The case of a Winnipeg family going to court to keep their 84 year old father alive should serve as a warning across Canada of things to come. The family has been successful in obtaining a court injunction to prevent the hospital and staff involved from withdrawing life support.

According to a variety of newspaper reports, the withdrawal of such care violates the family’s orthodox Jewish faith. The 84 year old patient is said to have limited brain function, can’t walk or eat and breathes with the help of a respirator. According to a Globe and Mail article from December 13 doctors say that barring divine intervention, the patient is unlikely to recover.

In another similar case reported recently in the media, a patient with a head injury was not expected to recover and his family was told that limited intervention should be the appropriate and ethical route to take. The family insisted that he receive advanced care and the patient recovered to the point of sitting up, talking and eating. The family took him home.

Nobody has a crystal ball and it seems to me that religious belief must be respected to some degree. {styleboxop width=300px,float=left,color=olive,textcolor=black,echo=yes}Different patients and their families will have varying attachment to the concept of divine intervention.{/styleboxop} After all, isn’t that what many religions propose – that there is a divine entity that can confer divine intervention?

There are many cases where the patient surprises everyone, including medical and nursing staff, by living much longer than expected with their cancer or other disease, in some cases for years instead of months, or where the patient makes an amazing recovery when death was anticipated. It happens. But who is to say in which cases with absolute certainty? It also happens that some patients expected to do well and survive do not.

People are not widgets with warranties and guarantees. Patients and their families have spiritual and emotional needs that should be respected, understood and accommodated.

In a Utopian health care system with unlimited resources and unlimited capacity this case would not be an issue. However, such a system does not exist and resources must be used in the most effective way.

It has been suggested that this case could set an important precedent. Anyone involved in the provision of care will understand that it will have an impact on how care is delivered.

Whose life is worth saving? Who should determine this and how?

If public resources are refused for “futile” care as defined by the system but not by the family or the patient, should the family have any other recourse for funding care?

If hospitals and staff are required to follow the family’s wishes in the cases of “futile” care, will there be less impetus to begin treatment in similar situations in the first place?

The issues surrounding end-of-life care and long term chronic care are not going away. In the next few decades the complexity of medical care will increase along with the associated complexity of ethical decision making.

Finding a solution that respects individual and family needs and religious beliefs as much as it respects public responsibility will be difficult but necessary.