The Manitoba Medical Association says that when physicians disagree with patients and relatives about whether to withdraw treatment from the terminally ill, the doctor’s opinion should be final.

The Manitoba Law Reform Commission is currently looking at how to handle such cases, to ensure a right to life-sustaining treatment. The commission comes on the heels of several high-profile cases in recent years, in which families complained bitterly about loved ones being taken off life support.

In 2001, the family of Rudy Bachewich had a Winnipeg Free Press reporter present to witness his death, as the terminally ill man gasped for air when he was taken off life support at Grace General Hospital. The ordeal lasted two hours and the family said that the decision to end support was not theirs. In 1998, Helene Sawatsky took the Riverview Health Centre and its doctors to court to have a do-not-resuscitate order lifted from her ailing husband. She lost the case.

In its submission to the commission, the MMA said, “Physicians are under no obligation to provide treatments they believe to be futile.” While acknowledging that the status quo often leads to acrimonious battles between family members and healthcare professionals, the MMA suggested “formulating a formal dispute-resolution process,” but reiterated (contradictorily so) that the final decision should remain in the hands of doctors.

The MMA added that the cost of healthcare should be considered when making such decisions. Economics is “relevant,” the association claims, because of the high cost of medical treatment and “the limitations of the public purse.” It added that, “In general, we would support the principle that resource allocation decisions be made at the level of social policy rather than at the patient’s bedside.”

Alex Schadenberg, executive director of the Euthanasia Prevention Coalition, told The Interim that the fear is not that patients and their families will demand excessive care, but that doctors will use a combination of paternalism – a view that the doctor knows best – and economics to deprive terminally ill patients of medical care, which increasingly includes the denial of nutrition and hydration.

Schadenberg said that there are few “situations where families demand more care than is reasonable and is, in fact, burdensome,” but added that “our system can deal with that.” The problem, he said, is of going too far the other way and not providing care that is needed.

“The question is: how do you protect those in our society are vulnerable? These people – the elderly, the lonely, the disabled – will be considered dispensable.”