Who should "play God?"

A CBC News article reports that the Calgary Health Region is appealing a court injunction which lifted a “do not resuscitate (DNR)” order from a comatose patient. Doctors at the Foothills Hospital had ordered the patient not be resuscitated (in the case of cardiac or respiratory arrest) because they felt his brain injury was so traumatic that he would never recover. The patient’s family sought legal intervention to give them time to obtain independent medical advice. Since that time, CBC reports the patient has made “a remarkable recovery” and is now able to speak, read and write.

The Health Region chose to appeal the injunction because it will create ambiguity over who has the final say – judges or doctors. Justice Sheilah Martin, who ordered the injunction, noted that the current law is unclear as to whether doctors or families have the final say. A medical ethicist at the U of C pointed out that if the injunction stands, it will set the precedent that judges have the final say on DNR orders; and judges would therefore have to be available 24 hours a day, to make the decisions that doctors are currently making.

Deciding when to stop treating a patient (or family member) is undoubtedly one of the most difficult decisions for anyone to make. Regardless of your opinion, everyone has to agree that the very last thing we need is ambiguity in the law defining who has the final say in letting a patient die. Currently, doctors make the majority of these kinds of decisions, and some would say doctors are impartial, not emotionally tied to the patient, and therefore best suited to make an educated decision regarding the likelihood that the patient will recover. Doctors however are human, and some patients will undoubtedly defy all odds and recover from the worst of circumstances.

Another CBC article reports the Manitoba College of Physicians and Surgeons has proposed a policy that would clearly give doctors the final say, but require them to give 96 hours notice to the family who would then be given the right to appeal via a second opinion or court intervention. I believe that a policy along these lines (maybe with more required notice) is probably the best option as it leaves most of the decision making power with doctors, but gives ample opportunity for the family to obtain secondary advice and court intervention if necessary. Regardless of your position, “playing God” is not for the faint of heart.