New policy gives Manitoba doctors final say on end-of-life treatment

Manitoba's College of Physicians and Surgeons has released a long-awaited statement on the issue of withholding treatment for dying patients.

It says a doctor's word is final when it comes to withdrawing or withholding life-sustaining treatment.

A patient has a right to refuse life-sustaining treatment, but does not have the right to demand it, according to the statement.

Doctors must consult with patients, family members, or someone who represents patients before deciding to withhold or withdraw care, and if the patient or proxy disagrees with the decision, the doctor must get a second opinion.

The statement will help doctors deal with family members acting for patients in cases where the family demands life-sustaining treatment even when the doctor believes it's futile, said Arthur Schafer, director of the University of Manitoba's Centre for Professional and Applied Ethics.

"This set of guidelines tells doctors when they are professionally entitled to reach that conclusion," he said. "It tells them the process they should go through — discussion with the family, getting a second medical opinion, if necessary — but it tells them the criteria. It tells them what to look for."

The college defines "life-sustaining treatment" as treatment that is undertaken to prolong the patient's life, but "not intended to reverse the underlying medical condition."

The minimum goal of such treatment should be maintaining or recovering a level of functioning in which the patient is aware of himself, aware of his environment, and experiences his own existence, the statement says.

"This statement is the result of extensive consultation and input from close to 100 stakeholder individuals and groups from across the province and country," college registrar Dr. Bill Pope said in a release.

"Those involved will now know what to expect and understand their rights and responsibilities during a difficult time.

"Our hope is that this statement will limit the need for outside intervention to the rare cases of irresolvable conflict."

College officials say the statement outlines practices that have been generally observed in Manitoba, but enshrines them in physicians' ethical obligations.

The statement becomes effective Feb. 1, 2008.