By Wesley J. Smith

Editor's note. The following is a lengthy excerpt from an entry on Wesley's superior blog (www.firstthings.com/blogs/secondhandsmoke/2010/10/26/canadian-doctors-refuse-cancer-patient-request-to-be-rescusitated) followed by brief comments from me.

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Wesley J. Smith

Should a dying cancer patient's request to have CPR at the end of his disease process be honored by doctors, or if they think it is inappropriate, should they be able to unilaterally refuse resuscitation? That is the question posed in a Canadian lawsuit in which a cancer patient clearly and specifically asked for CPR. From the story (http://www.thestar.com/news/article/880422--family-doctors-battle-over-do-not-resuscitate-order):

As Mann Kee Li lies in hospital fighting dire prospects, his family is engaged in a life-or-death struggle, not with the cancer spreading through his body, but with the doctors treating it. Li, a 46-year-old Toronto accountant and father of two young boys, wants doctors to use all medical measures possible to save him in the event of a life-threatening emergency. He made those intentions clear to his doctors at Sunnybrook Health Sciences Centre when he entered the hospital in August. He wrote it in a power of attorney document and confirmed it in a videotape statement, his lawyers say. While his doctor initially agreed to respect those wishes, physicians unilaterally reversed the decision a week ago without consultation and imposed a "do not resuscitate" order, his family alleges.

The doctors say the decision should be up to them:

The hospital and its doctors, meanwhile, argue the ultimate decision on whether to resuscitate a patient rests on physician judgment rather than patient wishes. "When clinical teams determine that further interventions would have no benefit to the patient . . . ethically and legally, health-care providers are not obliged to provide interventions that lie outside the standard of care and would be of no benefit, and indeed may well cause harm to a patient," said Sunnybrook executive vice-president Dr. Keith Rose in a written statement. Li's two treating doctors -- Robert Fowler and Cameron Guest -- declined an interview request. But their lawyer, Harry Underwood, told a court Friday that any order compelling doctors to administer CPR to Li would be "unconscionable." "He should be allowed to die in peace without this gross and monstrous intervention.

But the "monstrous intervention" is precisely what Li wanted. In other words, the doctors aren't just refusing to abide by the family's desires–but what the patient clearly and explicitly stated he wanted:

On Aug. 12, Toronto lawyer Mark Handelman interviewed Mann Kee Li for the purpose of preparing a power of attorney document detailing Li's wishes for care in hospital. Handelman videotaped the interview.

Here is a partial transcript included in Handelman's affidavit submitted in court:

(In referring to our afternoon meeting) "Are you aware that you told me that you wished to have all things done to continue your life?" Mann Kee nods affirmatively in response.

"Are you aware that you may no longer be able to make decisions, that you could lapse into a coma, never to regain consciousness?" Mann Kee nods affirmatively in response.

"In those circumstances would it still be your wish to have your life continued?" Mann Kee nods affirmatively in response.

"For as long as possible?" Mann Kee nods affirmatively in response.

"Are you aware some of the measures to continue your life could be painful to you?" Mann Kee nods affirmatively in response.

"For example, if your heart stops and doctors need to perform cardiopulmonary resuscitation they may have to pound on your chest?" Mann Kee nods affirmatively in response.

"That could break some of your ribs?" Mann Kee nods affirmatively in response.

"And that a broken rib could puncture a lung?" Mann Kee nods affirmatively in response.

"Do you want them to do that if necessary?" Mann Kee nods affirmatively in response.

"Even if you will never regain consciousness?" Mann Kee nods affirmatively in response.

While Li's desires certainly would not be mine, he clearly made an informed decision about what he wanted. We used to be told that such choices are sacrosanct. But then when people decided to fight to the bitter end for life, we learned that "choice" only applies if the decision is to stop treatment, not if it is wanted. In other words, choice can be a one way street toward death. ….

#1. There is absolutely no doubt--no confusion, no "he said, she said"--about Mr. Li's intentions. There is also no doubt or confusion about what the family alleges the doctors did--"physicians unilaterally reversed the decision a week ago without consultation and imposed a 'do not resuscitate' order," according to the story written by Robert Cribb of the Star.com.

"This is the second end-of-life case involving a Sunnybrook patient to reach the courts in the past month."

And #2. As Wesley Smith notes, other patients might make a different decision, especially when terminally ill. But the entire underpinning of several decades' worth of court cases (in instances where the patient's wishes were unknown) was that it WAS okay to stop treatment because that is "what the patient would have wanted."

There is no uncertainty here what the patient--Mr. Li--said he wanted. But if what he said he wanted doesn't square what the hospital wants to do, "any order compelling doctors to administer CPR to Li would be" (in the words of the hospital's attorney) "unconscionable."