CANADA: Life-Support Case A Risky Precedent, MDs Warn

WINNIPEG (Globe and Mail), December 13, 2007: The Canadian Medical Association says the case of a 84-year old Winnipeg man being kept on life support by a court injunction could set a dangerous precedent that would force physicians to provide futile or even potentially harmful medical care when a family demands it. The debate revolves around Samuel Golubchuk, whose doctors say has limited brain function, can't walk or eat, breathes only with the help of a respirator and, barring divine intervention, is unlikely to recover. His family says it's a violation of their Orthodox Jewish faith to remove him from life support, and their lawyer, Neil Kravetsky, argued in court this week that to do so would constitute assault and battery. The family believes it would be murder. A judge is currently considering whether to extend the temporary injunction that is keeping Mr. Golubchuk on life support in the intensive-care unit at Winnipeg's Grace Hospital. Mr. Golubchuk has been in that state of limbo since Nov. 30. In an affidavit filed with the court, a nurse said he was retaining 45 litres of water and was swollen to the point of bursting. Jeff Blackmer, the CMA's executive director of medical ethics, said physicians are paying close attention to the case to see whether the court will side with the family in dictating the level of care that will be provided. It could set an important precedent, he said. A conflict between faith and medicine "Physicians may feel that they're being placed in a position where they're required to [provide futile or potentially harmful treatment] when the patient or family demands it," he said. "We don't want to see physicians making decisions with one eye on the lawyers." According to documents filed in court, the physicians at Grace Hospital concluded Mr. Golubchuk could not recover from his ailments, and that rather than extending his life, they were prolonging his death. "When a clinician makes that determination then the ethical standard is that physicians do not have an obligation to offer care that has been deemed futile," Dr. Blackmer said. It would be worrisome if society chose to take those decisions out of the hands of physicians and place them with the courts, he said. Arthur Schafer, the director of the University of Manitoba's Centre for Professional and Applied Ethics, said the case, if it goes against the hospital, could have a potentially harmful effect on the practice of medicine. "If you bring someone into the emergency department you assume that their life may be worth saving and you get them on everything that could be needed," he said, adding that would include putting them on medication, dialysis or a respirator. "If the case goes against the hospital on the grounds that once you plug in you can't unplug, I think people will be a lot slower to plug in, and some people may die who should have been plugged in. So the social implications of a victory for Mr. Golubchuk, his children and their lawyer would, I think, make Canadian hospitals deviate from good medical ethics." By Joe Friesen © Copyright 2007 CTVglobemedia Publishing Inc.