It’s not practical and it might be illegal but it may be desirable. It’s safe to say there’s a quintessentially Canadian divergence of views when it comes to elective ventilation but it was ever thus when it comes to matters of organ transplantation policy. Little surprise then that the notion of improving organ donation rates by allowing people with severe brain injuries and hopeless prognoses to be placed on ventilators until they suffer brain death isn’t on the Canadian table. The topic hasn’t been broached and the time hasn’t come to even contemplate such a proposition, argues Dr. Sam Shemie, a physician in the Division of Pediatric Critical Care at Montreal Children’s Hospital in Quebec and Canadian Blood Services medical director for organs and tissues donation. Although Canadian organ donation rates are “mediocre at best,” far more rudimentary approaches to resolving the shortfall must be undertaken before even contemplating such “ethically controversial and difficult issues,” S
For some, it comes down to a matter of consent. For others, it’s standard practice or at the very least, one that needs to be more widely adopted to expand the tiny pool of organs now available for transplantation. And for still others, it’s a matter of weighing what’s in a patient’s best interest. Such are the thorny ethical issues surrounding the notion of elective ventilation, the practice of placing comatose patients who are near death on mechanical ventilation until they’re brain dead and their organs can be recovered. The great risk, albeit small, to the patient, is that he might not progress to brain stem death as expected, potentially leaving him in a persistent vegetative state − wherein he is able to breathe on his own but has no evidence of higher-brain activity − or a similar condition. Much of the debate surrounding the ethics of elective ventilation stems from “confusion over what is considered to be in the best interest of the patient,” says Eike-Henner Kluge, professor