WHO DECIDES ON LIFE OR DEATH?

Eighty-four year-old Samuel Golubchuck has suffered a brain injury, can’t walk, speak or eat on his own, needs a ventilator to breathe and is retaining 10 times the water of a normal intensive-care patient and his skin is swollen to the point of bursting.

Doctors at the Winnipeg hospital say that, barring divine intervention, it’s only a matter of time before he dies, and after four weeks in intensive care with no improvement, they want to remove the breathing apparatus keeping him alive.

His son and daughter say that constitutes assault equivalent to murder and is a violation of their Orthodox Jewish religious beliefs.

On the other hand, the physicians concluded the patient was not benefiting from treatment, they followed all the medical and ethical guidelines and came to a conclusion to end treatment based on their judgment and expertise.

The lawyer representing the hospital argued in court that patients do not have the right to demand treatment, nor do they have the right to demand the continuation of treatment.

Now the court has granted a temporary injunction to keep Mr. Golubchuck on life support. The judge requires more time to make his decision.

What should that decision be?

Does the immediate family have the right to continue life support for their father?

Or do the doctors and the hospital have the right to hasten his death?

15 Comments »

  1. 1
    Paul Costopoulos Says:

    One doctor said that they were not prolonging his life but they were prolonging his death. From the report in the newspapers and on the Globe and Mail web site I gather the man is “technically” already dead.
    The wife and I have settled this question for our survivors. In our will and in the power of attorney documents that we have signed, just in case, we clearly state that we do not want extreme measures to be taken if bad comes to worse and we are severely incapacitated. Just leave nature follow it’s course. No therapeuthic harrassment.

  2. 2
    Joe Agnost Says:

    If the family is going to pay to keep him alive – and if the bed isn’t needed for another patient (who actually has hope) – then I don’t see the problem with keeping him alive.

    But if taxpayers are footing the bill, or the bed is needed for another patient then I think the hospital has the right to stop treating him.

  3. 3

    Paul:

    But who decides what measures are extreme?

    Joe:

    You suggest that whether this man lives or dies dpends on whether another person needs the bed. I can’t imagine the man’s family agreeing to that proposition.

  4. 4
    Chimera Says:

    I don’t have enough information on this case, and there is nothing I can find on the ‘net by searching his name. So…I have a few questions.

    Is Samuel Golubchuck brain-dead? If so, then legally, he is dead, and the machines are simply keeping a reluctant body from decomposing immediately.

    Ten times more fluid than normal? Did I read that correctly? If he is that edemic, then he is literally drowning in his own juices. Give the man some peace, already!

    I would like to see chapter and verse on those Orthodox Jewish religious beliefs that say removing the life support system would be murder. And I also want them to listen to those orthodox Jews who believe they are simply thwarting God’s will by not allowing Samuel to die in the time God alloted him. When did orthodox Judaism take ownership of medical technology?

    If, in spite of medical knowledge to the contrary, the family still thinks papa is likely to recover, then let them move him to a private facility and pay for it themselves. The issue of taxpayers footing the bill for a hopeless case is a very real one. And to anyone who thinks it’s scandalous to indulge in such an argument needs to ask himself only one question:

    “Would I be willing to give up my chance at a needed hospital bed in order to accomodate the wishes of Samuel’s family?”

  5. 5

    Chimera:

    The doctors say the patient in question is brain dead.

    As for the family, I assume they believe in the religious beliefs they are expressing.

  6. 6
    Paul Costopoulos Says:

    Neil,
    I guess Samuel’s case is a good example of extreme measures. When a person can not breath by him or herself for several weeks, that her/his brain is dead and she/he has no hope, short of a miracle, of regaining vital signs, this is extreme measures. I have known a few cases who, when disconnected survived several days, even weeks, some patients are in a vegetative state for many years before the end. Of course I would not kill off those people just to free up a bed. But when the body and mind are already dead and only machines keep the body from decomposition, as Chimera says, then yes, by all means, in the name of decency, unhook the poor soul and let him go, whatever your religion. God is not that cruel.

  7. 7
    Chimera Says:

    Neil, anyone is entitled to say they believe in anything they want. This particular family is laying the basis for their belief at the door of Orthodox Judaism. I just wanted to know if that is correct…does orthodox Judaism actually state that the medical and legal standard of brain death does not equal death, and that someone’s body must be kept artificially alive by machines until the machines fail, too?

    I’m not out to change the religious definition of death. I don’t think the courts have any more business in religious definitions that religion has in the courts. I’d just like to have it clarified.

  8. 8

    WHO DEICIDES?

  9. 9
    neurologist Says:

    “The doctors say the patient in question is brain dead.” That is not true and reflects the media’s failure to ascertain and report accurately all of the relevant medical facts, as well as unquestioning reliance on testimony of physicians without neurologic training.

    Mr. Golubchuck has been described as “comatose” or “unconscious,” but an ICU physician noted in the chart that he was “awake.” This man with a history of a serious traumatic brain injury and probable aphasia (inability to communicate verbally) has not been evaluated by a neurologist during the course of his hospital stay, though he is said to show “minimal brain function,” a term of no precise meaning and the standard of care would demand such under the circumstances.

    Mr. Golubchuck was admitted to the hospital from a nursing home with pneumonia and has required the ventilatory support of a respirator. He triggers the respirator with his own respiratory efforts, and he has been off the respirator for as long as a day before a falling blood oxygen level required him to be re-connected to the respirator.

    A nurse has been quoted as saying that she was appalled by Mr. Golubchuck’s condition (empathy?), and that “he was retaining 45 liters of water, and his skin was swollen to the point of bursting…’he was rotting from the inside out.'” “Rotting from the inside out” is certainly colorful imagery but medically meaningless. (If he was literally “rotting from the inside out,” e.g., a gangrenous bowel, he would not have survived for days, let alone the two months that he has been in the hospital. 45 liters of water weighs 45 kilos or 100 pounds, so is this nurse claiming that Golubchuck weighs 45 kilos/100 pounds more than before he came to the hospital? Hard to believe and would certainly cause an informed person to wonder how they were managing Mr. Golubchuck’s fluids and whether they were otherwise treating him properly, e.g., use diuretics.

    It is scandalous that the question of whether this man should live or die is being bandied about when the basic medical data has not been obtained and shared. Those who think the ICU physician should be fully empowered to decide the issue with no “interference” by the family or a court, should entrust themselves to Grace Hospital and its staff. I certainly wouldn’t.

  10. 10
    Dave Says:

    Well, 6 weeks after your post, the man is still alive, improving, sitting up and receiving therapy. So much for that!

  11. 11
    Dave Says:

    BELOW IS THE NEWSPAPER STORY REFLECTING THE MAN’S RECOVERY. WILL ALL THE PREVIOUS POSTERS NOW PLEASE RETRACT THEIR MISSIVES!!!!

    Orthodox man improves amidst life support battle with doctors
    By Rhonda Spivak
    (2 FEBRUARY, 2008)
    The family of an 84-year-old Orthodox Jew who is on life support says his condition has improved substantially after hospital doctors unsuccessfully tried to pull the plug on him over two months ago on the basis that there was no hope for recovery.

    Miriam Geller says that her father, Sam Golubchuck – who is unwittingly at the center of a precedent-setting court case – is now “being weaned off life-support,” and “is awake and holding our hands.”

    “The nurses have him up in a cardiac chair every day, a couple of times a day for two to three hours” and “a physiotherapist comes in regularly to do arm and leg exercises,” she added.

    Golubchuck is alive today only because his family was successful in getting an emergency ex parte injunction (without notifying the hospital) from Justice Perry Schulman that prevented the doctors from removing him from life support, a move that would have violated the family’s wishes and religious beliefs. At a hearing on December 11, 2007, the hospital and doctors maintained that Golubchuck had minimal brain function.

    Following that hearing, the family’s lawyer, Neil Kravetsky, sought to file affidavits by Dr. Daniel Rosenblatt, a critical care physician in New Jersey, and Dr. Leon Zacharowicz, a neurologist from New York, that dispute the hospital’s position.

    “This appears to be the first case in Canada where a hospital has actually fought with a patient to take him off life support,” Kravetsky told Haaretz last month. “Other cases haven’t gone this far because the family has given in and the patient has died.”

    After a hearing on January 11, 2008, Justice Schulman allowed Kravetsky to refile edited versions of these affidavits so they could be admissible as evidence.

    In his affidavit, Dr. Zacharowicz said that even according to entries in Golubchuck’s medical chart made before December 11, “There is no evidence whatsoever that he is brain dead, close to brain dead, or dying, from a neurological point of view.”

    Zacharowicz concluded, “The decision of any medical professional to disconnect this clearly alive patient – whom medical records indicate is returning neurologically to his baseline, pre-admission clinical condition – is incomprehensible to me.”

    Justice Schulman will be allowing lawyers for the hospital to cross-examine Rosenblatt and Zacharowicz on their affidavits and to file additional affidavits in response. He has not made any final ruling in the case.

    Lawyers for the hospital maintain that it is the sole right of the team of physicians to decide when to withdraw life support, and that this decision ought not to be in the hands of the courts.

    On January 30, Manitoba’s College of Physicians and Surgeons released new guidelines that became effective February 1. They state that the final decision to pull the plug on a patient lies with the physician.

    The guidelines say that the minimum goal of life sustaining treatment is for patients to recover to a level at which they are aware of themselves, their environment and their existence.

    In the event a physician and a family do not agree as to whether the minimum goal has been met, the guidelines provide that the treating physician must consult with one other physician and then communicate the decision to the family.

    In the event that a patient could achieve the “minimum goal” but the physician concludes treatment should be withdrawn anyway, the physician must provide the patient’s family written or verbal notice 96 hours before life support is stopped.

    Kravetsky called the new guidelines “terrible.”

    “It’s extremely suspicious that after taking three years to prepare these guidelines, the college would release them now and direct doctors to follow them immediately when the court is ruling on this very issue,” he said.

  12. 12
    James Hill Says:

    There has been an interesting and unexpected corollary to this story. The man is recovering!

    http://www.haaretz.com/hasen/spages/950619.html

  13. 13
    Joanne Says:

    This is the end result of what Socialized Medicine will do to humanity. People are duped into thinking it is a panacea for high insurance cost or lack of insurance, that Big Government will take care of everyone, but it is simply another method that Government controls the lives of ordinary citizens, and end them, if it suits. It won’t be long before Canada mandates that you really don’t need that heart you have, or your corneas, since you are over 60, or that you don’t need to be hospitalized because you won’t be productive once cured… sounds Orwellian, but medical decisions like that are just around the corner. Consider the mental anguish the Golubchucks must endure, the feeling of hopelessness. Rationing health care is something you voted on, vote it out. You may find you have no control over who is allowed to live, or even, who is deemed worthy of any treatment. Wake up Canada!

  14. 14
    Beavis Shumaker Says:

    Praise Jesus! He is recovering! No, no, I’m kidding, everything that said he was recovering, was from around Feb 2008, and was all info supplied from the family. It is now June 22nd, and he is not recovering. I know people that are ‘working’ with him, and they say it’s ridiculous. He’s now on 24/hr a day dialysis as well. He basically has machines operating/circulation blood, air, waste, etc. He needs people constantly monitoring all the equipment, as well as people to turn or clean him, so he doesnt develop skin irritations or infections. And he is not in some retirement center, he is taking a bed in the ICU. His medical bills, if the family were paying them, would have easily totalled a half-million since November. Seriously, WTF!? “do the doctors and the hospital have the right to hasten his death?” He IS dead! I mean really, why not go to WalMart, pick up a RoboSapien, skin this guy, and taxidermy it to the robot, hand over the remote to the family and say, ‘There you go! As long as you keep a couple AA batteries on hand, he’ll be alive forever!’

  15. 15
    shirley Says:

    I FEEL AS IF I AM GOING TO THROW UP ALL OVER YOU ALL…I ONLY HOPE WHEN IT COMES YOUR TIME (AND IT WILL SOONER THAN YOU THINK) THAT YOU RECEIVE THE SAME MERCY YOU HAVE GIVEN THIS POOR MAN…THE DOCTORS ARE NOT GOD (PROVEN FACT EVERYDAY) AND YOU ARE NOT GOD (PROVEN FACT) … SHUT UP AND DIG IN THE DIRT BECAUSE YOU ALL ARE THE SAME AS BUGS….ROACHES TO BE EXACT


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