Brampton Civic Hospital
It's been more than a week since pastor Joshua Kulendran Mayandy has been given food or water at a Brampton, Canada, hospital where he is being treated for a brain impairment following a heart attack.
The medical facility's officials are following a determination that he will get his next sustenance only when he can ask the doctor for it.
The Sri Lankan Mayandy, who arrived in Canada 10 years ago to pastor a small church, complained of chest pain and was hospitalized after collapsing with a heart attack May 29.
He was revived successfully, although the apparent brain damage from the attack left him in a coma for a time. He was placed in intensive care where he regained consciousness. An eyewitness has reported he has regained movement in his arms and legs and that he recognizes the family he is living with.
According to Bernard Stephenson, another local pastor and friend who visits Mayandy daily, the injured man can speak some words.
But staff with Brampton Civic Hospital, which is part of the William Osler Health Center, disagree. According to Stephenson, doctors asserted all along that there was no hope of recovery.
The disagreement over his condition and capacity triggered in Ontario the involvement of the region's "Consent and Capacity" board, which by law determines the proper medical treatment for patients unable to make decisions themselves.
The system requires a strategic decision-maker for patients. Because that usually is a family member, it posed a problem for Mayandy because of the distance to his family in Sri Lanka.
As a result, Stephenson said, the hospital removed Mayandy's feeding tube, prompting his church supporters to file a complaint and get a court-appointed attorney.
The attorney contacted Mayandy's sister, Malika Arumugan, but the "consent board" determined she did not understand the situation. Instead, the board appointed a friend to represent the pastor.
Determination letter for Pastor Mayandy
The board's ultimate decision, after hearing from "all parties," ruled that Brampton Hospital could remove Mayandy's feeding tube and other modes of life-support, including intravenous fluids.
"We are satisfied, based on the evidence we heard and the agreements of all parties, that the patient remains treatment incapable with respect to all treatments," said the determination letter, signed by Jill Presser as presiding member of the board.
The board further ruled that Mayandy would need to ask for food and water for it to be given.
"As an example only, if the attending physician hears Pastor Mayandy make a capable request for food or water, he will be fed and hydrated."
The conclusion was that Mayandy would not recover.
However, Alex Schadenberg, director of the Euthanasia Prevention Coalition, says the board's decision simply is euthanasia by omission.
He also claims the hospital put pressure on Mayandy's friend, whose name has been redacted from the decision letter, to support its decision.
"Joshua, who is not otherwise dying, is being dehydrated to death. This is not the case when hydration and nutrition need to be withdrawn because he is actually dying and nearing death, but rather the decision appears to have been made to intentionally cause death by withdrawing IV hydration and nutrition because he is unlikely to recover from his disability," Schadenberg said.
He also believes Mayandy's friend and strategic decision-maker, chosen by the board, was pressured into supporting the hospital's position before he appeared before the Consent and Capacity board.
Schadenberg said, "It is deplorable that the Consent and Capacity Board in Ontario, the hospital and the lawyer for the hospital, who are all paid by the government and have nearly unlimited resources to pressure people to consent to their will, appeared to appoint a substitute decision maker to make decisions on behalf of Joshua, based on that person's willingness to a agree to a non-treatment plan, even though there is no proof that the plan of non-treatment represented the values of the person."
Mark Handelman, an attorney for Brampton Civic Hospital, said, "Justice was seen, and justice was done."
He said the decision was unanimous and denied that any pressure was applied to Mayandy's friend.
Schadenberg, however, points out that Ontario is "$20 billion in debt."
"There are unwritten rules. One of them is that long-term care is simply too costly," he said.
Schadenberg said by law he cannot intervene in the case unless Mayandy's board-appointed "friend" grants him permission.
Meanwhile, he said, time is running out for Mayandy, who can breathe, move and speak a little but cannot convince doctors he is worth saving.
The case recalls the high-profile life and death of Terri Schiavo, who died after being deprived of food and water in a Florida dispute that made headlines nationally.