CONCLUSION

Phil Bereano, a member of the National Board of the American Civil Liberties Union, talks about the progression beyond an analysis of rights as “atomized individualism.” Human rights are social rights, creating the texture of a desirable society which recognizes that the diminution of “someone else’s” rights actually diminishes the rights of every member of that society. ^[84]

This recognition is echoed by many Canadians who are gravely concerned about what happens to the rights of individuals when faced with decisions concerning life and death. Persons with disabilities face a myriad of social stigma. It is not easy for mainstream society to understand that “disability” is not merely a medical condition, but also a consequence of societal prejudice, exclusion and environmental structures. The fundamental values Canadians have endorsed through the Charter of Rights and Freedoms declare we believe in the security of the person, and that all citizens have equal benefit and protection under the law. The circumstances under which we are (or are not) protected reflect who we are as a society.

It is for this reason that the Manitoba League of Persons with Disabilities has undertaken the task to create this report on DNR Order placement and practices and the implications they have on persons with disabilities. The objective of bringing this information to light is to create a starting point for discussion between members of the health care, legal, policy-making, and disabled communities which will facilitate the development of a province wide policy regarding DNR Orders. This policy should reflect the equal rights of all Manitoba citizens to access the health care needed to sustain meaningful life - as determined by those who act in the best interest of the patient.

RECOMMENDATIONS FOR FURTHER ACTION

Recommendations drawn from the research for this report are as follows:

For Individuals

3.	Advance Health Care Directives - creating a “living will” or advance directive, although not absolutely and certainly in all cases, does provide physicians and surrogate decision makers with indicators as to the direction a patient would want his/her health care to occur, should the patient be unable to express this. An advance health care directive takes considerable pressure off the surrogates and physicians who would otherwise have to “guess” what the patient’s wishes would be.
4.	Prior Knowledge of Hospital/Health Care Facility Policy - provides information which may be critical as a patient considers which institution will be optimal in terms of receiving the kind of care desired. Discussions with personal physicians could include making this information known so if a sudden hospitalization is required, this preference is considered.
5.	Awareness of the Devaluing of Persons with Disabilities - there is a devalued social role of persons with disabilities, and it is important to recognize how this attitude has permeated institutions and decision-making bodies. Persons with disabilities should be vigilant in their expectations of equal care, and be aware of their rights as citizens to expect appropriate medical care.
6.	Awareness of A Full Range of Options - persons with disabilities are often not informed of the services and options available to them. Living a healthy, productive life within the community is achievable even for persons with severe physical limitations. Limited knowledge of these options and restrained staff hours often prevents health care providers from being able to give persons who are undergoing considerable lifestyle changes. An example of this is the predilection to paint being dependent on a respirator as a very grim existence. Another example is the view that if one requires considerable personal care this means living in an institution. Speaking with organizations that advocate for persons with disabilities might provide considerably more information in terms of options.

For the Community

1.	Development of a Uniform Province Wide Policy that Advocates Patient/Surrogate Knowledge and Consent Prior to DNR Order Placement. The individual’s wishes would govern the course of treatment. This would be reviewed regularly and would involve broad public discussion.
2.	Representation of Persons with Disabilities on Ethics Boards or other Bodies that Make Ethical Decisions Regarding Medical Treatment.
3.	Development of Nation Wide Template for Advance Health Care Directives to ensure consistency from one health care institution to another and from province to province.

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84	This was stated by Bereano as a response to a discussion re: the CRG's Genetic Bill Or Rights. Bioethics Listserv. Bioethics@onelist.com. March 30, 2000.

Our Last Rights - Contents