When is withdrawing care appropriate?

Interesting editorial in the Canadian Medical Association Journal, read it here. One passage brought back memories of my ethics placement at the Montreal’s Children’s Hospital:

The case of Samuel Golubchuk, an elderly and very ill man at the threshold of multiple organ failure in a Winnipeg intensive care unit, illustrates this problem. The doctors wanted to withdraw care, and they met with the family on several occasions to seek consent; however, a religious impasse was reached, and Mr. Golubchuk’s son and daughter would not give consent.

 The doctors wanted to withdraw care. One day during morning rounds, we were discussing withdrawal of treatment for a dying infant. A resident used these very words “withdraw care” and was immediately corrected by the attending neonatologist who said: “We never withdraw care…” and a chorus of students completed her sentence: “we withdraw treatment!”

Without referring to the particulars of the Golubchuk case, I wonder to what extent “religious impasses” are not reached when families are given the impression that “care” is withdrawn along with treatment. After all, no religion contends that physical life should never end. But most religions – at least those I know – advocate death with dignity. By this, I do not mean the so-called dignity brandished by euthanasia and assisted suicide supporters. I mean respecting the intrinsic dignity of every human being, regardless of their physical and mental condition. Faced with the imminent death of a loved one, families shouldn’t be made to feel like they are a burden to the system or that health care professionals are giving up on them. If health care professionals can’t or won’t respect the dignity of their dying patients, they are only inviting resistance from those who do. The Golubchuk case is not an invitation to draft more stringent end-of-life clinical guidelines – as was so sensitively done by the Manitoba College of physicians and surgeons, read my previous post on the topic here – but rather an invitation to review how we can effectively extend care where treatment is no longer appropriate.

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