Golubchuk case leaves ethical questions unanswered
WINNIPEG, MB—Samuel Golubchuk, an 85-year-old Orthodox Jew whose last months of life in Grace General Hospital ignited a national debate over end-of-life care, has left behind some unanswered ethical questions.
Golubchuk died on June 24, almost seven months after doctors recommended that he be removed from life-support system because he wasn't likely to recover and was barely conscious.
Golubchuk's children took the case to court, saying that turning off the machines that kept their father alive would violate his Orthodox Jewish beliefs.
After judges granted the family a temporary injunction, ordering the hospital to keep caring for Golubchuk while the case was decided, three doctors resigned.
Golubchuk died in an intensive care unit, still on life-support.
James Read, a philosophy and ethics professor at Booth College says it's unfortunate that a man's last days became a legal and political battlefield, but the discussion it kindled needs to happen.
"There are two questions here," says Read. "What are the goals of medicine, and who gets to decide?"
The second question doesn't have a legal answer in Manitoba. While the College of Physicians has stated doctors can make the final decision about when to stop life-support, the courts haven't made an official ruling.
"It has to be a collaborative decision," says Alan Green, a rabbi at Shaarey Zedek Synagogue.
"There's a very strong bias in Jewish law toward the preservation of human life," says Green. But the Jewish faithful range from those who don't believe in artificial life-support to those dedicated to preserving life at all costs.
Green visited Golubchuk in December.
"I spoke to him and it was absolutely clear to me that he was very much conscious. He was still very much in this world. He was looking at me and he squeezed my hand. I felt myself to be in the presence of someone who was very much alive," he says.
"At that time I would have sided with the family."
Rabbi Avrohom Altein ministers at three Winnipeg synagogues and provided some counsel to the Golubchuk family.
"In Jewish teaching there is infinite value to life. We have the obligation to do whatever we can even if it's only to live one day longer," says Altein.
Altein says doctors shouldn't have the power to make life and death decisions alone.
"Doctors are trained to deal with medicine… they're no better equipped to make ethical decisions than anyone else," he says. "To have an absolute system of ethics there has to be a religious element."
Read agrees there are factors beyond physical health.
"Religious beliefs and convictions need to be taken into consideration without it needing to fall in line with an official religious teaching," he says.
"According to a Christian worldview people need to be taken care of, but the preservation of human life is not always the greatest good. Other considerations might be greater," says Read.
The idea that a family might have spiritual concerns for their loved one that outweighs the physical has some doctors "completely flabbergasted," says Merril Pauls, a Christian emergency room doctor who works at the Health Sciences Centre.
When patients make choices that don't seem to fit their doctor's carefully presented data, the doctor often assumes they simply haven't understood the odds, he says.
"Somehow they have to understand it has nothing to do with the odds, it has something to do with their narrative," says Pauls. "The more you beat them down with data, the more they'll resist."
Instead doctors should learn to "sit down and understand where they're coming from," he says. "It's rather intimidating for doctors and nurses who don't have a lot of training in that."
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