Executive Summary

The intent of the "Do Not Resuscitate (DNR) Orders and Persons with Disabilities" project was to create a research paper that explored the many aspects involved in the complicated process of discerning the appropriateness of placing DNR Orders on persons in Manitoba. Particularly emphasized is the threat perceived by many persons with disabilities regarding the value of their lives, and the vulnerability they feel with the law in Manitoba pertaining to the placement of practices of DNR Orders as it stands now. The project objective included developing an understanding within the disability community in Manitoba of the legal, ethical and medical issues surrounding DNR Orders. It also involved developing an understanding within the medical community of the concerns of people with disabilities regarding DNR Orders. At the conclusion of the project these findings are presented to various voices representing Manitobans. These include:

	persons from the medical and medical ethics sectors;
	representatives from the various Regional Health Authorities (RHA's);
	persons involved in the legal aspects of DNR Order application; and,
	persons with disabilities who might be affected by and governance concerning DNR Orders and their applications.

Further research into the legal dimensions of DNR Order placement was conducted by Sherri Walsh, L.L.B., and is included separately as a part of this report.

The first chapter of this document contains a glossary of terms to help the reader navigate the sometimes difficult language associated with end-of-life issues. There is also a review of the history of DNR Order placments, the developments of various understandings regarding DNR Orders, and issues connected with these understandings. This includes a description of precedent settings legal cases, including those which occurred in Manitoba, namely Lavallee v. CFS Manitoba and Sawatzky v. Riverview Health Centre.

Other related cases across Canada are also reviewed.

Various cultural understandings of end-of-life issues are explored in the second chapter. Included in this section is the description of the first assisted suicide case brought to a Canadian court involving an Inuit community in 1963.

The lessons learned in exploring these cultural understandings provide a setting to examine the current context in which DNR Order applications exist. The third chapter looks at current discussions held by ethicists pertaining to DNR Orders. It also examines the positions taken by the Manitoba League of Persons with Disabilities, the Manitoba Medical Association, the College of Physicians and Surgeons, Manitoba Health and the law as it stands at the time this paper was written. Included in this section are the results of a survey of Manitoba physicians charting their opinions regarding such end-of-life issues as euthanasia and assisted suicide. This chapter also contains the results of a questionnaire sent to each Regional Health Authority in Manitoba and rural and urban hospitals, long-term care facilities, and health centres across the province. Following this is a summary of the Final Report of the Standing Senate Committee led by the Honourable Sharon Carstairs entitled, "Quality End-of-Life Care and the Right of Every Canadian." The chpater concludes with discussions on what constitutes "quality of life," including a description of material written by Frangoise Baylis, Dick Sobsey, and a strong story of two physicians who underwent considerable transformations in their understandings of what "quality of life" meant to them.

The fourth chapter emphasizes the importance of hearing the voices of persons with disabilities in any discussion regarding DNR Order policies, DNR Order placements, and understandings of what constitutes "quality of life." Current statistics regarding the representation of Manitobans with disabilities in various health policy decision-making bodies were gathered for this project and are reported in this chapter. Also found here are several written articles describing the perspectives of persons with disabilities and accounts of the experiences of Manitobans with disabilities encountering Do Not Resuscitate Orders.

This paper concludes with recommendations for future actions. These recommendations have been divided into two sections: the first being recommendations for actions on the part of individuals so that persons can be as prepared as possible for any encounter with a DNR Order placement; and the second section being recommendations which encourage policy making bodies such as the various structures of government and medical institutions, to re-examine the issues involved with DNR Orders, their placements, and the implications they have for all citizens of Manitoba.

The development of a protocol regarding the placement of DNR Orders using the knowledge gained from multiple sources, including the grassroots Manitoba citizenry provides an opportunity for those most likely affected by this practice will help answer the most basic of queries, namely - WHO FITS THE CATEGORY OF HAVING A LIFE UNFIT FOR LIFE?





Our Last Rights - Contents