Who decides when it is time to say goodbye?

The online series A Good Death is a CBC News co-production with students from the Graduate Program in Journalism at Western . | MORE

When it comes to dying, modern medicine is both friend and foe.

For some families, keeping their loved one alive through medical technology is nothing short of a miracle.

But for many doctors, such interventions can unnecessarily prolong dying and suffering. According to Prof. Arthur Schafer, director of the Centre for Professional Applied Ethics at the University of Manitoba, keeping a dying patient alive indefinitely, can violate a doctors ethical duty to minimize harm, both to the patient under their care, and to other patients by potentially depriving them of scarce resources they need.

He explained that "If physicians knew that once they initiated life-support it could never be discontinued, theyd be much more reluctant to initiate and it would be a bad thing for everyone; it would be bad medicine as well as bad ethics."

But figuring out who gets to decide when families and doctors disagree about when to pull the plug is not so straightforward in Canada.

The 1992 Quebec Court of Appeal case of Nancy B. established that doctors could not be accused of homicide if they discontinued life-support. But the final word on who makes the final decision is yet to be decided by the courts.

As it currently stands, each province has its own rules when it comes to resolving end-of-life disputes between doctors and families. And so does each provinces College of Physicians and Surgeons.

For example, the Ontario Health Care Consent Act states that a family member can make treatment decisions based on the patients beliefs and values ifhe or sheis unable to do so themselves. At the same time, the guidelines of Ontario's College of Physicians and Surgeons allow doctors to discontinue treatment if they consider it to be futile.

"To use the language of futility will be a red flag to some people who get very animated and very skeptical and suspicious of the use of futility reasoning," says Bernard Dickens, Professor Emeritus at the medical facultyand the Joint Centre for Bioethics at the University of Toronto. "But the fact remains that there are objective criteria; there are reliable prognoses."

But what if doctors are wrong?

Not everyone feels doctors can be trusted to diagnose correctly, all the time. The case of Zongwu Jin, a Calgary-man who sustained a head injury, fell into a coma and recovered after doctors issued a do-not -resuscitate order, demonstrates the fallibility of medical decisions made in end-of-life situations, says Winnipeg lawyer, Neil Kravetsky.

Kravetsky represented the family of Samuel Golubchuk, an Orthodox Jew whose family refused to consent to doctors requests to discontinue life-support, saying ending treatment went against Golubchuks religious beliefs and was tantamount to murder. Golubchuk died less than three months before his case went to trial.

It rarely ever happens that a person isdeclared to beat the end-of-life and does a full recovery, but even Schafer admits that "doctors do get it wrong sometimes" such as when a patients heart stops in a case of hypothermia, and doctors may think the person is dead although they can be resuscitated.

Both Schafer and Dickens say the best insurance is getting a second medical opinion an option many families choose after doctors determine the patients brain stem is maintaining ordinary mechanical processes such as breathing, but the upper brain that identifies intelligence and cognition isnt functioning anymore.

In the Golubchuk case, Kravetsky argued that removing someone from life-support goes against one of the fundamental guarantees of the Charter of Rights and Freedoms: the right to life, liberty and security of person.

The rights of the patient under the charter are not however, absolute, says Dickens. The charter, he explains, does not apply to the doctor-patient relationship although the hospital, as an agent of the state, is bound by it.

Having a single rule across the country with clear directives for doctors that give them the final say may resolve the tug-of-war over when to pull the plug, but dont look to politicians to find closure, says health-care lawyer Mark Handelman, currently representing Desmond Watson and Baby Joseph Maraachlis former legal counsel.

"It is possible that eventually a case goes to the Supreme Court of Canada or somebody says Wait a minute, there has to be a time at which values and beliefs are simply trumped by objective medical evidence."

With an aging population, the decision of who gets to pull the plug may be one of the most important and divisive issues we face as Canadians.

"This battle will put the abortion debate to shame," said Handelman. "It will make it look like a garden party."