In 2008, the Manitoba College of Physicians and Surgeons gave its members the power to withdraw or withhold life-sustaining treatments from patients, even if this is contrary to the wishes of patients or their families. The process to be followed in arriving at the decision to allow a patient to die is outlined in the College’s Statement No. 1602: Withholding and Withdrawing Life Sustaining Treatment.
Short of going to court, there is no appeal. One can easily imagine situations where the clock could run out before a legal remedy could be obtained. Not surprisingly, people who live with disabilities fear this power could result in life-saving treatment being withheld from them in the mistaken belief that their disabilities justify letting them die.
Who can blame them? How often have you heard people say, in reference to someone with a severe disability: “I wouldn’t want to go on living — he/she would be better off dead.”
The College’s policy statement does not dispel this fear. It establishes a benchmark for determining whether a patient will get treatment that centres on the patient’s ability to reach what it calls the “Minimum Goal of Treatment.” According to the College, this standard is defined as:
“. . . the maintenance of or recovery to a level of cerebral function that
enables the patient to:
- achieve awareness of self; and
- achieve awareness of environment; and
- experience his/her own existence.
For pediatric patients, the potential for neurological development must be factored into the assessment.”
In other words, the standard is based on the level of cognitive ability or disability. The statement does not specify objective medical criteria for determining if this “minimum goal” has been met. Hence, it is left to individual physicians to determine, subjectively, if a patient is or can achieve self-awareness.
More troubling, the College’s policy envisions situations where the “minimum goal of treatment” could be met, but where the doctor could nevertheless conclude that treatment should be withheld because of “subjective values and judgments regarding quality of life.”
Most troubling is the lack of an appeal mechanism and the apparent unwillingness of the provincial government to insist on or to legislate one.
The Manitoba League of Persons with Disabilities has been critical of this policy since its inception. On May 31, 2011, it, along with the Council of Canadians with Disabilities, outlined their perspectives at a public forum in Winnipeg.
The panelists were:
- Rhonda Wiebe – Co-chair, Council of Canadians with Disabilities Ending of Life Ethics Committee
- Jim Derksen – member, Manitoba League of Persons with Disabilities
- Dean Richert – Co-chair, Council of Canadians with Disabilities Human Rights Committee
- Valerie Wolbert – People First, Manitoba
- Catherine Rogers – People First, Canada
The speakers were informative, engaging and articulate. But don’t take my word for it. Watch the video and draw your own conclusions.
This issue ought to concern all of us. It is not solely a matter for people with disabilities. Sooner or late, all of us will die. Along that path we may find ourselves disabled and dependent on the judgements and decisions of others for our lives. Surely we should have final word on whether or not doctors will try to save our lives.
Paul S. Graham 