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MDs have final say
Statement clarifies end-of-life policy

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The final decision to pull the plug on a patient lies with the physician, according to new guidelines released by the College of Physicians and Surgeons Wednesday.

Manitoba’s College of Physicians and Surgeons is the first medical regulatory body in Canada to introduce guidelines for physicians to follow when dealing with end-of-life issues and comes less than two months after a Winnipeg family challenged the decision of Grace Hospital doctors to discontinue an 84-year-old man’s life support.

There are no Canada-wide guidelines on withdrawing life support, and the practice differs between most hospitals and provinces.

The new guidelines outline four different end-of-life scenarios and the process a physician must follow when they’re considering withdrawing life-sustaining treatment from patients. The guidelines say the minimum goal of life-sustaining treatment is for the patient to recover to a level where they can be aware of themselves, their environment, and his or her existence.

In the event physicians and families don’t agree, Dr. Bill Pope, registrar of the College, said the ultimate decision rests with the physician.

Pope said the guidelines are not a response to the recent court case and noted 100 stakeholders have been working to draft the regulations over the past three years.

In December, relatives of Samuel Golubchuk challenged physicians who wanted to remove the feeding tube and ventilator that was keeping Golubchuk alive.

The judge hasn’t ruled on the case, but relatives argued disconnecting life support goes against the family’s wishes and Golubchuk Orthodox Jewish religious beliefs.

Pope wouldn’t comment on the Golubchuk case, but said the College would review its statement should a judge rule in favour of a patient’s family.

The rules apply to all Manitoba physicians and come into effect Feb. 1.

“Nonetheless, doctors are permitted to make that decision.” Pope said. “We will require them to communicate with patients and have an open discussion to make that situation more transparent.”

If a physician and a patient’s family don’t agree on whether to withdraw life support, the guidelines instruct doctors to first assess the patient’s medical condition, consult with another physician, communicate the decision to the patient’s family, and document all communication between the physician and the family.

Although most physicians already follow this criteria, Pope said the new regulations will help reduce disagreements over end-of-life care and guide doctors who may not know what to do in certain situations.

The guidelines also outline what physicians should do if a patient refuses life-sustaining treatment, how to stop treatment in emergency situations where they can’t communicate directly with a patient or a relative who can speak on their behalf, and the process a doctor should follow if a patient’s family demands life support even if it causes undue harm and burden to the patient.

Dr. Mike Harlos, medical director of palliative care for the Winnipeg Regional Health Authority, said disagreements over end-of-life treatment are rare, noting he has only dealt with disagreements over withdrawing life support two or three times in the last 20 years.

However, Harlos said the new rules will be useful in coming years as the population ages and more people and their families make difficult decisions about continuing or ending life-sustaining treatment. Harlos recommends people communicate their wishes ahead of time with loved ones to reduce potential conflicts.

“The people that are aging have higher expectations not just for health care but for openness and dialogue and for participation and so do their families,” he said.

Republished from the Winnipeg Free Press print edition January 30, 2008 $sourceSection$sourcePage

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