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Manitoba MD body sets conditions for withdrawal of treatment.

The issue of medical futility was tackled in a cautiously worded directive issued by the Manitoba College of Physicians and Surgeons in a statement on the role of the MD on situations where the doctors are considering withdrawing life sustaining treatments from patients. The guideline in the first of its type in Canada.

Essentially, the College supports the right of the physicians to withdraw services in patients judged to be without possibility of regaining consciousness. However, the College sets out obligations and procedures for such an act.

The need for the statement arises out of the situation of a patient now on life support in Winnipeg Grace Hospital. The patient, an orthodox Jew, was admitted to the intensive care unit of the hospital in Nov. 2007. In December the physicians determined that there was no likelihood of recovery and the man had minimal brain function.

The family Samuel Golobshuk went to court, claiming that the man's religious beliefs would prevent him from choosing this option. Justice of the Queen's Bench Perry Shulman issued an ex parte injunction, ordering the hospital and the physicians to continue the life support while he considered the arguments and made a final judgment. Justice Shulman's ruling will have a major impact on health services in Canada.

This case has gained international attention from religious groups, Christian and Jewish, as well as comments from prominent ethicist.

College Registrar Dr. Bill Pope says the statement might be seen as "doctor-centered" by some and as imposing unnecessary limits on physician autonomy by others. The College statement calls for:

* patient involvement when withholding or withdrawing life-sustaining therapy is being considered;

* seeking consensus with patients or their decision-makers; and

* seeking advice from others who have valuable information and/or expertise, including members of the patient's family, other members of the health care team, ethicist, social workers and chaplains.

Justice Shulman heard testimony from Rabbi Yitzchok Chayton, staff chaplain at the Winnipeg Jewish Family and Child Service, who supported the family's contention that the man's religious beliefs would have made him decline withdrawal of the treatment. He argued that if a person is in the final stages of dying, one is not permitted to hasten or prolong the process. A public opinion survey by Angus Reid indicates that most Canadians would support the stand the family has taken in this case.

Arthur Shafer, director of University of Manitoba's Centre for Professional and Applied Ethics, commented that if Judge Schulman's decision goes against the hospital, it could have a potentially harmful effect on the health care system. Potentially, he points out, tens of thousands could be kept alive by machines, at great cost.

Thaddeus Mason Pope, Memphis University law professor and an expert on medical futility care issues, calls the Manitoba statement an "admirable attempt to provide guidance." But he finds two things lacking:

* it contains no process or opportunity for transfer to another health care facility; and

* the consultation requirements for a decision to end treatment "are not sufficiently rigorous".

Pope points to Texas as an example, where a multi-disciplinary ethics committee must approve such decisions.

The Manitoba College's statement is the first attempt in Canada to regulate the withdrawal of treatment.

Seek advice from health care team members, ethicists, social workers and chaplains.

As we go to press: Samuel Golubchuk will remain on life support at the Winnipeg Grace Hospital, Justice of Court of the Queen's Bench Perry Shulman ruled. He will remain in this state until Judge Shulman can hear arguments by the hospital and Golubchuk's adult children. The Justice said that the hospital did not have adequate structures for dealing with such disputes.
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Title Annotation:HEALTH; Manitoba College of Physicians and Surgeons
Publication:Community Action
Geographic Code:1CANA
Date:Feb 20, 2008
Words:605
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