The Manitoba Futility Guidelines

Many have been commenting on the Manitoba futility guidelines released two weeks ago. I'll quickly mention just one from this weekend.

Harold Buchwald was the former chair of the ethics committee at the Winnipeg Regional Hospital Authority. But his piece in yesterday's Winnipeg Free Press seems more than a little naive. He writes:

[T]he wishes of the family should prevail. The new end-of-life guidelines released Jan. 30 by the College of Physicians and Surgeons of Manitoba do not alter this fundamental principle. . . .

[T]he guidelines inferentially recognize that in the event of a continuing disagreement between the physician and the patient's family, the ultimate decision still rests with the family.

Buchwald seems to base this conclusion on two aspects of the Guidelines: (1) the 96-hour notice requirement and (2) the requirement to attempt a transfer. But these provisions actually support the opposite proposition: that, in intractable conflicts, the ultimate decision rests with the providers. The 96-hour notice is notice that LSMT will be unilaterally withdrawn. While Buchwald correctly notes the family may seek an injunction, that just highlights that the default position is that the providers can and will act unilaterally. Moreover, even if the family has the resources to get to court, providers will argue that the court should defer to the Guidelines and deny the injunction. The transfer obligation is similarly illusory since when, as is usual, not transfer can be found, providers may proceed to unilaterally stop LSMT.