MGordon_MD
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Jan 23, 2009, 8:25 AM
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Ending Life Support - Difficult Decisions
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By Dr. Michael Gordon
“You might as well just kill her. Why not shoot her and get it over with?” “It is an act of euthanasia – I thought euthanasia was outlawed in this country.” “I am going to report you to the media - you can’t just kill people you know.” “Stopping the respirator is the same as killing her – is that the business you are in?”
These are some of the quotes I have heard over the past few years from family members faced with the conundrum of discontinuing life-sustaining respirator treatment in Intensive Care Units (ICU). The recent highly controversial Winnipeg orthodox Jewish man who was kept on a respirator after the ICU physicians felt that life- support should be discontinued, greatly fueled the flame of controversy. The Canadian and Israeli media weighed into the picture with some writers characterizing the situation as “euthanasia”. Some religious leaders took up the mantle as one of religious freedom. When death did occur, prior to the case for which a court injunction was obtained, going to trial, the death was described as “natural” by the family.
How are health care providers who pursue the best of life-saving treatments in the nation’s intensive care units to deal with allegations that when they believe that their efforts have been unsuccessful that they are accused of being “cruel”, “ignoring religious beliefs” or “killing beloved family members?” In medicine those who practice life-support, and knowledgeable in the limits of life-support methods, and the likelihood of recovery from end-stage conditions when vital organs fail, can usually accurately predict when further treatment will not be clinically beneficial. This medical perspective may conflict with the family’s non-medical, personal, religious and psychological perspective. Losing a loved one is never easy – having the process interface with the complexities of the modern medical technology does not make it easier.
Prior to the advances in life-support technologies, many older individuals, especially with late stage heart, brain and kidney diseases died from their diseases without any attempt to prolong their life, hoping that there might be some recovery. Therefore there was no option of discontinuing life-sustaining treatment. With the increased access and common use of life-support technologies it has become common for individuals with previously fatal diseases to receive a reprieve from death by the use of life-support technologies. The rationale is, on occasion, some individuals recovered from the illnesses that previously would have led to their death. With such treatments some recover, even if they are left with severe disabilities or unfortunately in permanent coma or some comparable state. The new standard for life-support in ICUs became in essence, “give people the best possible chance for recovery”.
The problem is when the life-support treatment does not achieve its goals – it has to be discontinued. One cannot keep a person on life-support indefinitely. That is the emotional problem for families and for some with strong religious convictions - it is easier to not start a treatment than to stop it. But, if we do not agree that if the treatment does not work it must be stopped we could in essence end up depriving people of the chance to respond to such attempts at treatment. Using life-support is not “natural”- as a means of keeping someone alive- it is “artificial”. Allowing someone to die from their disease after life-support has been tried but failed, is what is “natural” and it must be allowed to happen with the tenderness, care and love that the person deserves- not with a sense of hostility and anger and disapproval that unfortunately often occurs.
This article originally appeared in the Canadian Jewish News.
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Dr. Michael Gordon is Medical Program Director, Palliative Care Baycrest Geriatric Health Care System in Toronto, Canada and Professor of Medicine, at the University of Toronto. He is co-author with Bart Mindszenthy of Parenting Your Parents.
Parenting Your Parents is available in bookstores and online at: Indigo-Chapters, Amazon and Barnes & Noble. It is available in a US edition: Parenting Your Parents: Support Strategies for Meeting the Challenge of Aging in America.
For bulk orders email info@dundurn.com. Call: 416-214-5544 or Fax: 416-214-5556
(This post was edited by MGordon_MD on Jan 23, 2009, 8:42 AM)
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