Tuesday, December 11, 2012

Thank God for Small Favours

Today, I'm especially thankful that my initial interest in law and policy did not flourish to the point where I immediately pursued a career in either field. The Supreme Court of Canada heard arguments today in a case involving a man named Hassan Rasouli, an Irainian-Canadian who had an operation for a brain tumour. As a result of the surgery, he suffered an infection that caused catastrophic damage to his brain tissue - enough to render him in a vegetative state. After long months, he has recovered to the point of minimal consciousness.

The case considers the sticky issue of who makes the ultimate decision in removing life support for those in clinical brain-death: the doctors or the family. The case has remarkable complexity, such that I can only barely wrap my head around the questions being asked by it, let alone hope to answer them in a manner consistent with the law of the land and the obligations of the state.

For the one thing, there's the obvious question about whether or not it is ever right to withdraw life-support unless a person specifically requests it - in fact, I know a few people who would say that even requests by the patient for the removal of life support should be ignored. I find that those people in particular have a bad understanding of how life support works. To go further,is this even the right "test case" for the issue itself? Where Mr. Rasouli is experiencing slow improvement in his condition, many vegetative patients do not. What about them? Suppose it is mandated that the will of the family substitutes for the will of the patient in these cases - who will pay costs associated with long-term life support?

The issue for me, I think, is wrapped up in something more fundamental than ethics, what constitutes brain death, or whether the withdrawal of care should be left to family or the professionals. It's a question, really, with how we define death.

Now, there are a number of really easy ways to decide someone is dead. If their heart is no longer beating and they are not drawing a breath, they're dead. Fortunately, many people who are "dead" in this way can be recovered, often with brain damage associated with hypoxia (the loss of oxygen flow to the sensitive tissues of the human brain), but sometimes without, even hours afterword (this is particularly true in cases where death could be most closely linked to hypothermia - almost as if the tissues are preserved by the lower temperature). Obviously then, having your heart stop beating is not a good metric for death.

Now, from what we know of the human condition through rational observation and testing, the brain is the seat of the human consciousness. We can argue till the cows come home about how that works (personally, I believe that a soul is responsible for personality and decisions - the part of us that passes on - which interacts with the more mechanical brain), but the fact of the matter remains that without the brain in proper working order, the mind simply doesn't work properly. For this reason, most clinicians now use the idea of brain death - an absence of electrical activity in the brain - to define final death. While we can restart the heart.... we can't usually restart a brain once it's actually come to a stop.

But this is too simplistic. Even in a vegetative state where no response to any stimulus comes from the patient, often there is brain activity remaining. This person is dead to the world - nearly literally - yet clinically "alive".

I hope to God I'd never have to make this particular decision for anyone. I certainly hope I'd never find myself in Mr. Rasouli's position. This sort of thing I have actual nightmares about. Loss of proper brain function terrifies me on a level that almost nothing else can compare to.

I almost never do this, but please pray for the family in this case, for the patient, for the doctors, and for the Justices who must now decide it. May they all find peace in this decision, and may the decision reflect what is best for the world.

You couldn't pay me enough money to be the one to decide it... or even to be one of the nine who do.

No comments:

Post a Comment