Review of Historical Precedents, Past Practices, and Analysis of Social Environments

I came into this world
without my consent
and left in the same manner.
- from a grave in
Chattanooga, TN

“Who should make life and death decisions about the terminally ill?” was a question posed by Rex Murphy, host of the nationwide phone-in radio show “Cross Country Checkup,” a part of the programming of the Canadian Broadcasting Corporation.^[12] Murphy introduced the topic of DNR Order placement practices in Canada by quoting Hamlet’s soliloquy, “to be or not to be, that is the question.”

Canadians voiced many opinions during that broadcast. It was noted that our life expectancy as a nation has increased by two decades for both women and men within the last century. In one generation, our understanding of death has been transformed by medical advances. Several persons commented on the role late twentieth century western medicine has played in expanding the arch under which the issues of life and death are discussed. Repeatedly, different listeners who joined in the discussion emphasized how medical science has protracted life. The borders between physical survival and clinical death are, in the words of Murphy, “extremely nuanced.”

It is important to take12 note of the historical events which have shaped the thinking and the actions of Canadians and brought these kinds of concerns into public awareness and discussion. The following chapter will provide an overview of historical decisions, legal precedents, medical practices, and various cultural understandings of illness, dying and assisted death in order for us to better understand the social environment from which much of our contemporary discussion springs.

Many Manitobans with disabilities have become increasingly concerned since the Manitoba Court of Appeal decided in December of 1997 that consent was not required in order for a physician to issue a non-resuscitation order for a patient. There were many extenuating circumstances which brought about this judgement, but the decision has continued to be of great concern because of its precedence.

The position of the MLPD and the Council of Canadians with Disabilities (CCD) regarding this issue is as follows:

Our members and Provincial Council have the belief that patients (or their substitute decision makers) need to have some control over when and how DNR Orders are put on their files. [13]

Self-determination, a concept which is integral to the basics of living independently and the impetus for the existence of the disability movement as a whole, is threatened at the most fundamental level by a decision such as the one which occurred in 1997.

A description and analysis of legal decisions concerning DNR Orders provides ways for us to understand the complexities of the legal aspects of this issue. This is done in greater detail in a legal study written by Sherri Walsh which serves as an attachment to this paper, but a brief sketch of some of the historical cases that have impact on legal decisions today are included here.

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12	CBC Radio. November 15, 1998.
13	David Martin, "Self Determination Threatened by DNR Orders," CCD Latimer Watch. Winnipeg: Council of Canadians with Disabilities, 23 December, 1998.

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