Dialogue needed on end-of-life care

Re Sunnybrook case raises question of who

decides life support, Sept. 28 As a practising physician at another major teaching hospital, I read Robert Cribb’s article with interest, as end-of-life decision making is something patients, families and health-care providers deal with on a daily basis. It is worth pointing out that we are able to come to a patient-centred consensus on the most appropriate philosophy of care in the vast majority of cases, and that the types of situations presented in this article are very much the minority. That said, many health-care providers find ourselves in situations where we feel bound to perform procedures at the request of patients’ family members that are clearly unlikely to benefit the patient. I have personally broken the ribs of a patient while performing CPR in a situation where the consensus of the health-care team was that this intervention was futile. That patient’s family disagreed despite our best efforts to educate them on the reality of the situation. In my opinion, we did this patient no favour by performing this invasive procedure with essentially no hope of a favourable outcome, and many years and thousands of patients lat- er, this continues to be the most disturbing experience I have had as a physician.

I am certainly not alone in having had this type of experience. Canadian society needs to engage in a dialogue over how, where, with what technological intensity, and at what cost to our public health-care system will our aging population spend their last days? If this patient’s situation and the health-care team’s response to it leads to this type of much-needed public dialogue, some good will have come from this highly unfortunate man’s story. David Frost, Toronto