Legal ambiguities surround authority to make end-of-life decisions.

consent from patients, substitute decision-makers or an independent tribunal in order to pull the plug on life-sustaining treatments they deem futile? An informal survey of Canadian case law indicates that courts have been all over the map on the issue, which has recently resurfaced in the headlines as part of a dispute between two physicians at the Sunnybrook Health Sciences Centre in Toronto, Ontario and the family of a comatose man (www.cmaj.ca/lookup/doi /10 .1503 /cmaj.109-3855). The decision, which could radically alter how end-of-life decisions must be made in Ontario, pivots on the question of who should call the shots at end-of-life, an issue that has divided physicians, ethicists and legal minds for decades. The Ontario case involves 59-year-old Iranian mechanical engineer Hassan Rasouli, who has been in a coma since he contracted bacterial meningitis following brain surgery at Sunnybrook in October, 2010. Physicians Dr. Brian Cuthbertson and Dr. Gordon Rubenfeld say Rasouli is in a permanent vegetative state and want to withdraw life support to prevent him dying a slow death from complications of being bedridden. But Rasouli’s family has refused their consent, arguing that his religious beliefs should be respected and that, as a devout Shia Muslim, he should be kept alive on mechanical support “until all signs of life are gone” (www.can lii.org /en/on/onsc/doc/2011 /2011onsc 1500 /2011onsc1500.html). The Ontario Court of Appeal is now deliberating whether to overturn a Superior Court ruling in April that would require doctors to obtain consent from patients or their substitute deci-