a "severe and progressively deteriorating neurological state" and was in a persistent vegetative state. They were in "unanimous agreement" that he did not have any chance of recovering and that there were no treatment options available to help him. The parents disputed the conclusion that Joseph was in a persistent vegetative state, saying he responded to being tickled and jostled when he felt discomfort. The family wanted a tracheotomy for him, believing it would allow him to breathe on his own, and thus be taken out of the hospital so he could "die peacefully with mom, dad at home." They hoped the procedure could prolong Joseph's life by up to six months because it had extended his older sister Zina's life by six months when she was dying of the same condition. The couple also stated that, if their son was able to live longer due to the procedure, he would die "when God says he should." The doctors at the hospital refused to perform a tracheotomy because they said it would needlessly protract Joseph's death and increase the risk of infection, pneumonia, and other complications. Since the time of Zina's tracheotomy, more had been learned about the condition, leading doctors to conclude it was not appropriate in Joseph's case. Dr. Douglas Fraser, a pediatric critical care specialist and the lead doctor handling the case, proposed that Joseph's breathing tube be removed, with the expectation that he would die soon afterward from his inability to breathe unaided. His parents refused to agree to this proposal. Legal challenges London Heath Services Centre directed the case to the Consent and Capacity Board of Ontario. It explained in a statement that it sought the Board's decision on "whether or not Joseph’s parents were complying with the principles for substitute decision-making under the provincial Health Care Consent Act in refusing to consent to the proposed treatment plan." The hearing before the Board took place in January 2011. On January 22, the Board released its decision, holding that the course of action in the child's "best interests" would be "removal of the endotracheal tube without replacement, a Do Not Resuscitate order and palliative care." The parents were ordered to consent to the removal of the breathing tube. They decided to appeal the Board's decision in the Ontario Superior Court of Justice, retaining a lawyer, Geoff Snow, through legal aid. The case was heard by Justice