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Dec. 21, 2007
When does life end?
Medicine and religion clash as man dies.
RHONDA SPIVAK
The family of an Orthodox Jewish man, 84-year-old Sam Golubchuk, has gone to a Winnipeg court to require his hospital to continue giving him life-support, including a ventilator and feeding tube, in accordance with their religious beliefs. The hospital wants to disconnect Golubchuk's ventilator and pull his feeding tube because there is no hope for recovery and he has minimal brain function. Golubchuk has been on life support since Nov. 7 of this year.
Golubchuk is one of the founding members of Chavura T'fillah Synagogue, a small Orthodox synagogue in Winnipeg's North End. Prior to his illness, he regularly attended Talmud Torah, another Orthodox synagogue in the North End, where his children also attend.
Golubchuk's son and daughter, Percy Golubchuk and Miriam Geller, retained legal counsel to prevent Grace Hospital from what they say is a violation of their father's religious beliefs and hastening his death. A spokesman for the hospital referred comment on the matter to the Winnipeg Regional Health Authority (WRHA). Heidi Graham, spokeswoman for the WRHA, confirmed that Golubchuk has been on life support since Nov. 7, but said that it would be inappropriate for her to comment further, since the matter is before the court.
Neil Kravetsky, the family's lawyer, said the family wants to see Golubchuk die naturally, and vehemently opposes having their father removed from life support.
"There have been cases similar to this in Manitoba involving orders not to resuscitate a patient," said Kravetsky, "but this appears to be the first case where a hospital has actually fought with a patient to take him off life support. Other cases haven't gone this far because the family has given in and the patient has died. But Mr. Golubchuk hasn't died and the family is not giving into the hospital's wishes."
On Nov. 30, Kravetsky was successful in getting an ex parte injunction on an emergency basis from Manitoba Court of Queen's Bench Justice Perry Shulman, preventing the doctors from removing Golubchuk's life support.
On Tuesday, Dec. 11, Kravetsky and hospital lawyers had a full-day hearing that went into the evening before Shulman, who is to decide whether to grant an interim injunction before trial to prevent the hospital's actions. His decision in this rare case could be precedent setting across Canada, in that the ruling will have to deal squarely with the issue of whether it is the patient and his or her family or the doctor who has the final determination over whether to withdraw treatment.
"Justice Shulman has reserved his decision on this and I expect it could be some time before the decision is rendered," said Kravetsky. "In the meantime the ex parte injunction the family has obtained is in place such that the hospital cannot withdraw the life support. If Justice Shulman were to render a decision allowing life support to be withdrawn, I would seek the family's instructions to try to appeal the order and get a stay of the order."
The hospital has taken the position in court that its physicians have followed all patient care rules and had made scientific decisions to remove Golubchuk from life support. Kravetsky said, "There is no evidence that Mr. Golubchuk is brain dead and his heart is functioning independently."
In a court affidavit, Rabbi Y. Charytan, a Chabad-Lubavitch rabbi who works for Jewish Child and Family Services and has known Golubchuk for several years, said Orthodox Jews believe "life must be extended as long as possible and we are not allowed to hasten death."
Charytan said he told hospital officials that "it is a sin and not acceptable" for them to remove life support from Golubchuk.
Golubchuk fell in June 2003 and suffered an injury to his brain, but he could still understand and communicate. Golubchuk was then cared for in a nursing home but he went to Grace Hospital's emergency ward in October of this year, suffering from pulmonary hypertension (high blood pressure in the arteries that supply the lungs) and pneumonia.
Rabbi Altein, the city's senior Chabad Lubavitch rabbi, who knows the Golubchuk family well, said that, "Quality of life is not an issue as far as halachah [Jewish religious law] goes.... What is at issue is at what point a person is considered to be a goses [a person who is in the final stage of dying]. When a person is a goses, you are not allowed to hasten the process of dying, but you don't have to prolong it.... According to Rabbi Bleich, from Yeshivah University in New York, a halachic expert in this area, a person is considered a goses if they cannot possibly live for 72 hours, even by using whatever machines modern medicine has available to them. This means that if Golubchuk were a goses and he wasn't on life support, according to halachah, we would not be required to put him on life support. However, even when a person is a goses, if he is already on life support, then the life support cannot be withdrawn. In this case, there is no doctor that has said that if Mr. Golubchuk stays on life support, he won't last 72 hours, so it can't be said he is a goses."
In Altein's view, "doctors are not well equipped to make the moral and ethical decisions" raised in this case, "contrary to what many people may believe."
In an affidavit, Dr. Bojan Paunovic, the director of the hospital's intensive care unit, said that there is no benefit in treating Glubchuk any longer since he is dying. "I have accepted, against my medical judgment, the extension of time on the ventilator in order to allow time for the family to realize the hopelessness of the situation and the futility of further treatment," said Paunovic, according court documents. "I do not feel that I can ethically participate in the administration of this treatment any longer."
Arthur Shafer, director of University of Manitoba's Centre for Professional and Applied Ethics, is of the view that, if the case goes against the hospital, it could have a potentially harmful effect on the practice of medicine.
Shafer said, "If the Orthodox Jewish position is what I understand it to be, then it seems to me it is indefensible. Based on what I understand the facts of this case to be, Mr. Golubchuk appears to be in an irreversible vegetative state. He could potentially be in this state for a very long time. If so, would the Orthodox Jewish community want to see tens or hundreds of thousands of people in Canadian hospitals kept alive for decades by ventilators and other machines? Is that how they want us to spend our scarce medical resources?... [Former Israeli prime minister Ariel Sharon], who is in an irreversible vegetative state, may be getting this kind of treatment, but if every Israeli got this kind of treatment, the whole state budget would be used up. Should every Jew really be kept alive like Ariel Sharon?... In my view, doctors should not be required to provide treatment that, in reality, is no treatment at all. It seems to be unethical to make them do this."
Shafer also said that there should be no moral difference between putting someone on life support and then taking them off as opposed to never putting them on in the first place. "When a person is rushed to emergency [in a serious life-threatening condition], medical practice in Canada is to automatically put them on life support in order to investigate and assess their condition. Are we going to say that once they are put on life support for purposes of assessment and doctors learn that they are in an irreversible vegetative state, we can't take them off? If so, I think people will be a lot slower to plug in, and some people may die who should have been plugged in," he said.
Rhonda Spivak is a Winnipeg freelance writer.
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