New Developments Regarding Do Not Resuscitate Orders in Manitoba

(12 February 1998) — "Do Not Resuscitate Orders" raise many concerns for persons with disabilities in medical settings. When a "Do Not Resuscitate Order" (DNR) is placed on a person's medical chart, it means that medical personnel will not intervene in times of medical crisis to save the person's life. As with many other issues, the key factor here is who decides when a DNR order is appropriate. If the individual, or their designate, has made this choice, then a DNR is appropriate. If the individual, or their designate, has not been involved in the decision making process with regard to the application of a DNR, then the principle of self-determination has been violated.

The Manitoba Court of Appeal recently made a ruling in the case of Child and Family Services of Central Manitoba v. Raymond Lavallee and Susan Lorraine Hay, which affects self-determination when it comes to DNR orders. In this decision, the Court holds that it is for the doctor to determine whether or not heroic measures are to be used to maintain the life of a patient in an irreversible condition.

In the decision, the Judge stated, "...neither consent nor a court order in lieu is required for a medical doctor to issue a non-resuscitation direction where, in his or her judgment, the patient is in an irreversible vegetative state. Whether or not such a direction should be issued is a judgment call for the doctor to make having regard to the patient's history and condition and the doctor's evaluation of the hopelessness of the case. The wishes of the patient's family or guardians should be taken into account, but neither their consent nor the approval of a court is required."

The Manitoba League of Persons with Disabilities (MLPD) has sought a legal opinion on this case. Arnie Peltz with the Public Interest Law Centre comments, "As to the broader implications for people with disabilities, I think there is reason for concern. Strictly speaking, the case is about a situation of irreversible vegetative state, as illustrated by the tragic facts of the baby's condition. However, as noted by the counsel for the Agency during my discussions with him, there is no clear bright line between this situation and many other possible situations involving people with less severe permanent disabilities. The Court appears to be saying that these are matters for the exercise of physicians, and if the physicians turn out to be wrong afterwards, then an action for negligence can be taken, directing the physician or his insurer to pay money damages to the estate of the deceased. What a comfort!"

Another matter of concern is the way in which the court made its decision. Despite the fact that this is a matter of concern to a wide range of groups in society, the court made its decision without hearing from any of these. Even the parties directly involved in the case did not have an opportunity to make an informed comment on this issue. The Court refused to adjourn so that researched presentations could be shared on the matter of physician responsibility. Once again important decisions that have a bearing upon us are being made without any input from our community.

The Court decision is already being felt in Manitoba. The Public Trustee is responsible for consent to treatment for people for whom an Order of Supervision has been issued, appointing the Public Trustee as committee. As a result of the decision in the Lavallee case, the Public Trustee will not consider the issue of whether or not a "Do Not Resuscitate" should be placed on the chart of someone with an Order of Supervision. Irene Hamilton, Public Trustee for the Province of Manitoba, informed the Health Science Centre Executive Director of this decision in December of 1997. Orders of Supervision are usually applied to individuals who are considered unable to make legally binding decisions. Consequently, some of Manitoba's most vulnerable people will have no one giving a sober second thought as to whether a DNR is appropriate given the medical circumstances.

Much to our shock and horror, people with disabilities find that medical personnel sometimes are all too willing to give up on us, even when we are not in terminal situations. Negative stereotypes about disability make some medical personnel assume that our lives are so wretched that we would not want to continue. Rather than offering us treatment for common ailments like pneumonia, they offer to make us comfortable so we can have an easy death. Indeed, this happened to a Manitoban activist within the disability community. With such stereotypes at work, it seems that the vulnerable within our community may be even at greater risk with the result of the Lavallee decision. The Manitoba League is continuing to monitor this situation.

MP Clifford Lincoln Speaks Out Against Euthanasia

Member of Parliament, Clifford Lincoln spoke out against euthanasia in the House of Commons on 2 February 1998 during debate on Svend Robinson's motion on assisted suicide. Mr. Lincoln's comments were prompted by concern for Peter, his 31 year old son who has Down's Syndrome.

According to the Globe and Mail, "[Mr. Lincoln] said he chose to speak about Peter because he is worried what the impact of laws legalizing euthanasia would be on people who cannot speak for themselves." According to Mr. Lincoln, Peter Lincoln "cannot hear, almost not speak and lately his kidneys collapsed."

Reform M.P. Ken Epp also spoke out against Mr. Robinson's motion. Mr. Epp spoke about his sister Marion, 53,: "She lives in an extended care centre because she was born with cerebral palsy. She cannot speak. She never has. She cannot look after herself. She cannot dress herself. She needs help eating....Somehow many have come to the conclusion that it would be better for people like her to die. That is a false assumption."

Mr. Robinson charged that M.P.s were misrepresenting his intentions. Dismissing the concerns of the community of persons with disabilities seems to be a common tactic of pro-euthanasia forces. David Martin, Provincial Coordinator of the Manitoba League of Persons with Disabilities, countered this tactic in the Winnipeg Free Press commenting, "I urge...academics to recognize that the disability community has a legitimate right to fear that a slippery slope to publicly sanctioned euthanasia has started to emerge in the Canadian body politic."