Hospital can remove B.C. senior from life support against daughters' wishes, judge rules

St. Paul's Hospital is seen in this undated image. (CP / Richard Lam)

A B.C. Supreme Court justice has given medical staff at a downtown Vancouver hospital permission to remove a 65-year-old man from life support, against the wishes of his two daughters.

Judge Christopher Hinkson found the delicate case hinged on the question of whether keeping Leo Edward Bikus alive would be in his "best interests" – a question that divided the patient's adult children from doctors at St. Paul's Hospital.

"The physicians in this case opine that the best course of action is to stop a treatment, while the family wishes it to continue," Hinkson wrote in his Aug. 3 decision.

The court heard Bikus collapsed while getting out of bed on May 18, suffering a heart attack due to a blocked coronary artery, and was without a pulse for 46 minutes before paramedics resuscitated him.

"Two of Mr. Bikus' heart vessels were occluded with clots. His heart muscle was also severely weak and it was unable to carry oxygen throughout his body," Hinkson said.

He underwent an angioplasty and was admitted to the hospital's Cardiac Intensive Care Unit the same day, according to the decision, and "has been unresponsive since." 

DOCTORS 'UNANIMOUS' IN ASSESSMENT

Physicians conducted a variety of neurological assessments on Bikus over the following days and, to the family's dismay, found no reason to believe he would ever recover.

Testing showed "no discernible electrocerebral activity," according to a note from a doctor specializing in critically ill patients, who found the best prognosis was "profound neurological impairment."

Bikus' pupils responded to light but he had no response to painful stimuli and no cough, gag or corneal reflexes.

"The unanimous and uncontradicted views of Mr. Bikus' treating physicians is that it is in his best interests for the life-sustaining treatment to be terminated, as such care would simply prolong his life and be futile, leading to a persistent vegetative state, with no conscious awareness," Hinkson wrote.

Doctors also warned that keeping the patient alive would "likely result in further harm, including bed sores, infection and other complications," according to the decision.

LIMB MOVEMENTS GIVE FAMILY HOPE

Despite those assessments, the patient's daughters, Evangeline De Châtillon and Elise Bikus, remained hopeful, particularly after witnessing their father's limbs and feet moving, and sought a court injunction preventing the hospital from terminating his life support.

The sisters presented video in court that they characterized as demonstrating a "cortical response" indicating he was regaining consciousness.

Doctors disagreed, however, dismissing the movements as unconscious reflexes.

The court refused to accept the family's interpretation of the video without the support of an expert medical opinion, and the family was unable to secure one.

Three hearings were adjourned to give the daughters time to obtain such an opinion, and Hinkson declined to adjourn a fourth time after learning the doctor chosen by the family had, for reasons unknown, neglected to review the patient's records at St. Paul's Hospital, even after being granted privileges to do so.

WHO CAN DECIDE TO END LIFE SUPPORT?

With Bikus' condition rendering him unable to either provide or refuse consent for his ongoing treatment, the court had to consider who was best positioned to do so on his behalf.

Under B.C.'s Health Care (Consent) and Care Facility (Administrations) Act, the duty first falls to a patient's spouse, should they have one – but while Bikus was married, the court heard he had been estranged from his partner for more than 20 years.

That left decision-making duty to his two daughters.

Under the law, substitute decision-makers are required to act in a patient's best interests, and St. Paul's Hospital argued the sisters, despite their good intentions, were failing to do so.

The hospital asked the court to overrule their wishes using parens patriae powers, which allow judges to order treatment against the objections of a family member or legal guardian for the benefit of a patient.

Hinkson pointed to the case of B.C. v. Dawson, in which the parents of a severely disabled six-year-old boy had refused to consent to an operation that would save his life. A judge gave doctors permission to carry out the treatment anyway.

"In this case, Mr. Bikus’ condition is deteriorating, and the uncontradicted medical evidence before me is it will continue to do so," Hinkson said.

"Notwithstanding the views of the plaintiffs, I find that their opposition to the withdrawal of treatment for Mr. Bikus is not in his best interests."

The judge refused to grant the daughters' injunction, and instead issued an order allowing St. Paul's Hospital staff to "discontinue any life-sustaining treatment or health care services which, in their opinion, are not in his best interests within 24 hours."