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When is withdrawing care appropriate?

May 5, 2008 by Véronique Bergeron Leave a Comment

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I wonder to what extent “religious impasses” are not reached when families are given the impression that “care” is withdrawn along with treatment.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.

Filed Under: All Posts Tagged With: compassionate care, death, dignity, Health care, Manitoba College of Physicians and Surgeons, Samuel Golubchuck, treatment, Withdrawal

That’s not funny

February 11, 2008 by Véronique Bergeron Leave a Comment

One of the unfortunate side effects of graduate studies in biomedical ethics is that you find humor in things that are decidedly not funny. Such was the case when I heard Dr. Bill Pope interviewed on CBC’s The Current. The head of Manitoba’s College of Physicians and Surgeons, Dr. Pope was commenting on the College’s new statement on withdrawal of life-sustaining treatment. When asked if the statement addressed some of the cultural and religious issues involved in end of life decision-making, Dr. Pope replied:

“This is why we used strictly clinical criteria.”

I laughed.

I know this is, strictly speaking, not funny.

But one must be exceptionally naive or willfully blind to believe that clinical observations can, in and of themselves, guide a decision to withhold or withdraw life-sustaining treatment. Clinical criteria don’t have opinions, which is why we need physicians to interpret them. Something informs the decision on where the buck stops, things like culture, religion (including atheism), economics and personal preferences. Clinical information needs interpretation and I am more concerned about a physician who believes that she has no biases than about one who comes out clearly as a [fill in the blank].

What worries me most about Dr. Pope’s comment is not that people will be taken off life support. Death is, after all, a part of life. What worries me is that he wraps himself in a flag of moral neutrality. Deciding that a practice – abortion, withdrawal of life support, euthanasia – is morally neutral is not a neutral decision.

Filed Under: All Posts Tagged With: Dr. Bill Pope, Manitoba, Manitoba College of Physicians and Surgeons

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