Monday, October 25, 2010

The Duty to Let the Dying Die

I used to be dead.   At least I was once. For a while.  No pulse, no respiration, not even any twitching.  A goner.   That is until a team of fire department paramedics stationed just two blocks away raced over with what (I am told) was some ungodly needle affair and paddles and stuff.   I didn't even know I was dead until I woke up a couple of days later to find out I wasn't.

That incident somehow got me focused on death.  I went right out and got my affairs in order.  A new will, a power of attorney, and a "living will" complete with a DNR, "do not resuscitate" clause.  I should be all set to go next time.

Death is and ought to be an intensely personal thing.  That's why living wills are so important.   They come into play when you're no longer able to speak for yourself.  Oddly enough, that can be when you most need to be heard.  Curious, isn't it?  If you haven't got one, get one.

We DNRs are the easy ones.   Pretty straightforward. easy to follow instructions.  Just keep us comfortable and see us out the door.   But what about the hard cases, where the patient wants his doctors to do anything and everything possible to forestall death?   Just how far ought the medical profession go to meet that demand?

That debate rages right now at the Sunnybrook Health Sciences Centre.  48-year old  Toronto accountant Mann Kee Li has been there since August battling terminal cancer.  His living will calls for all medical procedures possible in the event of a life-threatening emergency.  Last week, however, the hospital doctors concluded enough was enough and issued their own DNR order against the family's wishes.   The family has taken the hospital to court.

Now here's where it gets weird.   On Friday, Justice Barbara Conway issued a ruling that effectively revoked the hospital's "do not resuscitate" order and dumping the whole thing on Ontario's Consent and Capacity Board as though this was an issue of either consent or capacity.  Barry Swadon, the family's lawyer, says the ruling is a game changer,
"It is a recognition by the Superior Court that physicians should not be making DNR orders without first obtaining consent of patients or substitute decision makers.”

This is where you become involved.   If physicians require the consent of patients or family to issue DNR orders, your medicare bill could be in for a bubble.  It's insanely expensive but medical science can keep many terminally ill alive long after nature has come calling for them.   If the patient is beyond all hope of ever again enjoying any quality of life and life can only be sustained by the hospital paying its hydro bill what is the point of extending life?  Isn't that life beyond any meaning?

Quite frankly I cannot understand the thinking that would see a loved one put through this for no good end.   Judge Conway showed that there is no justice in cowardice.


Anonymous said...

I dont think that there are very many instances where people insist on long-term extreme measures. Most senior-ish have just the opposite as their wishes. The one instance that you have pointed out is, I think, an aberration and not the sort of instance worth making policy to address.

I think our society would do better to have a specific criteria of when to stop trying to keep extremely premature infants alive. That is a more up and coming issue.

The Mound of Sound said...

Most of us are, indeed, rational but families placed in this situation aren't always grounded. The decision taken by this judge is horrible and ought to be appealed.