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Sri Lankan pastor being dehydrated to death without consent in Canada

Lifesite News has the story.

The pastor, Joshua, had not indicated his end-of-life decisions in writing or appointed a decision maker for health care. He is able to breathe on his own and is partially conscious, able to answer some one-word questions on the telephone with his sister. Evidently, "Do you want to be dehydrated to death?" isn't a question the hospital officials are interested in asking him. The hospital's determination that he must die appears to be based solely on the conclusion that he won't recover fully. The disabled should be very concerned about this.

More disturbing still (advocates of "choice" in dying, please note), someone--the court? the hospital?--told a candidate "decision maker" that he must agree to Joshua's death by dehydration in order to be appointed. Joshua's sister, who does not live in Canada, had previously been rejected by the court for reasons that are unclear. (The statement made was that she "was not capable of making medical decisions" for him.) The faux "decision maker" (really, at this point, just a mouthpiece for the hospital) agreed to the conditions and has been appointed. Joshua's dehydration began on August 17.

Read the whole Lifesite article.

Letters calling for Joshua's food and fluids to be restored and protesting the pressure placed upon decision makers in his case may be sent to Brampton Civic Hospital at

communications@oslerhc.org

and to the Consent and Capacity Board of Ontario (I guess I don't dare say "death panel," do I?) at

ccb@ontario.ca

Comments (55)

Dear Staff of Brampton Civic Hospital,

I'm appalled at the heinous decision to kill your patient Pastor Joshua. Giving food and water is not treatment. This callous disregard for human life has made headlines around the world.

Jesus Christ himself said:

"And if you give even a cup of cold water to one of the least of my followers, you will surely be rewarded." Matthew 10:42


How could it be illegal to give food and water to a vulnerable man? To exclude his family from decisions about his welfare? Who decides when a life is not worthy of life? Why isn't our question "how best do we help the kind of life a person actually has?".

The principle informing this decision is an utterly terrifying one, that must be let loose from somewhere - please don't give it air at Brampton Civic Hospital and please don't go down in historical infamy. This principle has the potential to lay waste the historic culture of care in our civilisation.

Help him, please don't kill him!

-M

Australia

More disturbing still (advocates of "choice" in dying, please note), someone--the court? the hospital?--told a candidate "decision maker" that he must agree to Joshua's death by dehydration in order to be appointed.

His family/friends/supporters should simply remove him by force. This is one of those cases where Christians who go through the usual "render unto Caesar" and passive resistance are doing no one a favor. Get him out of there and make any civil servant rue the decision to get out of bed that morning if they get in their way.

Mike T, this is one where if someone had a plan for this that had a snowball's chance of actually working, I'd be on board with it.

By the way, I'm going to forestall my liberal commentators here by saying it myself:

Deaths by dehydration of this kind happen in the United States. Pretty frequently, actually, which is horrible and wrong.

What is unusual about this case in Canada is the following combination: On the one hand, they have the pretense that the hospital is not making a unilateral decision, a pretense kept up by appointing a "substitute decision maker" for Joshua. (I believe that they don't bother with this in the UK. My impression is that there they just do whatever they are going to do to you.) On the other hand, the game has been rigged by refusing to appoint any "substitute decision maker" who will not agree to the hospital's terms.

Now, killing a person by dehydration is morally horrible even if the family agrees to it. But the fakery in this case adds a new and despicable element. A substitute decision maker is supposed to be the patient's representative, doing what the patient would want in the circumstances. Thus we have the forms of "choice" combined with arm-twisting that makes those forms an empty show. This is disgusting all on its own, not to mention unprofessional. It certainly should be illegal even in Canada.

Dog bites man.

Mike T, this is one where if someone had a plan for this that had a snowball's chance of actually working, I'd be on board with it.

They would likely only fail when the police call in SWAT or the RCMP, though that's no reason to just give up.

Do we know more about what caused his condition? It says he collapsed in front of the ER in May and apparently suffered neurological damage; was it a stroke? Are we at the point where we're going to euthanize anyone who has had a major stroke? Nuts.

Actually, J. Christian, that is probably more true than you know. Stroke patients are particularly vulnerable to this form of (especially unpleasant) euthanasia, and stroke patients are some of those about whom we have the worst horror stories involving their writing notes, whispering, etc., _asking_ for food and water and not receiving it. The reason is that many stroke patients are regarded as being unable to swallow. I say "regarded," because my impression is that ability/inability to swallow comes in degrees, and it isn't always actually _true_ that they are literally unable to swallow, though it is often true that there is increased risk of aspiration with mouth feeding. The medical profession, for reasons best known to itself, has decided that it is better to kill a patient by the slow horror of unrelieved dehydration (unrelieved except by drugging him) than to take the _risk_ that he will aspirate and choke if allowed to drink and eat soft foods by mouth. Probably lawsuit worries have something to do with this. Put that together with the fact that even a simple NG tube has for the past twenty years or so been declared to be "medical treatment" or "extraordinary means," and you have a recipe for the regular death by dehydration of stroke patients. "No, he can't be allowed to drink naturally, because he might aspirate." "No, we aren't going to put an NG tube on him, because his case is inappropriate for the continuation of _treatment_ or the use of extraordinary means." What's left? Nothing.

unrelieved except by drugging him

So they can drug him, but a simple IV for fluids and nutrients is extraordinary???

Lydia,

Thank you for posting this. This sort of things leaves me sickly speechless. I passed it along to a friend of mine who has highlighted it on his blog. He is one of the pastors who was down in Florida praying for Terri Schiavo. His co-pastor is the lone member of the clergy who was actually arrested trying to violate the court ordered dehydration.

Kamilla

C Matt, yep. Though an IV for fluids probably isn't going to give the person enough to be comfortable. I have heard that an IV by itself it still leaves the patient pretty thirsty. An NG is pretty simple, too, though, medically speaking.

Let's face it: The goal here is to kill the patient while keeping up a fiction that one is merely refraining from "treating" the patient. So of course it isn't logical, as witness all the other active measures taken. When they were preparing to dehydrate Terri to death, they dressed her in warm clothes to make her sweat to hasten the end. The whole "merely refraining from doing something" thing is the most blatant fig leaf in the world.

What really ticks me off is this:

The alternative was a continuation of the costly legal battle before the Consent and Capacity Board or allowing the Public Guardian to take over. Since we were not able to sustain the costly legal battle and the family did not want Joshua to fall into the hands of the Public Guardian, this friend decided to accept the terms. He was subsequently granted SDM status with those limiting conditions.

Either way, whether by Public Guardian or SDM, he was doomed. They should have publicized the case and tried to get financial support, not allowing an SDM.

Secondly, the SDM is supposed to have freedom of conscience. What cabal of "health" care workers think it is legal to even form a coercive contract?? The SDM ought to simply demand the tubes be put back in or sue them silly (in fact, call the police for attempted murder). If the hospital protests, tell them the contract is void because of lack of free consent. The resulting trial would bring this case to light.

I'm sorry, but this is just wimpy defense.

Also, so what? The guy won't recover. Too bad. He is alive. He is conscious. One cannot even make an argument for a vegetative state. What sane idiot would agree to kill him? I agree. This is attempted murder - the direct, cold, calculated taking of another human life. Call the police and arrest the doctors. Get a restraining order. There is ample precedence. Otherwise, close the hospital, or hire the mob to run it. It would accomplish the same thing.

These doctors are murders, plain and simple, if the data presented in the article is correct and complete.

I can't write anymore without doing damage to my keyboard.

The Chicken

Yes, it would be _very_ interesting to see what would happen if the SDM walked in and said, "Okay, today I, as the SDM, am telling you, the doctors, to reinstate his tube feeding. What's that? That's not what I said yesterday? Well, I was under pressure, but that's not really what I think is in his best interests or what he would want, and I'm the SDM, so I'm telling you now what my true decision is on his behalf." What would they do? Are they actually going to _say_, "You can't do that, because the court would never have appointed you as SDM if you hadn't made an off-the-record agreement to agree to his death"? I mean, they can hardly _admit_ that, can they? And this agreement would have had to be entirely unwritten.

Probably they would try to say that the decision to stop tube feeding was irrevocable and that he "couldn't" change his mind on it. At which point he should call the Consent and Capacity Board, the courts, and everyone else and tell them that his decision as SDM to ask for care for the patient is being rejected.

But I really do begin to fear that these people are past shame. I have no doubt that they would use force at this point to keep him under their control until he is dead. And publicity by itself is not going to move them.

As I understand it the only costs would be for the attorney and, are we to understand that there isn't one anti-euthanasia attorney in the province that would take the case pro bono? Also I believe that decisions from the CCB can be appealed to the Superior Court of Justice and thence to the Court of Appeals and the Canadian Supreme Court. We need more information.

C'mon al. There shouldn't be a need to hire an attorney in the first place. There are many other objections that can be offered why this looks to be a purely economic decision made by a corporation protecting its bottom line, since the victim is a citizen of another country who may very well be ineligible for Canada's national health insurance coverage (not that this would make it something other than murder), and of course all liberals are part of the collectivist hive mind and are responsible for everything that supposed liberals do in other countries, even though that argument wouldn't last three seconds if used against an American conservative.

So, Al, are you implying that they are lying? No arm-twisting on the candidate SDM? No bias in rejecting the sister as SDM? Is "We need more information" code for "I bet this is all a cock-and-bull story"?

hire the mob to run it. It would accomplish the same thing.

The mob is for-profit, which would make it far more likely that they'd regard him as a cash cow than a liability.

All I know is that the only information I can find is based on an e-mail and phone call involving one person and I know nothing about that person.

"No arm-twisting on the candidate SDM?"

"...appeared to appoint a Substitute Decision Maker (SDM) to make decisions on behalf of Joshua, based on that person’s willingness to agree to a non-treatment plan..."

Notice that you seem to have turned an "appeared" into a fact. We need actual information as to what went on with the appointment. "Appeared" doesn't cut it.

"No bias in rejecting the sister as SDM?"

Tell me exactly why she was rejected. You don't know and neither do I.

"First: Joshua (48), who is not otherwise dying..."

We don't really know much of anything about his condition, do we?

"He has progressed from being in a deep coma with signs of decerebration and decortication to almost full movement of his arms and legs and coherent use of mostly one-word answers and occasionally multi-word sentences with his sister over the phone."

"He recognizes the family he was living with for the past 10 years, who have been at his bedside from morning to evening, 7 days a week."

This doesn't really say much. Are we dealing with real communication or random vocalizations interpreted as such? Same for the movements. It is easy for folks who are emotionally involved to misinterpret things.

How extensive is the brain damage?

I understand that none of this is of any consequence to you all, however it is for most folks, for whom actual condition matters. It isn't ok is lie or, as you put it in a thread south of here, "exaggerate" in order to achieve ideological or theological ends that one deems desirable. It also isn't ok to run with other folks delusions. If someone to whom I was close was suddenly in a dire situation I might well not be able to accurately access the situation.

A lot of stuff that comes from activists (left and right) needs to be vetted. If you can't get better information, you should be wondering why.

You should also keep in mind that many of you have positions on end of life matters that few share and wouldn't want imposed on them. If you can't make your case with the truth, maybe you don't have a case.

The guy who wrote the e-mail is a doctor. Presumably, he knows the facts.

The Chicken

So we move from vague and totally unspecified doubts, based on no contrary evidence, cast upon the statements made in the story to the hypothetical "if you can't make your case with the truth..."

Interesting.

Al's here, right on cue, to tell us that _somehow_ this isn't what it seems, nothing for _him_, at least, to get upset about, move along folks.

Fine, Al. You don't get upset if you don't want to. We will. Why don't you move along and stop wasting my time with your evidence-free doubts designed to make you feel better about this story?

I find it striking that I post a story about the pro-death folks in Canada blatantly imposing their will on everybody in sight--the patient, the patient's family, the patient's friends--with no indication whatsoever that they are following the patient's wishes. And Al reads it and winds up by talking about how people are worried that we pro-lifers are going to impose our positions on them! It's incredible. He's wholly impervious to evidence. Al, it's like you just have one story you are capable of believing, talking about, or telling. Other stories, even stories blatantly in the other direction, are somehow just occasions for telling that story. I swear, I could post a story in which the family was seeking help because the patient was being dehydrated to death *contrary to the patient's express and written wishes*, and what would you do? You'd come in and say, "Who knows? We don't really have good information. It may not be that way at all." And then you'd go back to talking about how afraid all the mainstream people are about having pro-lifers' wishes imposed on them!

You're turning into a robot. You oughta watch that.

"I find it striking that I post a story about the pro-death folks in Canada blatantly imposing their will on everybody in sight--the patient, the patient's family, the patient's friends--with no indication whatsoever that they are following the patient's wishes."

"He's wholly impervious to evidence..."

I have yet to see any "evidence" beyond some assertions.

"And Al reads it and winds up by talking about how people are worried that we pro-lifers are going to impose our positions on them! It's incredible."

I asked a simple question on several previous threads on this topic. You would never answer the question but our friend William finally did. Here is his reply:

I asked,

"Do folks like moi have any rights in yours?"

He answered,

"You talk about rights as though it were a choice between a Big Mac and a Quarter Pounder. I'm okay, you're okay."

"Being out of one's mind is not a terminal condition nor is it punishable by death. Sane Al cannot leave an AD telling me not to feed him should he become insane and refuse to eat. You have a right not to be murdered, and I have a moral obligation not to do the murdering."

"Posted by William Luse | August 15, 2010 3:36 AM"

While I appreciate his candor, I find his answer to be appalling. At least one of you would enforce their theological views on someone who is repulsed by them. Since you have always evaded answering the question I assume your silence is agreement with William.

"So we move from vague and totally unspecified doubts, based on no contrary evidence, cast upon the statements made in the story to the hypothetical 'if you can't make your case with the truth...'"

I was very specific and you were the one who first broached the hypothetical.

"The guy who wrote the e-mail is a doctor. Presumably, he knows the facts."

Then MC, let him let us know what tests have been done. How long was his brain deprived of oxygen?

Given the Schaivo fiasco, none of my questions are unreasonable.

One further point here. In the Rifqa Bary case there was more than enough information to make an informed decision. If your cause is just, information is your friend.

Al, you make it sound like somebody is being shady here or hiding something. This is the information we have. Evidence is evidence, even if it is not the type of investigative report with the detail, etc., that Al wants. "Assertions" are what all news reports are based on. Plenty of trials, too. As in, somebody's "assertion" that he witnessed A shoot B. Here we have the "assertions" by someone close to the case that this is what is going on. It's nothing but special pleading for you to say, "Well, maybe that isn't really what's going on."

And by the way, you have a legal mind. Yet you seem to be implying that the obviously inappropriate pressure on the SDM was totally appropriate if Pastor Joshua isn't as aware as the story asserts that he is. So _then_, if he's just making "random vocalizations" or whatever, it's _okay_ to dehydrate him to death without his consent and to refuse to appoint an SDM without a pre-agreement to dehydrate him to death? Doesn't that seem a teensy bit inappropriate and unprofessional to you? Or is it all okay if he's "life unworthy of life"?

You know, you could look a lot less like a liberal lockstep thinker if you would just be willing to say something like this: "If the story as recounted here is accurate, this is wholly inappropriate and professionally wrong as well as legally questionable. And even if the patient is less aware than represented, the shenanigans with the SDM would be totally out of place." See. Not so hard. Makes you look less like you just won't believe anything you don't want to believe.

At least one of you would enforce their theological views on someone who is repulsed by them.

The fact that you are repulsed by a theological view does not make it wrong, nor does it mean that you should not be compelled to abide by it. In the case at hand, someone's theological view is being forced upon Pastor Joshua, as it was upon Schiavo. You're not opposed to such compulsion, as long it flows in your preferred direction.

Ultimately, saying, "That probably isn't really happening" or "This is just one story, so this is no evidence, and I have no way of knowing what is really happening" is as much an illustration of the "choice devours itself" phenomenon as is openly justifying what is happening. If every time the frightening totalitarianism of the pro-death movement is revealed and crushes some vulnerable person, its apologists say, "Who knows, that probably isn't really happening," they are in denial and are showing that they will hear nothing against their preferred side. While continuing, of course, to tell us that they believe in "choice." The left did the same about forced abortions in China for a long time. Maybe they still do, for all I know.

"The left did the same about forced abortions in China for a long time."

Not at all. There is no "left" that universally demied or approved of abortions in China. A small subset of the over-population folks rationalized totalitarian behavior - to their shame. They were not the "left" nor were they representative of anyone but themselves.

"The fact that you are repulsed by a theological view does not make it wrong, nor does it mean that you should not be compelled to abide by it."

Again your candor is appreciated. The totalitarian instinct clearly isn't confined to elements on the left.

"Al, you make it sound like somebody is being shady here or hiding something."

No, we might have someone deliberately deceiving, we might have friends who can't accept reality, or we might have a gross miscarriage of justice. We don't really know.

"This is the information we have. Evidence is evidence,"

What you have is evidence of some sort of alleged dispute over the medical care someone is receiving and a unit of the provincial government violating the law.

You have run with the sketchiest of information and drawn all sorts of the most extreme conclusions.

"If every time the frightening totalitarianism of the pro-death movement is revealed and crushes some vulnerable person, its apologists say, "Who knows, that probably isn't really happening," they are in denial and are showing that they will hear nothing against their preferred side."

You seem to believe that you are obliged to believe and pass on anything that agrees with your ideology. If the allegations are true then an injustice is happening. Presumably tests have been done. Has an appeal been filed? There is now an article on this,

http://www.bramptonguardian.com/news/article/866362

It seems the pastor has an attorney who doesn't agree. The incident happened in late May. Can you describe his present condition? We don't really know anything.

Again, why the harping on his condition? If his condition is worse than the Lifesite article represents, is it then okay to require someone to agree to remove food and hydration _before_ appointing that person as SDM?

"...is it then okay to require someone..."

We don't know that and your source doesn't explain how he knows that given the confidentiality that often surrounds these matters. Was that the actual wording or was that his interpretation of things?

"Again, why the harping on his condition?"

Because that matters to most folks and allows for an evaluation of the actions of the hospital, CCB, and SDM. Actions, BTW, about which we only have very limited and one-sided information.

Way back in another lifetime I was in a position in which I had to vet opposition research. Once checked it usually didn't pan out. Rejecting it didn't make me popular. I don't trust activists - any activists.

You didn't answer my question, Al. I should be used to that by now. Misdirection by casting unsupported doubt upon sources seems to be your stock in trade.

The totalitarian instinct clearly isn't confined to elements on the left.

That's rich. The laws against murder ought to be enough to protect people like Pastor Joshua, which in fact they once did. They've been on the books a long time, even before I became a totalitarian.

If this is the question:

"...is it then okay to require someone to agree to remove food and hydration _before_ appointing that person as SDM?"

This isn't as simple as you want it to be.

Is that what was actually required or is it his interpretation of whatever did happen? I've already made this point and you seem to not get its significance. Perhaps that is why you believed Betsy McCaughey. This should be the first question anytime one person says another did or said something.

If all the CCB did was check out the candidates' views on care under a given set of circumstances that may not be a problem. The selection of jurors in a capital case may be on point. Appointing someone who could never pull the plug would seem to defeat one of the purposes an SDM may have to perform in the best interests of the patient (for myself, I would never want someone in that position who would put their beliefs ahead of my well being and dignity).

It obviously could be improper. Again - we don't have enough information.

"Again, why the harping on his condition?"

If this is the question, I raise it because we don't know his condition and condition determines treatment. This isn't some thought experiment you all can use to beat up on liberals and imaginary death whatevers.

There is, presumably, a real person in a hospital in Canada. He is in some condition; either he is conscious and communicating or not. He apparently has some degree of brain damage - we don't know how much.

The last time you all did this, it turned into a cheap political stunt and a fraud on the American people. These are your friends; if this is real and this poor guy is being railroaded into an early grave, it should be possible to get the same level of information you gave us on Rifqa Bary.


Yeah, because just like Rifqa, Pastor Joshua is able to run away and talk to people and all and tell people what he wants and...Oh, guess not.

But I hear you on the question. In other words, sure, fine, as long as the pre-agreement with the SDM was worded as, "If you had someone in _exactly the situation_ in which (entirely coincidentally of course) this patient is, _would_ you agree to stop all nutrition and hydration on him until death?" And if the person wouldn't say the magic "yes," then he doesn't get appointed. Then, why, that's okay. I get it. Thanks for the clarification. So much for choice and _independent_ determination of the patient's best interests. And if they did the same thing before setting up a court-appointed lawyer, you'd probably _still_ tout the lawyer's opinion as some sort of independent legitimation of what was done. Though heaven knows why. You seem to have no sense whatsoever of the meaning of checks and balances, which is the _whole burden_ of the hospital's song here: "See, _all these different people independently agree_ that this is best." And if it isn't so, if there's no causal independence at all, if the game was rigged, that's still okay with Al, so long as the pre-questions were worded as hypotheticals.

By the way, can the "pull the plug" nonsense. Perhaps you didn't notice, but he is breathing on his own. Look, Ma, no plugs. We're talking about dehydrating a non-dying patient to death. It often takes 10-14 days.

Bill -- don't worry, under Obamacare all we totalitarians have to do is get to the right level of bureaucratic authority, and if Al the heretic falls unconscious, we can just dehydrate the son of a bitch!

"and if Al the heretic falls unconscious, we can just dehydrate the son of a bitch!"

Whoa! Way harsh dude, but you do qualify as second choice on my durable power of attorney.

"...would_ you agree to stop all nutrition and hydration on him until death?"

Again, as I am the very soul of patience, I need to point out that you have absolutely no evidence that that is what happened. Why do you need to believe this? Why have all these people conspired to see this guy dead?

Folks can judge for themselves if your interpretation of what I wrote is fair and reasonable.

Al, the whole point of appointing a family member or close friend to be SDM is that the person is more likely to be close to the patient's actual beliefs, values, etc. The fact remains that you said expressly that a SDM should not be appointed if he said that he would never agree to dehydrate the patient to death. (Which is what you must have meant in this context by "pull the plug.") This is directly contrary to the pretense that a SDM is appointed as a representative of the patient. What if Pastor Joshua would never agree to that for himself? What if such an intransigent attitude, which you consider so horrifying, really would be his choice? Then screening a SDM to make sure the SDM would agree to death by dehydration under some circumstances when _Al_ thinks he would "have to" be willing to make this choice ("in the best interests of the patient") is a complete betrayal of the pretense that this has some connection to the patient's own wishes. One wonders how far you would take this. For example, suppose that Pastor Joshua were married and that his wife were living in Canada but that he had not written anything appointing her SDM. Would she, also, be subject to the screening that she _must_ be willing to agree to dehydrate a patient to death under some circumstances or other in order to be his SDM? (On the grounds that she might "need to" make that decision "in his best interests"?) What if she asserted, believably, that her position contrary to any such decision under any circumstances was a function of her and the patient's shared religious values? Still no dice? What, then, do choice and the patient's own wishes have to do with the matter anymore?

This is actually a pretty interesting exercise in watching choice devour itself. Al presumably thinks his position is all about freedom for the patient, yet he is in favor of pre-screening an SDM based on the person's willingness to do what he, Al, not the patient, would want the SDM to be willing to do, with the result that someone like (for example) me could never have an SDM appointed who truly represented my values and with the result that I could never be appointed an SDM even if my position were the same as the patient's previous position while competent. Not, that is, unless I were appointed or appointed someone else in writing ahead of time. But for all who do not put things in writing, Al's pre-screening means that people with my beliefs about death by dehydration can't have or be an SDM representing those beliefs. And why? Because _Al_ wouldn't want me to be _his_ SDM. Talk about projection! And so much, again, for choice. "You must be willing at least in principle to agree to dehydrate a patient to death or the court should not appoint you an SDM."

Bill -- don't worry, under Obamacare...we can just dehydrate the son of a bitch!

What fun would there be in giving him what he wants?

Posted below are the critia for an SDM. Below that is the list of those who may give consent for treatment. I copied them from the Health Care Consent Act, 1996. One of the dangers is answering a hypothetical is that some may come (or seek) ro substitute it for reality should that action advance their side (sigh).

Just so we all are on the same page, I will again point out that we don't know that the CCB required that any SDM agree to withdraw the feeding tube prior to their appointment. Lydia seems to have a Mulder-like need to believe what continues to be an unsubstantiated assertion. We don't know what was said to any applicant. Having dug around a bit it would seem to be the law that applicant shopping as to a specific course of treatment shouldn't happen and I certainly agree. We have absolutely no evidence that such actions were committed by the CCB.

My answer to the hypothetical was merely that cessation of treatment is sometimes in the best interests of the patient and appointing someone whose emotional state or ideological commitments would prevent them from serving those interests makes little sense. I have no information as to the vetting process employed by the CCB; neither does Lydia.

Here is a case where an injunction was granted (you will need ti fix the link).

httpCOLONSLASHSLASHwwwDOTcanlii.org/eliisa/highlight.do?language=en&searchTitle=2009+ABQB+691+(CanLII)&origin=%2Fen%2Fab%2Fabqb%2Fdoc%2F2009%2F2009abqb691%2F2009abqb691.html&path=/en/ab/abqb/doc/2010/2010abqb213/2010abqb213.html

This may be on point,

Rotaru v. Vancouver General Hospital Intensive Care Unit,

http://www.canlii.org/eliisa/highlight.do?language=en&searchTitle=R.S.B.C.+1996%2C+c.+181&origin=%2Fen%2Fbc%2Flaws%2Fstat%2Frsbc-1996-c-181%2Flatest%2Frsbc-1996-c-181.html&path=/en/bc/bcsc/doc/2008/2008bcsc318/2008bcsc318.html

2008 BCSC 318

"This is actually a pretty interesting exercise in watching choice devour itself. Al presumably thinks his position is all about freedom for the patient, yet he is in favor of pre-screening an SDM based on the person's willingness to do what he, Al, not the patient, would want the SDM to be willing to do, with the result that someone like (for example) me could never have an SDM appointed who truly represented my values and with the result that I could never be appointed an SDM even if my position were the same as the patient's previous position while competent."

This only shows the downside of falling in love with a turn of phrase. This whole "choice devours itself" meme may stoke the passions but it serves no purpose in the real world where hard decisions sometimes need to be made.

Lydia's paragraph quoted above ears no relationship to my position nor to what I read as the current law in Canada. Once again we need to focus on the reality that Lydia's position is based on an unsubstantiated allegation. As a reading of the actual law below will show, her assumptions above bear no relation to what the CCB is supposed to do. The allegations in the e-mail are serious and bear investigation, but I don't see that happening yet. I read that they are going to appeal and the law allows this so we will see.

A decision that may be relevant.

"[21] Applications involving end-of-life, urgent medical treatment or similar circumstances require immediate attention to resolve what often are diametrically opposed positions. Rule 395 provides that “an applicant shall, on an affidavit of the facts, apply ex parte to a judge.” The Rule accommodates those very pressing cases where circumstances do not allow for notice or where notice would have the effect of defeating the purpose for which the order is sought. In most cases of this type, however, applicants will have been in close communication with and already will have given some notice (either formal or informal) of the initial application to those who potentially might be affected by the order sought."

May v. Alberta Health Services, 2010 ABQB 213

The current law,

"Best interests

(2) In deciding what the incapable person’s best interests are, the person who gives or refuses consent on his or her behalf shall take into consideration,

(a) the values and beliefs that the person knows the incapable person held when capable and believes he or she would still act on if capable;

(b) any wishes expressed by the incapable person with respect to the treatment that are not required to be followed under paragraph 1 of subsection (1); and

(c) the following factors:

1. Whether the treatment is likely to,

i. improve the incapable person’s condition or well-being,

ii. prevent the incapable person’s condition or well-being from deteriorating, or

iii. reduce the extent to which, or the rate at which, the incapable person’s condition or well-being is likely to deteriorate.

2. Whether the incapable person’s condition or well-being is likely to improve, remain the same or deteriorate without the treatment.

3. Whether the benefit the incapable person is expected to obtain from the treatment outweighs the risk of harm to him or her.

4. Whether a less restrictive or less intrusive treatment would be as beneficial as the treatment that is proposed. 1996, c. 2, Sched. A, s. 21 (2)"

"Consent

List of persons who may give or refuse consent

20. (1) If a person is incapable with respect to a treatment, consent may be given or refused on his or her behalf by a person described in one of the following paragraphs:

1. The incapable person’s guardian of the person, if the guardian has authority to give or refuse consent to the treatment.

2. The incapable person’s attorney for personal care, if the power of attorney confers authority to give or refuse consent to the treatment.

3. The incapable person’s representative appointed by the Board under section 33, if the representative has authority to give or refuse consent to the treatment.

4. The incapable person’s spouse or partner.

5. A child or parent of the incapable person, or a children’s aid society or other person who is lawfully entitled to give or refuse consent to the treatment in the place of the parent. This paragraph does not include a parent who has only a right of access. If a children’s aid society or other person is lawfully entitled to give or refuse consent to the treatment in the place of the parent, this paragraph does not include the parent.

6. A parent of the incapable person who has only a right of access.

7. A brother or sister of the incapable person.

8. Any other relative of the incapable person. 1996, c. 2, Sched. A, s. 20 (1).

Requirements

(2) A person described in subsection (1) may give or refuse consent only if he or she,

(a) is capable with respect to the treatment;

(b) is at least 16 years old, unless he or she is the incapable person’s parent;

(c) is not prohibited by court order or separation agreement from having access to the incapable person or giving or refusing consent on his or her behalf;

(d) is available; and

(e) is willing to assume the responsibility of giving or refusing consent. 1996, c. 2, Sched. A, s. 20 (2).

Ranking

(3) A person described in a paragraph of subsection (1) may give or refuse consent only if no person described in an earlier paragraph meets the requirements of subsection (2). 1996, c. 2, Sched. A, s. 20 (3)."

Al, this is what you said:

If all the CCB did was check out the candidates' views on care under a given set of circumstances that may not be a problem. The selection of jurors in a capital case may be on point. Appointing someone who could never pull the plug would seem to defeat one of the purposes an SDM may have to perform in the best interests of the patient

and

My answer to the hypothetical was merely that cessation of treatment is sometimes in the best interests of the patient and appointing someone whose emotional state or ideological commitments would prevent them from serving those interests makes little sense.

Please explain how this is _not_ approval of pre-vetting and ruling out people who are unwilling to cease giving food and water under any circumstances, even if the position of such people is plausibly the same as the position of the patient.

Also, I note how, "This is just one person's e-mail, and I don't trust his word" has morphed into, "We have absolutely no evidence that what this person says has happened has in fact happened." How do you do that? I mean, heck, Al, even when I don't trust someone's word I would usually be a little more careful. I guess that comes from being an epistemologist. Even, "I think the author of the e-mail is untrustworthy and therefore his testimony is _little_ evidence for what he says," would be an improvement, though your skepticism seems to come out of the blue and to be based on the perception that the author of the e-mail (despite being a friend of Pastor Joshua) is an "activist." But _absolutely no evidence_? That's a great example of just making evidence disappear--Poof!

I don't know if the people are untrustworthy or not and, in circumstances like this where emotions can get the best of one, that may be irrelevant. If you read some of the decisions you saw family members at odds with doctors and doctors disagreeing. There is simply no way to know what is going on in many of these situations if one relies solely on the testimony of one person.

The head of the Euthanasia Prevention Coalition is, by definition I would think, an activist. The original writer may be correct or his judgment may be clouded by grief and theological considerations. I don't know and I don't think it is responsible to level serious charges based on an e-mail from a person in an emotionally charged situation passed on by an activist.

"But _absolutely no evidence_? That's a great example of just making evidence disappear--Poof!"

I think we view the nature of evidence differently. if I say I was out last night and I saw a flying saucer that might, at best, count as evidence that I was out and saw something. It is no evidence of what I saw. Unless I am lying or delusional it may be safe to believe I was outside but what I saw is another matter.

The email is, at best, evidence that something is going on. It is where we start.

"Please explain how this is _not_ approval of pre-vetting and ruling out people.."

You could start with my use of the word "may". I'm not sure what level of specificity is proper beyond the obvious impropriety of the CCB requiring agreement as to a given course of treatment. For one thing, under Canadian law, doctors are not required to follow a course of treatment desired by a SDM (futile care laws in the U.S. do the same). I don't see how you would qualify a SDM without getting some idea of how they felt about such things as one of the requirements is that they be able to actually make decisions.
Perhaps both never-say-die-torture-al William and homicidal Paul wouldn't make the grade as my SDM in Canada.

This is easier for you as you would never withdraw nutrition. As I can see circumstances where that would be appropriate, it is more complicated for me.

Perhaps both never-say-die-torture-al William...

Heavens, al, what a calumny. I would never do such a thing. I'd give you all the palliative meds you wanted short of a fatal dose. Also, I've met Paul and can assure you that he's not a seriously homicidal maniac. He just plays one online.

Oh, this is false: This is easier for you as you would never withdraw nutrition.

And this is likely false: it is more complicated for me.

"And this is likely false: it is more complicated for me"

First you would compel me to accept medical procedures I don't want and now we discover you can read minds and your friend would summarily execute heretics. Religious conviction is truly a marvelous vehicle for a better life.

you would compel me to accept medical procedures I don't want

Or, put another way, you'd compel me to withdraw a procedure you don't want with the intent of killing you.

Religious conviction is truly a marvelous vehicle for a better life.

Finally you speak the truth.

"Or, put another way, you'd compel me to withdraw a procedure you don't want with the intent of killing you."

No, you confuse intent with result; the result would be that I would die. If you were in a position to effect my wishes you would be doing your job and that would likely be your intent. If doing that would be problematic you would properly need to find a new situation. Mere knowledge doesn't, by itself, constitute intent. Having a job in health care and having the intent to kill would be pathological.

In a free society, folks, assuming they are competent, have a right to refuse medical care. Defining competence as being willing to acquiesce to your standard of care takes us back to Soviet standards of sanity.

If doing that would be problematic you would properly need to find a new situation.

There it is, the tyranny of liberalism. Get on board with the deathworks or find a new job.

Mere knowledge doesn't, by itself, constitute intent.

This is moral idiocy. If the knowledge you speak of means that I know you're going to die if I take away your food and water, and if I in fact take away your food and water and you in fact die because of it, then yes my knowledge constitutes intent.

Having a job in health care and having the intent to kill would be pathological.

Yes, witness the presence of Michael Schiavo among us.

folks, assuming they are competent, have a right to refuse medical care

Yes, they do. They do not have the right to be murdered.

In case someone missed it, up-thread Al conceded that desiring to dehydrate an unconscious patient is "homicidal."

See, not so complicated after all.

Al, but people like you make it so...complicated for people to _obtain_ nutrition and hydration. As witness the present case, in which you are so hesitant and want so many tests, etc., before deciding that it is inappropriate to dehydrate Joshua to death. If his sister tells us that he's answering questions over the phone, even that will doubtless be dismissed (since it is relevant to _you_) as just the confusion of her grief.

By the way, the news story Al linked says that the board says Pastor Joshua will get food and water if he makes a _capable_ request for it. How nice. Anybody remember Marjorie Nighbert in the U.S.? She made requests for food and water but didn't get it because the court ruled she wasn't legally competent. So even that concession has an interesting qualification.

Paul, I'll bet the only reason Al used "homicidal" is because you sounded like you really _wanted_ to dehydrate him to death. You have to not enjoy it to make it non-homicidal. You didn't sound sufficiently medically detached.

"As witness the present case, in which you are so hesitant and want so many tests, etc., before deciding that it is inappropriate to dehydrate Joshua to death."

Lydia, you need to re-read what I've posted. Situations like this are not uncommon in the U.S. and Canada. People fall into dire circumstances. Doctors can screw up. Friends and family can be loath to face reality and let go. This is why we have courts.

We obviously can't scurry into fact-finding/litigation mode without putting things on hold. That is why I posted the reference to injunctions.

Consider that we have received absolutely no reliable information as to his condition or why the hospital wishes to discontinue the use of the feeding tube. You have done absolutely no due diligence here. Passing on messages that confirm ones ideological views can be satisfying, I guess, but
I'm more interested in what's really going on.

About this dehydration. Recently an elderly family member stopped eating and drinking. Her doctor recommended hospice which we considered appropriate given her overall condition and her strongly expressed views on the matter. She drifted off and died peacefully with no signs of distress during the process. One of the questions we asked initially was about hydration and discomfort. We were assured it wasn't going to be a problem and it wasn't.

The references on this all seem to indicate that your representations are way overblown. You may be over-reacting to a word and a concept, not something that is always inevitable. Many factors may be at play here. I recall the story of a miner who decided to walk from his mine in the Pinto Mountains to Cottonwood Springs (a few miles, Mojave Desert) on July 4th, 1905. Triple teen temperatures and he was dead in hours. Or consider hypothermia. Used by skillful interrogators, cold can be used to make a person miserable for days. Fall in the Beaufort sea without a survival suit and you are unconscious in minutes and dead soon thereafter.

Dehydration as it affects a healthy person being deprived of liquid appears to be a different process then what goes on when a person is in dire medical straits to begin with.

I understand the temptation to use words to make the most persuasive case but resisting that temptation is often a good thing.

I can understand Paul's desire to wiggle out of this but, just so everyone is up to speed, here is what he wrote,

"and if Al the heretic falls unconscious, we can just dehydrate the son of a bitch!"

Note the use of the word "unconscious", a condition that is not by itself indicative of anything. Folks who have followed this know quite well that I have never advocated treatment protocols that use mere unconsciousness as a marker. No rational person would unless they had other motives. I hold that his wording makes his motives obvious. As a side note my understanding of the relevant theology makes such an imagining a serious sin. Is this the case?

The information we have indicates that Joshua is non-dying. These medical deaths by dehydration of non-dying people are what they are, and a fair bit is known about them. What the situation was with your elderly relative I'm not sure. She may have been in the end-stage of some other illness. Moreover, a lot depends on the part drugs--particularly morphine and atavin, which are sometimes heavily used in such circumstances--have to play. Drugging someone to make him peaceful does not in itself change a death by dehydration into something else.

Al didn't believe me when I said that Paul wouldn't really kill him. I don't know what more I can do to defend our editor.

Al appears to lack a sense of humor. That was irony, Al, in case you didn't guess.

"Al appears to lack a sense of humor."

Then why am I laughing? And why does Paul get to have all the fun?

"The information we have indicates that Joshua is non-dying."

Would you share it with us. All I have seen are bare statements as to non-dying and communication ability and no actual description of his condition.

"Drugging someone to make him peaceful does not in itself change a death by dehydration into something else."

It doesn't make a death by any underlying condition into something else, it just alleviates pain which is the goal of pain management. Surely you don't have a problem with pain management? William has already indicated that pain management should cease at a certain point even, I assume, if it means severe suffering for the patient. Do you agree?

We now seem to agree that dehydration isn't always a horrific death. We still lack the information necessary to make a judgment as to the propriety of removing the feeding tube in this case. Even with more information, I understand that folks may disagree.

My point had nothing to do with pain management either for or against. My point had to do with the claim that a person died "peacefully." If that "peacefulness" was a result of drugging the heck out of the person so that he would suffer, at least, less from the pain that he would otherwise suffer from death by dehydration, this does not make death by dehydration a peaceful death. One could hang, draw, and quarter someone under general anesthesia and the death would not be a peaceful death. That was my point.

William has already indicated that pain management should cease at a certain point even, I assume, if it means severe suffering for the patient.

I said that? If I said that I renounce the saying of it and denounce myself for saying it.

"I said that? If I said that I renounce the saying of it and denounce myself for saying it."

Apologies, BTW, if it was someone else, but at some point, in some cases, effective pain management becomes, in effect euthanasia as the levels of pain medication affect respiration.

"One could hang, draw, and quarter someone under general anesthesia and the death would not be a peaceful death."

Actually it would be very peaceful, quite messy, but peaceful. I've had abdominal surgery and recall not one thing about it.

I hope everyone has drawn the proper lesson from all this. If Terri and Joshua had taken the time to prepare advance directives and designate who they wanted to make decisions for them were they to become incapable themselves, they wouldn't have become cannon fodder in the culture wars.

Also in Joshua's case, a designation of someone local would have made standing less problematic should litigation become necessary.

Be a responsible adult and take a few minutes to familiarize yourself with the law in your jurisdiction and follow the process. This is usually discoverable and down-loadable on-line.

http://www.caringinfo.org/stateaddownload

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