When law and life collide
By Garry Cass
The intersection of law and life can be a very difficult and scary place. Most of the time, it is an intersection that people pass through without incident. Occasionally there are collisions; just ask anyone who has been involved in a messy divorce, has ever had to deal with the government or an uncooperative insurance company or is in the criminal justice system.
Another law and life collision was just argued in the Supreme Court of Canada. In the case of Hassan Rasouli, the court is being asked to decide, in part, whether physicians have the right to withdraw life-sustaining treatment without consent where they believe that life-sustaining measures are no longer medically indicated. The court is being asked to make a decision on a very emotionally-charged issue. That decision will have far reaching ethical and economic implications once it has been made and released.
This article, however, is not an analysis of the Rasouli case. It is a call for self-determination.
To be honest, I know that very few people like to think about their own mortality or their own mental or physical vulnerability. Most people do not want to think about falling into a vegetative or near-vegetative state. Most people do not want to think about becoming seriously ill and mentally incapable of making their own treatment decisions. These types of scenarios are both uncomfortable and scary.
Most people only confront these types of issues after they either experience or hear of a horror story. The result is often emotional and reactive thinking, which does not necessarily lead to the best personal decisions.
I am suggesting, on the other hand, that people take the bull by the horns and deal with these issues proactively, absent the emotion. The decisions you will be making, when properly papered, become an advance treatment directive; a statement of your wishes for future treatment in dire circumstances should you be incapable of making the decisions personally at that time.
To get the ball rolling, here are a few questions. These are “if/then” questions, with the “if” part being “If I am incapable of making my own treatment decisions, then…”
Under what circumstances, if any, would I not want to be kept alive with the assistance of life support devices?
If I am subsequently diagnosed with a potentially fatal disease/condition, would I want to have it aggressively treated?
If , in addition to being incapable, I am also terminally ill, would I want all measures possible to be taken to keep me alive for as long as possible?
Hopefully these few questions will lead to more questions that are personal to you and ultimately to clear conclusions which you can convey to your personal care substitute decision makers and reduce to writing in a personal care power of attorney or equivalent document.
And finally, a few thoughts about substitute personal care decision makers. These are people that are close to the donor of the power of attorney for personal care and are emotionally invested. The key thing to do before making the appointment is to have a very frank conversation with the candidate and let him/her know your views with respect to life shortening or life ending decisions. Are you satisfied that the person you wish to appoint can move past the emotion and has the courage of your convictions? When push comes to shove, can the person you wish to appoint carry out your wishes and instructions? If you are not satisfied that this is the case, then perhaps another candidate should be considered. Because of the implications, this is one decision that has to be made with your head and not with your heart.