions and "result in patients being able to pick and choose their own treatment. … This overturns established models of medical decision making."
Much of this case will rest on what constitutes treatment. If removing a ventilator system and a feeding tube - as Gary Hodder, Ms. Salasel's lawyer, told the court - is treatment, then doctors must seek consent. But if it's simply ending a treatment that doctors decide isn't working, Mr. Underwood said, it isn't.
The judges hearing the case reserved decision on Wednesday.
In the meantime, the Salasel-Rasouli family goes back to the daily trek by public transit from Finch station, in the city's northwest, to Sunnybrook. Ms. Salasel, a family physician in Isfahan, Iran, has started volunteering at the hospital.
"I want to be useful in this hospital, because they're caring for my husband," she said. "Seven months ago, his doctors told me, 'There is no hope, there is no hope.' But he's still alive."