I have always said that if euthanasia were ever legalized in Canada, that soon these decisions would be combined with the hospitals cost containment policy, and quickly people would be offered euthanasia or euthanized without request or consent, as happens 32% of the time in Belgium, according to a recent CMAJ report.
Robert Cribb, staff reporter for the Toronto Star reported about another case at Sunnybrook hospital in Toronto today. The article stated:As Mann Kee Li lies in hospital fighting dire prospects, his family is engaged in a life-or-death struggle, not with the cancer spreading through his body, but with the doctors treating it.
Li, a 46-year-old Toronto accountant and father of two young boys, wants doctors to use all medical measures possible to save him in the event of a life-threatening emergency.
He made those intentions clear to his doctors at Sunnybrook Health Sciences Centre when he entered the hospital in August. He wrote it in a power of attorney document and confirmed it in a videotape statement, his lawyers say.
While his doctor initially agreed to respect those wishes, physicians unilaterally reversed the decision a week ago without consultation and imposed a “do not resuscitate” order, his family alleges.
“There’s something seriously wrong with the system,” says David Li, Mann Kee’s younger brother who travelled to Toronto from his home in Singapore this week to join the family’s 24-hour watch at the hospital.
“I can’t understand what’s going on in the heads of these people. They’re effectively playing God . . . I’m at a loss for words.”
Julie Cheah, Li’s wife, says she was “shocked” to learn doctors had decided to withhold emergency treatment “without even giving us a heads-up.”
The hospital and its doctors, meanwhile, argue the ultimate decision on whether to resuscitate a patient rests on physician judgment rather than patient wishes.
“When clinical teams determine that further interventions would have no benefit to the patient . . . ethically and legally, health-care providers are not obliged to provide interventions that lie outside the standard of care and would be of no benefit, and indeed may well cause harm to a patient,” said Sunnybrook executive vice-president Dr. Keith Rose in a written statement.
Li’s two treating doctors — Robert Fowler and Cameron Guest — declined an interview request.
But their lawyer, Harry Underwood, told a court Friday that any order compelling doctors to administer CPR to Li would be “unconscionable.”
“He should be allowed to die in peace without this gross and monstrous intervention.”
This is the second end-of-life case involving a Sunnybrook patient to reach the courts in the past month.
They both pose a highly charged question that inhabits a legal and ethical grey area in Canada: When patients and their families disagree with doctors over life-saving treatment, who decides?
On Friday, lawyers for Li, the hospital and the two doctors treating him sought an order from a Superior Court judge clarifying just what should happen if Li’s life falls into question.
With the weekend looming, Madam Justice Barbara Ann Conway crafted a handwritten order that struck a vague balance of interests — it effectively revoked the “do not resuscitate” order imposed by Sunnybrook physicians but made clear that it didn’t compel them to actually resuscitate Li in case of emergency, leaving the matter to their own judgment.
Acknowledging her order reaches only “midway ground,” Conway then tossed the legal hot potato to an independent provincial body called The Consent and Capacity Board to conduct a hearing. An emergency hearing is scheduled to begin Monday morning.
The court order lifting the “do not resuscitate” order is likely a precedent in Canada, said Barry Swadron, the lawyer arguing the case in court for Li’s family.
“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.”
Li, described by his younger brother as a hardworking father and a man of deep integrity and loyalty, was first diagnosed with thymic carcinoma in 2001. The cancer gradually spread to his liver and he underwent chemotherapy at Princess Margaret Hospital last year that was unsuccessful, says an affidavit filed in court by his wife.
He took a turn for the worse in August when he awoke one morning unable to stand or walk.
Paramedics delivered him to Sunnybrook.
He is currently in and out of consciousness and unaware that his wish for life-saving care is being denied by doctors, his family says.
The end-of-life arguments in the case couldn’t be more polarized.
“I think it was terribly wrong of the treatment team to change the man’s code status without even advising the family that they had done so,” says Mark Handelman, one of Li’s lawyers and a trained bioethicist who specializes in health-care law.
Dr. Fowler’s affidavit, referred to in court, claims Li’s condition changed “materially” during his stay at Sunnybrook and that “CPR will be ineffective” even if it were administered.
Last month, the Star reported on the case of Douglas DeGuerre, another Sunnybrook patient who requested full emergency care, which was changed by doctors without consultation, according to allegations filed in court by his daughter.
His daughter, Joy Wawrzyniak, says she pleaded with doctors to save her father’s life as he was in critical condition two years ago.
They stood back and refused as he suffered an arrest, she alleges.
He passed away moments later.
That case remains before the courts. Sunnybrook officials declined to comment.
“There needs to be far more communication between doctors and patients and substitute decision makers and I think we need to clarify the law on whether or not doctors are unilaterally entitled to withhold treatment that does not meet a purely medical standard of care,” said Handelman.
“I agree that doctors do not have to propose treatments that they think are not appropriate or to which they have a moral objection but I think they need to be more careful about what they propose or do not propose.”
Transcript details patient’s wish to live
On Aug. 12, Toronto lawyer Mark Handelman interviewed Mann Kee Li for the purpose of preparing a power of attorney document detailing Li's wishes for care in hospital. Handelman videotaped the interview.
Here is a partial transcript included in Handelman's affidavit submitted in court:
(In referring to our afternoon meeting) “Are you aware that you told me that you wished to have all things done to continue your life?”
Mann Kee nods affirmatively in response.
“Are you aware that you may no longer be able to make decisions, that you could lapse into a coma, never to regain consciousness?”
Mann Kee nods affirmatively in response.
“In those circumstances would it still be your wish to have your life continued?”
Mann Kee nods affirmatively in response.
“For as long as possible?”
Mann Kee nods affirmatively in response.
“Are you aware some of the measures to continue your life could be painful to you?”
Mann Kee nods affirmatively in response.
“For example, if your heart stops and doctors need to perform cardiopulmonary resuscitation they may have to pound on your chest?”
Mann Kee nods affirmatively in response.
“That could break some of your ribs?”
Mann Kee nods affirmatively in response.
“And that a broken rib could puncture a lung?”
Mann Kee nods affirmatively in response.
“Do you want them to do that if necessary?”
Mann Kee nods affirmatively in response.
“Even if you will never regain consciousness?”
Mann Kee nods affirmatively in response.
Link to the Toronto Star article.
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