Manitoba doctors have been handed new rules governing how they decide to pull patients off life support, but a lawyer fighting one such decision calls the rules hypocritical.The 15-page statement unveiled Wednesday by the College of Physicians and Surgeons of Manitoba is believed to mark the first time a Canadian body has spelled out step-by-step procedures for doctors to follow.

Doctors can consider ending life-sustaining treatment if a patient has no realistic expectation of achieving self-awareness, awareness of his environment and the ability to experience his existence, the guidelines say.

Family members must be consulted if the patient is unable to communicate. If the family insists that treatment continue, the doctor must try to consult another physician and keep the family abreast of developments.

In the end, however, the doctor can make the final decision without the family’s support, as long as he gives them 96 hours advance notice of when treatment will end.

“It’s no different to what the courts have directed, which is basically that physicians have the authority to withhold or withdraw life-sustaining treatment as they feel clinically appropriate,” said Dr. Bill Pope, head of the college.

“But it makes it clear. It also requires that physicians involve patients and patients’ families where appropriate.”

The written policy was quickly criticized by a lawyer embroiled in a life-support case as giving too much power to doctors.

“There is hypocrisy throughout the paper,” said Neil Kravetsky. “The paper says you must make all efforts to communicate with the patient and it’s very important what the patient has to say … but if they don’t agree with you, do what you want.”

Kravetsky represents the family of Samuel Golubchuk, an 84-year-old man who is on life support at a Winnipeg hospital.

Doctors say Golubchuk has minimal brain function and they want to remove his ventilator and feeding tube. But Golubchuk’s family has asked a Court of Queen’s Bench judge to quash the decision, arguing it would be an offence to Golubchuk’s religious views as an Orthodox Jew.

A similar battle played out in Calgary last year, where the family of Zongwu Jin sought a court order to force hospital officials to keep treating the 66-year-old man after he suffered a brain injury. Jin eventually started recovering and performing exercises aimed at helping him walk again.

The Canadian Medical Association Journal has called for a national discussion on when and how doctors should withhold treatment from patients. A medical ethics expert said doctors in other jurisdictions may want to look at Manitoba’s new policy.

“What this does is it gives (physicians) guidelines for what professional ethics requires of them,” said Prof. Arthur Schafer, director of the Centre for Professional and Applied Ethics at the University of Manitoba.

“I don’t think it’s a departure from common sense … and I think it is how most physicians would have behaved up until now, but there haven’t been any guidelines.”

Patients’ families still have the ability to seek a court order if they disagree with the doctor, Schafer said, and courts will look at the case on a legal basis instead of an ethical one.

The college said the new guidelines will help make patients and their families more aware of their right to be consulted, and help ensure all doctors are following similar procedures. http://canadianpress.google.com/article/ALeqM5iM2fgKbVM_ATJU3jUuRNu6IhkEhA