Remembering physicist Steven Hawking, who died last month, it’s hard not to think about 42-year-old Roger Foley stuck in his hospital bed in a London, Ont.

Famously, Hawking lived productively for more than 30 years with the challenges of amyotrophic lateral sclerosis (ALS), a degenerative neurological disease. Foley has a set of different but similarly limiting conditions, including cerebellar ataxia. It, too, is a progressive condition affecting movement and speech.

Hawking survived for decades with the assistance of a phalanx of nurses, therapists and an array of expensive devices. Foley is in a hospital bed he refuses to leave because, he says, the inexpert home care provided through provincial support placed his fragile well-being in jeopardy.

Hospital officials threatened to bill him $1,800 a day for his hospital room if he would not return home to what he describes a substandard, injurious care. Alternately, they offered him medical aid in dying.

On Feb. 14 (Valentine’s Day) Foley’s lawyer, Ken Berger, filed suit in Ontario Supreme Court on his behalf. The suit charges that Foley’s Charter rights have been violated through official “failures to relieve the plaintiff’s intolerable suffering, [instead] providing the option of assisted suicide rather than assisted life.”

Foley’s condition is in his own words “grievous and irremediable,” the standard by which the Supreme Court judged medical assistance in dying is to be available to all. But while the condition is irremediable, as was Hawking’s, that does not mean his life quality is unsustainable. With proper and qualified home aides and support Foley could live a safe and full if restricted life.

That, his suit alleges, is what he has not received. After being fed food left out too long he was hospitalized for food poisoning; he was dragged on the floor by caregivers who did not know how to effectively transfer him from his bed. “Workers lacked the ability to assist with his exercises. He suffered injuries as a result.”

One issue is therefore the standard of home care provided Ontarians requiring skilled home assistance. At present, agencies contracted through Local Health Integration Networks send out employees who may or may not be trained to provide the kind of care those like Foley require.

The deeper question — and the one that makes this case of national importance, is its challenge under the Supreme Court’s decision legitimizing physician-assisted death in the famous case of Carter et al. “The MAID provisions fail to require the defendants [local health organizations] to take any steps to even try to help relieve intolerable suffering or even require that other options even be tried before assisting vulnerable persons with disability to assisted death.”

Shorn of its careful legal words, the question is simply this: If all are guaranteed MAID in the face of “irremediable suffering” are we not first obliged to assure the choice of a safe and supported life with restrictions before offering a medically supervised termination?

“Before anyone … can even be considered for assisted death,” Berger told CTV news, “they need to have all necessary services provided to help them relieve their substantial suffering.”

Hawking wrote his famous book A Brief History of Time not simply to educate laypersons in the wonders of cosmology but also to provide monies for his care and support. He worried without additional private funds that, as the ALS progressed, he would end up in a nursing bed in an institution rather than continue his life’s work.

Foley was national manager of e-business at the Royal Bank of Canada before his illness ended that career. Unlike Hawking, he cannot personally fund the care levels that the famed physicist enjoyed. In theory, if not always in practice, that is what provincial care agencies are obliged to provide.

“I have no desire to take up a valuable hospital bed,” Foley explained. “But at this point, it’s my only option.”

Nor does he wish to die prematurely. Rather, what he seeks is the right to live as fully as possible within the limits of his condition.

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And that is what this case is all about.

Tom Koch is a consulting ethicist and gerontologist who has written frequently on the issues of medical assistance in dying.