Futile Care Case in Canada

When I was in Toronto recently at the international anti-euthanasia conference, I focused my speech on the looming threat of Futile Care Theory as the next big bioethical controversy. And already, I am proved prescient. A Canadian hospital is trying to force an elderly man off of a respirator and feeding tube over the objections of his family. From the story:

A Winnipeg family is going to court today to try to force a local hospital to keep their ailing father on life support, saying the hospital’s decision to withdraw such care violates their orthodox Jewish faith. Orthodox Jews believe it is essential to do whatever possible to extend life, and “sacrilegious” in any way to hasten death, the children of Samuel Golubchuk say in court documents. They are also claiming damages for assault from the Grace General Hospital and critical-care doctors, whom they accuse of acting arrogantly and trying to remove the patient from a ventilator and feeding tube on the Jewish sabbath.

The hospital and its doctors, though, say they have gone out of their way to respect the family’s wishes but would now be violating ethical guidelines to keep offering care they say would only drag out the 84-year-old’s painful death.

First, we should reject the concept of “dragging out the death” which turns the concept of extending life on its head. As I often say, dying isn’t dead, it is living. It is a stage of life. Refusing to extend life when the patient wants it is to turn the very purpose of medicine on its head and impose doctors’ or hospitals’ values onto patients and families where value judgments truly belong.

Here is what the doctors say:

But the patient suffers from a variety of irreversible ailments and trying to prolong his life now would actually contravene rules of the Manitoba College of Physicians and Surgeons that bar futile treatments, Dr. Elizabeth Cowden, the Grace’s chief medical officer, says in an affidavit.”I do not feel that I can ethically participate in the administration of this treatment any longer,” Dr. Bojan Paunovic, head of the hospital’s intensive-care unit, says in his own affidavit.

What is wrong here is that the treatment isn’t being cut off because it doesn’t work—which is a true futile treatment—but because it does! In effect, the patient is being declared to be futile. And just because the hospital created their own rules, that doesn’t mean they should be able to dictate who loses the right to live even though they are no doubt acting in the best of faith.

I am glad this is going to court. There are “cusp” cases where it may be so against the best interests of the patient and cause so much suffering that continued treatment can be unconscionable. But that isn’t up to doctors to decide unilaterally because they create their own rules. That is what we have courts for with the right to cross examination, a public hearing, and appeal, where the burden of proof should be on the doctors. In short: Due process—the very thing denied by conventional futile care hospital protocols.