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Don't give MDs power to pull plug: disabled

End-of-life guide a risk, MPs told

By: Jen Skerritt

Posted: 06/17/2010 1:00 AM | Comments: 0 (including replies)

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Jim Derksen voiced concerns about legalizing assisted suicide. (BORIS MINKEVICH / WINNIPEG FREE PRESS ARCHIVES)

What's the debate?

What is Manitoba's statement on withdrawing life-support?

Manitoba's college of physicians and surgeons introduced new guidelines in 2008 that outline four different end-of-life scenarios and the process physicians must follow when they're considering withdrawing life-sustaining treatment. The guidelines say the minimum goal of treatment is for patients to recover to a level in which they can be aware of themselves, their environment and their existence.

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.

If a patient could achieve the "minimum goal" but the physician concludes treatment should be withdrawn, the doctor must provide the patient's family written or verbal notice 96 hours before life support is stopped.

In the event families and physicians don't agree, doctors have the final say.

What do other provinces do?

There are no Canada-wide guidelines on withdrawing life-support, but four years ago the Law Reform Commission released a report saying the Manitoba health-care system needed to establish clear and uniform guidelines. Other jurisdictions, like Ontario, have a Consent and Capacity Review Board established to deal with end-of-life cases quickly. Instead of waiting months for a court trial, a three-member panel is convened within a week. They hear both sides, try to mediate and if no compromise can be reached, the panel makes a ruling.

Giving Manitoba doctors the power to pull the plug on a patient discriminates against disabled people who may fall short of the minimum standards to remain on life-support, local advocates told a Parliamentary committee Wednesday.

Jim Derksen and Rhonda Wiebe, Winnipeg members of the Council of Canadians with Disabilities, said certain policies -- including Manitoba's end-of-life guidelines -- put disabled patients at risk of improper treatment because of common attitudes that "it's better to be dead than disabled." They spoke out in front of a federal palliative and compassionate care committee in Ottawa, and voiced their concerns about legalizing assisted suicide and other inequities in end-of-life care.

Manitoba's medical regulatory body is the first in Canada to introduce guidelines for physicians to follow when dealing with end-of-life issues. They say the minimum goal of life-sustaining treatment is for patients to recover to a level in which they can be aware of themselves, their environment and their existence.

In the event families and physicians don't agree life-support should be withdrawn, doctors have the final say.

Derksen said some patients with cognitive impairment or conditions such as dementia may not be able to articulate that awareness, forcing doctors to make a judgment call. He said there is no objective test or brain scan performed to determine whether a person meets the minimum standard to remain on life-support.

"In other words, if there's too much disability, the patient (does not) meet the minimum goal," Derksen said. "That, to me, is pretty wrong and probably unconstitutional."

His concerns over Manitoba's College of Physicians and Surgeons end-of-life guidelines come just shy of the second anniversary of Samuel Golubchuk's death. The 85-year-old man died in Grace Hospital on June 24, 2008, at the centre of a controversial debate over who should decide when a person is pulled off life-support. Golubchuk's eight-month battle to remain alive pitted a patient's right to continue treatment against Winnipeg physicians who argued continuing to care for the elderly man was "tantamount to torture." They said Golubchuk had no self-awareness and that their decision to terminate support is in no way biased against disabled persons.

The court injunction Golubchuk's children sought to keep him alive died with him, and the question of who gets to decide when someone dies hasn't been fully answered.

Winnipeg Regional Health Authority officials conducted a review of Golubchuk's case to shed light on how to better handle conflict between patients and physicians, but the report is still in draft stages.

A spokesman from the Manitoba College of Physicians and Surgeons was unavailable for comment Wednesday.

Wiebe said she's concerned some medical professionals could be swayed by a common stereotype that living with a disability is "miserable." She said there should be more supports in place within the medical system to ensure disabled patients aren't treated differently. Wiebe said she wants the public to know a disabled person's quality of life is as good as anyone else's.

"We see that as a human rights violation because if you are a person with a cognitive disability you may not meet that standard," Wiebe said. "It shouldn't be a medical decision."

jen.skerritt@freepress.mb.ca

Republished from the Winnipeg Free Press print edition June 17, 2010 A3

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