Who should have the final
say on end-of-life cases?
On June 24, after seven and a half
months on life support in a Winnipeg ICU, Samuel Golubchuk,
the 84-year-old man made famous by the lively court
battle he sparked, died.
The uncomfortable legal and eth-ical
questions to which his case gave rise, however, continue
to threaten doctors' authority in end-of-life dec-ision-making.
Not long after Mr Golubchuk was admitted to the Grace
Hospital ICU with pneumonia, physicians told his Orthodox
Jewish family there was no point in keeping him on a
respirator and feeding tube his chances of recovery
were zero percent, they said. But the family refused
on religious grounds. Doctors told the family they planned
to unhook him anyway. The family decided to take them
That's when things really got ugly.
International media picked up the story and a right-wing
American group dubbed Mr Golubchuk "Canada's Terry Schiavo."
On February 13, a Manitoba judge sided with the Golubchuk
family and extended an interim injunction preventing
doctors from withdrawing care until a full trial could
be heard in September.
As days of waiting for a resolution
turned into weeks, and weeks into months, the ICU physicians'
discomfort with providing "useless" and potentially
painful treatment grew. Three of them Drs Anand
Kumar, David Easton and ICU director Bojan Paunovic
announced in May and June they could no longer
ethically justify treating Mr Golubchuk.
"If we honestly attempt to follow
the court mandate to focus on keeping Mr Golubchuk from
his natural death, we will likely have to continue to
surgically hack away at his infected flesh at the bedside
in order to keep the infection at bay," Dr Kumar wrote
in May, calling further treatment "tantamount to torture."
"This is grotesque. To inflict this kind of assault
on him without a reasonable hope of benefit is an abomination.
I can't do it."
"Suddenly I have been faced with
an almost impossible decision," Dr Easton wrote in a
letter to the Winnipeg Free Press. "Do potential
legal consequences and threat of 'jail' take precedence
over my duty to not inflict further harm to the patient?"
He decided they did not.
The three doctors refused to provide
any more care for Mr Golubchuk or do further critical
care rounds, prompting warnings from the hospital's
chief med-ical officer that the hospital's ICU might
have to be shut down because of understaffing. A new
physician was found to care for Mr Golubchuk, but soon
after he died "of natural causes."
Along with Mr Golubchuk, most of the lawsuit is now
dead. It is unclear whether any of the elements of the
case for instance, seeking damages from the doctors
and the hospital will continue. In the meantime,
because the doctors never succeeded in removing Mr Golub-chuk's
respirator and feeding tube, the Golubchuk family has
"We won the injunction," the family's
lawyer, Neil Kravetsky, told NRM. "That is a
precedent. There are no others in this kind of case.
So people who are faced with what Samuel Golubchuk's
family was faced with, they know there is something
to rely on in the future."
Not everyone agrees. "At the human
level I think one has to feel relief for Mr Golubchuk,
because he was not in a vegetative state but in a near-vegetative
state he was feeling pain and discomfort," says
Winnipeg bioethicist Arthur Schafer, PhD. "But on the
other hand we won't have a court ruling that will clarify
The Manitoba College rushed out
guidelines earlier this year to assert doctors' right
to the final say, regardless of families' opinions
a position that Dr Schafer supports. Mr Kravetsky calls
the guidelines "the most insensitive, hypocritical,
unfeeling document I have ever read."
"We need resolution on this issue,"
one of the three doctors who resigned told The Globe
and Mail anonymously. "These cases are just occurring
over and over again."