Thursday, August 2, 2012

Who has the right to decide when to withdraw medical treatment.


Today, there are two court decisions from two countries both dealing with a similar question, that being, who has the right to decide when to withdraw medical treatment.
 
The first case, decided by the Consent and Capacity board in Ontario, concerns a 90 year-old man, referred to as GS, who is a survivor of the Nazi Holocaust, was a victim of a car accident and has been in coma for the past 20 months.

An Ottawa hospital was given the right, against the wishes of the family, to withhold aggressive measures, but the hospital did agree to continue life-sustaining measures until he died a natural death.

GS’s daughter, who had often been in disagreement with medical staff about her father’s hospital care, opposed the plan.

GS’s daughter and three grandsons all testified that although GS could not speak, he recognized them during visits and showed signs of happiness. She suggested her father did not react the same way with doctors and nurses because he feared they were trying to kill him.

The family described GS as a religiously observant Jew, a disciplined man with a strict health regime and a fighting spirit. GS’s daughter noted that her father, an immigrant from Romania, had successfully recovered from hip surgery and two heart surgeries before his car accident. (He worked as an engineer in Montreal before retirement.)

The board also heard about the existence of a power of attorney document signed by GS in April 2010. In it, GS expressed his wish that his life not be prolonged under certain circumstances: if he’s in an irreversible coma; if he’s terminally ill and life-sustaining procedures will only delay his death; or if the burden of a treatment outweighs its expected benefits.
First: This is not a case of euthanasia. Heroic measures and burdensome testing is being withheld but life-sustaining treatment, such as hydration and nutrition are not being withheld from GS. In other words, this decision is not attempting to withdraw treatment, but rather withhold treatment that is deemed unnecessary.

Second: If the family is upset by the decision they should appeal the decision to the Ontario Court of Appeal.

Third: The question of who has the right to decide is significant in these cases because doctors are required to obtain consent, in Ontario, before they can implement a treatment plan.

The problem that the family may have in this case is that GS has signed a Power of Attorney document that basically states that the doctors medical treatment decision is acceptable. Whether or not someone intends what their Power of Attorney document states, once it has been signed, it is a legal document.

People who are concerned about these issues need to order the Life Protecting Power of Attorney for Personal Care from the Euthanasia Prevention Coalition.

The Second case is that of a child in the UK, known as baby X, who is believed to be in a coma. Baby X had a traumatic accident in May 2012 that is believed to have caused an irreversible brain injury.

Justice Hedley decided that it was appropriate to withdraw the ventilator from Baby X and that treating  Baby X with palliative care was an appropriate decision, even though this decision is against the consent of the parents. Justice Hedley also decided that life-sustaining treatment, presumably hydration and nutrition, should be continued indefinitely.

First: This is not a case of euthanasia. This is a very difficult case to access, because Baby X is likely to die after the ventilator is withdrawn but Baby X may survive and continue breathing. Hydration and nutrition appears that it is not being withheld from Baby X.

Two: The judge did agree to a plan of treatment, that being palliative care. I am not sure whether the parents have consented to this treatment plan but it is clear that they are not consenting to the withdrawal of the ventilator.

Third: The question of who has the right to decide is paramount in this case. The judge has provided consent to a treatment plan against the consent of the parents. Baby X is unable to consent to treatment therefore the wishes of the parents is normally upheld as the substitute decision makers.

It is important to note that doctors are not obligated to provide medical treatment that the doctor considers to be futile, burdensome or outside the parameters of the normal medical standard.

These cases clearly show that a tension exists between the right of the physician to refuse to provide treatment, that the physician deems to be futile, and the rights of a person to receive treatment, that is believed to be beneficial, or respects the faith of the person or the substitute decision maker.

The contention is whether or not the parents preferred treatment plan is in the best interests of Baby X. Since the death of Baby X is the likely result of the withdrawal of the ventilator, therefore, the wishes of the parents should be respected, but limited. The doctors cannot be forced to provide treatment that is considered futile.

Justice Hedley should have decided to limit his decision to withholding aggressive medical treatment, in a similar manner as the Ottawa decision. Consent would not be given when or if Baby X required further medical intervention. Natural death would then occur without infringing upon the rights and religious beliefs of the parents who only wish to care for their child.

No comments:

Printfriendly