As Dennis Daye lay unconscious in Sunnybrook Health Sciences Centre Tuesday, his wife and physician sat in a hospital hearing room five floors above, locked in dispute over whether to keep him alive or let him die.
This article was published by The Toronto Star January 24, 2013 . To see this article and other related articles on The Toronto Star website, please click here
A massive stroke last month brought the 65-year-old retired truck driver to Sunnybrook, where doctors removed a large section of his skull due to swelling — a trauma that stole much of his brain function and continues to place him in medical peril, Dr. Robert Fowler, one of Daye’s physicians, testified before a three-member Consent and Capacity Board panel.
Daye’s unknown wishes for life or death in these circumstances — and the kind of medical care that is now in his best interests — are now under dispute before the provincial board that mediates end-of-life conflicts between physicians and substitute decision-makers.
On the one side of that debate are Sunnybrook physicians, represented by Fowler, who wish to remove life-sustaining care and allow Daye to die peacefully.
On the other, Daye’s wife and substitute decision-maker, Pilar, who wants her husband, a status Mohawk who attended Christian church services, to be treated with traditional, plant-based medicine.
Daye is the latest in a string of patients whose medical fortunes have become a matter of vigorous contention at Sunnybrook.
An ongoing Star investigation has reported four previous cases in which Sunnybrook physicians have come into legal conflict with families over medical care options.
“We are the largest single-site resource for critical-care beds in the province, so that may have something to do with (the number of end-of-life disputes), but my sense is every hospital is dealing with these issues,” said hospital spokesperson Craig DuHamel.
Just last month, Canada’s Supreme Court reserved judgment on the case of Hassan Rasouli, a Sunnybrook patient whose family is seeking life-sustaining medical care despite a legal challenge from his physicians.
On Dec. 10, the same day the Supreme Court heard arguments in the Rasouli case, Daye suffered the stroke that would eventually bring him to Sunnybrook.
Daye now lies unconscious with “extensive” and “irreversible” brain damage. He breathes with the assistance of a ventilator and is fed through a tube, Fowler testified.
Neurologists who have assessed Daye rate his prognosis “incredibly poor,” Fowler testified. “There’s a consolidated opinion that he will always be dependent on others and in an institution for care.”
Daye remains listed as “full code,” meaning he is to receive resuscitation should he enter cardiac arrest.
Fowler and his colleagues seek to change that status.
Sunnybrook physicians initiated the Consent and Capacity hearing to obtain an order removing aggressive care such as ventilation and CPR and adopting a “more palliative approach,” he said.
Without artificial ventilation Day would “pass away … I suspect it would be hours,” Fowler said.
He says conversations with Daye’s daughter from a previous relationship, Keri Anne, led physicians to conclude that their patient would not want to be kept alive on machines.
“I firmly believe that this would cause him so much distress,” Daye’s 37-year-old daughter testified before the panel, describing her father as an active man who attended powwows to celebrate his cultural heritage.
“If my dad was able to make that decision, knowing he wouldn’t have any quality of life and do the things he wanted and, more than that, be constricted to a bed and have somebody care for him, I believe that my dad would absolutely not want that.”
On cross-examination, Keri Anne conceded she hasn’t seen her father in the more than five years since he married Pilar, with whom she has no relationship.
She didn’t attend their wedding. And Keri Anne doesn’t refer to Pilar as her stepmother because “I don’t believe that’s a title that she’s earned.”
The tension between Daye’s wife and daughter is reflected the two women’s very different accounts of his wishes and values.
Pilar, owner of a Brampton bakery, insists her husband would choose traditional medicine as a treatment plan — an approach he’d been practising for several years with her, she said in an interview.
A hospital dietitian and pharmacist consulted on the alternative treatments have found no evidence of efficacy, Fowler said.
But he also acknowledged, upon cross-examination from Pilar’s lawyer, Mark Handelman, that treatments currently considered ineffective by the medical establishment could well become accepted in years to come, much as contemporary medical treatments were considered questionable in years past.
Questioned by Handelman on whether traditional remedies pose a problem, Fowler said: “Conceptually, no … as long as they are safe.”
“What could be more unsafe that your treatment proposal?” Handelman asked Fowler, pointing out that removal of life-sustaining care would produce an almost certain swift death.
Pilar’s insistence on ongoing treatment clearly stems from a deep love for her husband, Fowler said.
“I’ve been worried that it’s been difficult for Mrs. Daye to separate what (her husband) might want and what she wants.”
Like Daye, Rasouli’s wife challenged the treatment plan laid out by her husband’s physicians, who wish to cease aggressive care for the 60-year-old engineer who suffers from the results of a virus acquired during an operation in the hospital two years ago.
Originally assessed by Sunnybrook physicians as being in a “permanent vegetative state,” Rasouli’s condition was upgraded last year to “minimally conscious.”
Rasouli’s physicians refused to take their case to the Consent and Capacity board, choosing instead to seek a court order that would allow them to overrule the wishes of Rasouli’s family.
They were unsuccessful. An appeal court reaffirmed that decision, refusing to empower physicians with a unilateral right to determine Rasouli’s treatment plan against the wishes of his substitute decision-maker.
A final decision from the Supreme Court is expected within six months.