Hassan Rasouli (Mr. R) is a 60-year-old gentleman who was admitted to Sunnybrook Hospital in Toronto in October 2010 for removal of a benign brain tumour.
Unfortunately, his case was complicated by a post-operative bacterial infection, causing severe brain damage.
Since Oct. 16, 2010, he has been on a mechanical ventilator, and he receives nutrition and fluids through a tube inserted into his stomach. Doctors say he will never regain consciousness.
Mr. R’s daughter said she has observed him to lift fingers when instructed and open his eyes when his name is called — clear signs to her that her father was on the path to recovery.
The physicians caring for Mr. R have appealed to the courts to permit removal of the ventilator without the consent of the family. The Supreme Court will hear the case in November.
Why did the physicians bring the case to court? As caring physicians, they are morally distressed by the unintended but nevertheless real consequence of ICU care for Mr. R.
Such care causes pain. It can lead to bedsores, infections, blood clots. It is undignified since the patient needs to be exposed for the hygienic procedures that he cannot provide for himself.
The patient is dependent on tubes in his throat, nose, stomach and bladder. All these consequences may be worth enduring for a good outcome, but emphatically not worth the struggle if Mr. R will never rise from his bed independently, never converse with his family again, never share memories.
Then the continuation of ICU care can only mean extended pain and suffering.
There is an aspect of this case that will not be considered by the Supreme Court: the cost of Mr. R’s care. ICU care has been estimated to be $2,000 per patient per day. So his care to date comes to about $1 million.
It is the duty of physicians to provide care that is in the best interest of patients without considering the costs incurred. On the other hand, it is the responsibility of government to spend tax dollars thoughtfully, in the best interest of society.
Think of our unmet health care needs here in Sudbury. How much would it cost to find a proper home for all our ALC patients? How much to pay our home care workers a proper wage? How much to provide decent housing for our poor elderly subsisting on their CPP?
Then consider that health care spending in Ontario has been increasing by six per cent for years and has not been successful in meeting these needs. The new Ontario budget proposes to hold future yearly increases to 2.1 per cent.
Nowhere in the new budget do these questions come up. Should they? Ask yourself, can Ontario still afford to fund Mr. R’s care and others like him?
It has been estimated that more than 20 per cent of health care budgets go to fund care toward the end of life. Is that morally justifiable today, in the setting of our unmet societal needs?
If Mr. R’s family insists on continuing the present level of care against the advice of physicians, should the family assume the cost of his care?
Is it reasonable to develop thoughtful limits on what a caring society must provide cost-free to its citizens?
Dr. Peter Zalan is president of the medical staff at Health Sciences North. His monthly column tackles issues in health care from a local perspective.
Posted by Laurel Myers
