Tuesday, June 17, 2008

Extra-ordinary Treatment vs Ordinary Care

This morning I was interviewed on CBC radio in Winnipeg Manitoba concerning the Golubchuk case.

I was asked what level of treatment constitutes ordinary care, and should be always provided, and what constitutes extraordinary treatment that is optional.

First: The Golubchuk case is unique because Samuel Golubchuk is an orthodox Jewish man who holds a distinct set of principles. I respect the Golubchuk family and I uphold their right to defend the principles that they and their father hold.

When people call me and ask specific medical questions I always differentiate between medical decisions that will be of benefit and carry a minimal amount of burden and those that provide very little benefit and may have a significant level of burden.

When a treatment is of benefit and the burden of the treatment is minimal then the treatment should be provided. When the treatment provides a minimal benefit or causes a significant level of burden then the treatment should be considered optional, based on the wishes of the person or their substitute decision-maker.

Basic care provisions, often referred to as ordinary care, should be considered obligatory. Basic care provisions include warmth, care, comfort, pain relief, fluids and food (unless it is physiologically impossible to provide, or the person is nearing death, or if its provision is a significant burden to the person) and other basic necessities of life. The respirator should not be considered obligatory but may be necessary for the continuation of life.

We must never cause death, but only allow death to occur.

Therefore we must reject any action or omission that directly and intentionally causes the death of a person. This is an issue of fundamental justice and equality.

You cannot allow one person to directly and intentionally cause the death of another person. This would give one person the power over life and death of another person. You can never control this and it will always result in a direct threat, by action or omission, of the lives of the most vulnerable.

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