Scope and Outline of the Project

The Manitoba League of Persons with Disabilities (MLPD) was approached in the fall of 1998 with a request for support by Helene Sawatzky, who’s husband Andrew was a resident of the Riverview Health Centre in Winnipeg. This need for support arose because the Sawatzky’s were deeply concerned about a “Do Not Resuscitate” (DNR) Order which had been placed on Mr. Sawatzky’s medical chart. This placement had occurred without the medical staff obtaining consent from either Andrew or Helene Sawatzky. They had to take the issue to court in order to have the DNR Order removed. The MLPD was sought out by them to assist as an advocate on behalf of this individual’s rights; in doing so, the League played a role as intervener in the subsequent court case in support of the Sawatzky’s.

This particular involvement served as an impetus for a research project conducted by the MLPD which examines the questions and issues arising out of this situation. The project objectives include the development of an understanding within the disability community in Manitoba of the legal, ethical and medical issues surrounding DNR Orders. It also involves developing an understanding within the medical community of the concerns of people with disabilities regarding DNR Orders. The project will conclude by bringing together various voices representing Manitobans - these would 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 any governance concerning DNR Orders and their applications.

The objective of this gathering is to put forward a model protocol that would address the concerns surrounding the placement and removal of DNR Orders. Creating a “starting point” (such as a model protocol) for discussion regarding this sensitive and complicated topic could then be used for discussion purposes within the larger community. 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 to influence decisions made in answering a very basic query - namely, WHO FITS THE CATEGORY OF HAVING A LIFE UNFIT FOR LIFE?

Research for this project was conducted as follows:

	the Chief Executive Officers and Chief Medical Officers of hospitals in Thompson, Flin Flon, The Pas, Dauphin, Brandon, Winkler, Beausejour and all hospitals in the Winnipeg area were contacted with a request to provide information regarding the practices they currently employ in their administration of DNR Orders, and the level of representation of persons with disabilities presently existing in those decision making bodies (i.e. ethics committees, policy making boards) which deal with the placement of DNR Orders.
	the Chief Executive Officers and Chief Medical Officers of all the Regional Health Authorities (RHA’s) and Long Term Care Authorities throughout the province of Manitoba were contacted with a request to provide information regarding any protocols they have/have not established regarding the administration of DNR Orders in their catchment areas, and the level of representation of persons with disabilities presently existing in any decision making or feedback advisory bodies which deal with the placement of DNR Orders.
	examination of Manitoba government legislation and the Ministry of Health policies and responsibilities, as they pertain to the role of the Public Trustee and the Primary Care Mandate regarding DNR Orders.
	examination of such documents within Canadian legislation as:
	the Special Senate Committee Report on Euthanasia/Assisted Suicide,   the Canadian Charter of Rights and Freedoms, and   the Canada Health Act.
	an overview of legal materials and Canadian judgements pertaining to disability rights, patients’ rights, quality of life issues, euthanasia, assisted suicide, and unlawful death of vulnerable persons.
	a review of international decisions involving disability rights, patients’ rights, and DNR Orders.
	obtaining the perspectives of members of the ethics and medical ethics community regarding current practices and possible future placement protocols for DNR Orders.
	an exploration of methods of establishing and implementing Living Wills and Advance Directives as they pertain to disability and patients’ rights.
	interviews with individuals who have been directly affected by the placement of DNR Orders either on themselves or members of their families.
	the gathering of various disability perspectives on DNR Order experiences, quality of life judgements, and issues pertaining to assisted suicide and euthanasia.

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





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