I refer to the case of Baby Isaiah, whose fate has yet to be determined. He was disabled at birth due to lack of oxygen during his delivery and remains in the hospital, breathing with the help of a mechanical ventilator and occasionally taking unassisted breaths. His parents, devastated, remained cautiously optimistic until they received a letter dated Jan. 13, 2010, informing them that withdrawal of active treatment was medically reasonable, ethically responsible and appropriate. The letter further asserts that it would be in Isaiah's best interest to discontinue support and, with sadness, such support would cease on Jan. 20, 2010.
To date, the issue is unresolved and Isaiah remains on a ventilator.
As a physician, I specialize in the management of the weak and disabled. My task is clear: restore an individual's health if I am able, and protect my patient's rights as a human being. I must state categorically that I am not a vitalist. Patients may choose to decline my treatment and as a consequence, die. I will support this choice but need not enable it. The College of Physicians and Surgeons of Manitoba, my regulating body and proclaimed public defender, has a statement on end-of-life care available on its website: http://www.cpsm.mb.ca/statements/st1602.pdf. It attempts to address the disagreements between physicians and patients or their identified decision-makers by following a protocol.
The statement empowers physicians in Manitoba to involuntarily withdraw care but they must provide a 96-hour window during which a patient may seek a legal injunction.
Stated in another way, if baby Isaiah were in Winnipeg, the "plug" may have already been pulled.
I am an intensive care physician practising in Manitoba. I provided care in a similar case involving an adult patient. During this patient's long intensive care unit stay, much distress was experienced by the medical staff and the family. Trust was lost on both sides of this conflict.
In my investigation of Isaiah, I learned that he had gained weight, moved and breathed occasionally on his own. His photos displayed an infant who by all accounts seemed normal in appearance apart from some paraphernalia of the critical care trade.
Although the issue before the court is the degree of brain injury incurred by Isaiah, I realize that it is Isaiah's status as a human being that is on trial. In contemporary thought, once born, humanity is considered automatic and should not be revoked by disability. The yardstick of being a human being is set too high for Isaiah. Discussion on the prediction of degree of disability, including mental capacity, is not relevant as are counter-arguments based on the physical appearance of normalcy. All that really matters, to be blunt, is if Isaiah is dead or alive. Brain death is complete and irreversible cessation of all brain function from the cortex to the brainstem. In some circumstances, the heart may still beat, the blood circulates and many organ systems can still operate. Patients who are brain dead are quite unstable even with the functions listed above working. Most patients with cessation of brain function experience rapid multiple organ system failure unless doctors intervene. If Isaiah is alive, which includes everything but brain dead, he is entitled to the full rights and privileges of any living Canadian citizen.
As a physician, I am profoundly concerned that I am allowed by college decree, or worse, potentially by statute, to take a life, as an agent of the state. I refuse to be a selector. My moral obligation as a physician demands that I not participate in the debate except to say that I treat all human beings the same. This rationing debate feels like code to me for something more sinister. There is no more important consideration to me than guarding against the abuse of my professional power in the way that I deal with vulnerable people who seek my care.
Dr. Joel B. Zivot, an associate professor in the department of anesthesiology, University of Manitoba,
is the director of the intensive care unit, cardiac sciences program, at St. Boniface General Hospital.