I just read a piece in the current issue of the Canadian Medical Association Journal on the much talked about "decision to withdraw or withhold life-sustaining care." This piece focuses on the Samuel Golubchuk case which I gather is like Terry Schiavo but with the family saying no on religious grounds (and getting an injunction to back that up), and some physicians taking it personally. Interestingly, the authors of this piece argue (and I reproduce verbatim):
"First, the considered withholding or withdrawal of life sustaining care is not "murder." Lawyers may make it seem so by exploiting the dubious distinction between acts and omissions — when in truth discontinuing invasive procedures such as tube feeding is both an omission (e.g., discontinuation of care) and an act (e.g., removal of a tube). Wise judges would reject this linguistic charade and bravely adopt an ethical approach to decision-making, which always emphasizes the best interest of the patient. In these circumstances, it is the disease that kills the patient, not the doctor or the treatment."
And...
"...some families will overreach in their demands to preserve life, often because they use fundamentalist religious beliefs or cultural norms to narrowly define the best interest of the patient. In dying, just as in living, no right, including the constitutional freedom to one's religion, is absolute. Requiring caregivers to stand in the way of the natural process of dying by forcing them to impose what, under the circumstances, are extraordinary measures with no foreseeable benefit, should not be accepted by the courts or society at large. Although religion and culture assist in better understanding the context of decision-making, it should not impinge on the rights of others. To make religion a factor in allocating a hospital bed is inequitable, for it privileges religious patients over others who may need care more urgently and whose chance of a favourable outcome may be better."
Needless to say, I find both arguments fascinating for obvious reasons. While both strong arguments, the first one somehow cancels out the second. Or perhaps its just me and my lawyerly linguistic charades. What I mean is that it seems suspect to argue first that it is the disease that kills, and then follow that with a suggestion that we need to consider tradeoffs in our publicly funded health care system (knowing fully well that those tradeoffs can only be procured by the doctor not the disease).
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