Doctors offer to treat dying Winnipeg man after colleagues refuse

[Praxius]

Samuel Golubchuk, 84, has been on life support with minimal brain function at the Grace Hospital since last fall.

http://www.cbc.ca/canada/manitoba/story/2008/06/18/winnipeg-doctor.html

A doctor in Winnipeg has agreed to treat a dying 84-year-old man amid a legal and medical row between his family and physicians who say keeping him alive is unethical, a published report said Wednesday.

Three doctors at the city's Grace Hospital have refused to continue providing care to the elderly patient, Samuel Golubchuk, who they say has no brain function and should not be kept physically alive on a ventilator.

But other doctors have come forward and agreed to provide care, said Heidi Graham, spokeswoman for the Winnipeg Regional Health Authority.

"Our regional critical care program and hospital have developed a plan that involves having one attending physician of record for the patient in question," Graham told CBC News on Wednesday morning.

"This physician will be supported by two other physicians. These three physicians have already agreed to this, and this situation will allow the other physicians in the Grace intensive care unit to continue with their scheduled rotations if they so desire."

Graham also confirmed that discussions are underway that could result in the return of some of the doctors who refused to care for Golubchuk.

'God decides … not the doctors': daughter

Golubchuk and his family are Orthodox Jews who believe it is immoral to hasten death.

"When a person is born, it's written down when they're going to die. So it's God that decides this, not the doctors," said Miriam Gellar, Golubchuk's daughter.

Gellar said her father still makes eye contact with her and is able to squeeze her hand. She believes he could still recover and that the doctors who refuse to treat her father are "misguided" and have "no compassion."

"We feel he knows we're there with him. We gave him his card on Father's Day and his eyes lit up," she said. "Give the person a chance to recover and, you know, to live out their life the way they're supposed to. We're speaking for him. This is his choice."

Last month, in a letter to the Winnipeg health authority, Golubchuk's original attending physician, Dr. Anand Kumar, said he would no longer work in Grace Hospital's critical care unit because it meant providing medical services to his former patient that were "grotesque."

Golubchuk had developed bedsores, Kumar wrote, and doctors were having to trim infected flesh from his body to prevent infections from spreading.

"To inflict this kind of assault on him without a reasonable hope of benefit is an abomination," Kumar's letter said. "I can't do it."

Do no harm: ethicist

Kumar advised the family to remove Golubchuk's ventilator and feeding tube, but they went to court instead and obtained a temporary order to continue treatment until the case can be heard fully in September.

Earlier this week, two doctors who had been maintaining Golubchuk's life support treatment also withdrew from the case.

"This week, I have come to the 'ethical line in the sand' that I had previously said I would never cross," Dr. David Easton said in a letter on June 17.

"Do potential legal consequences and threat of 'jail' take precedence over my duty to not inflict further harm to the patient? I have been, and am, extremely conflicted in all of this."

"I had perhaps naively thought that by having my own institution 'strongly suggesting' me to act against my will and provide said care, that I would somehow be absolved of these issues internally, but in fact has further compounded them and increased my degree of conflict to an indescribable degree."

Arthur Schafer, a medical ethicist at the University of Manitoba, said the physicians were correct to follow their conscience once they'd formed a professional opinion on Golubchuk's case.

"They did morally the right thing," Schafer said. "As every first year medical student learns, the basic principal of medical ethics is 'do no harm.' "

But Percy Golubchuk, the patient's son, said it's all about being able to trust that a medical team will provide the care that's needed to preserve life.

A person, he said, "should not be afraid when you go into a hospital that you might not come out because a doctor thinks your life is not worth living."

Golubchuk's father was put on life support late last year when he was being treated in hospital for injuries suffered in a fall.

Ok first off:

"When a person is born, it's written down when they're going to die. So it's God that decides this, not the doctors,"

^ Then if that is the case, the doctors are interfering with God's plan by keeping him on life support in the first place, considdering by natural causes, if it was removed, he would die.

If God decides this, then obviously the Doctors do not..... and in the same breath, neither does the family.... and that's exactly what's going on. They themselves are contradicting their own beliefs.

Secondly:

Golubchuk had developed bedsores, Kumar wrote, and doctors were having to trim infected flesh from his body to prevent infections from spreading.

"To inflict this kind of assault on him without a reasonable hope of benefit is an abomination," Kumar's letter said. "I can't do it."

^ And I respect that decision. What kind of life would he have left if he did recover, only to end up with a good chunk of his body removed to avoid infection? And don't forget, they got a court order to keep him on the life support until at least September..... so what kind of condition is this poor guy going to be in by then??

This isn't the man making the decisions, it's his family on emotional and skewed religious views. If he was making the decision himself based on religions views, that's his choice, but for his family to make him slowly rot away because they can face reality is completely disgusting.

This is very similar to what occured with my grandmother and how my family tried to keep her on life support for as long as they could after she had her stroke. In the end they had no choice but to remove the system or she would die from the damage the system would have done to her being down her throat, etc...... she died regardless..... all the life support system did was prolong her death.

And my family's beliefs were similar to the above religious beliefs of not quickening their deaths (Or assisted suicide if you will) ~ But this isn't assisted suicide and it's not speeding up their deaths..... all it is doing is prolonging their inevitable death which can not be avoided.

What's worse about this case compared to my grandmother's is that this man is going to be on the life support for much much longer, he's suffering from bed sores and infections, the doctors have to remove his flesh to prevent those infections from spreading, etc..... and he's apparently got 3 more months of this coming his way...... oh and he's apparently has no brain activity from what the doctors claim.

In my grandmother's case, she was still concious, still could move her hands and head, look around and the sort.... but she couldn't talk because of the tubes, and due to the drugs they had her on, she was usually in and out of it all the time..... and if at anytime they turned off the machine, she would have died, because she couldn't breath on her own.

I swear to whatever God might be out there..... if I ever suffer from anything that lays me up on life support and the chances of my survival are nill..... flick the switch and get it the hell over with.... I'd rather die with a little bit of dignity then to let my family watch me slowly rot away in front of them.

Trust me, it only makes it harder in the end.

 

[lone wolf]

No brain function? God's already decided. All the family is doing now is an indecency to a dead body. Get over the pity party and say goodbye....

 

[tracy]

I would encourage anyone who hasn't done it already to prepare a legally binding advanced directive and share that information with someone you trust to carry out your
wishes.

I don't know if this is immoral or not only because I don't know what this man would have wanted. If he raised his children to have those beliefs, it stands to reason he may share them too. I worked at the traditionally Jewish hospital in Toronto and an Orthodox rabbi explained to us why they didn't believe in removing life support. I don't share their views, but if it's what they choose for themselves then I wouldn't stand in their way either. I found it harder on our unit because it was babies who have absolutely no way of deciding such a thing, but if it's an adult and they want to rot away in a bed that's their business.

I do think the family is probably kidding themselves and I support the doctors 100% in their decision to stop treating this man. They shouldn't have to compromise their ethical beliefs to do that. It's a hard position to be in and we all have to make the decisions we can live with. I hope the rest of the hospital staff is also given the same courtesy.

 

[tracy]

BTW, bedsores really piss me off. That's just a sign of bad nursing care.

 

[Praxius]

BTW, bedsores really piss me off. That's just a sign of bad nursing care.

Well for one thing, if your conscious and able to move yourself, that reduces the affects of bedsores and makes it easier for the nurses to move you around or treat anything that exists..... when you're brain dead, a dead weight, should be dead and you are dieing.... it's not as easy to prevent those things, esspecially when you got a crap load of tubes and machines hooked into your arms and shoved down your throat just to keep you alive.

On a normal person capable of moving on their own and isn't loaded up to machines is one thing... jar this guy the wrong way or accidentally disconnect something and then chances are he'd be dead pretty fast, and then they have the family sueing their asses for negligence.

It's not always bad nursing.

 

[tracy]

Well for one thing, if your conscious and able to move yourself, that reduces the affects of bedsores and makes it easier for the nurses to move you around or treat anything that exists..... when you're brain dead, a dead weight, should be dead and you are dieing.... it's not as easy to prevent those things, esspecially when you got a crap load of tubes and machines hooked into your arms and shoved down your throat just to keep you alive.

On a normal person capable of moving on their own and isn't loaded up to machines is one thing... jar this guy the wrong way or accidentally disconnect something and then chances are he'd be dead pretty fast, and then they have the family sueing their asses for negligence.

It's not always bad nursing.

Been there done that and you're right it isn't ALWAYS bad nursing. Usually would probably be a more accurate word.

Patients should be turned at a minimum every 2 hours. It doesn't matter if it's not easy. Being scared of disconnecting something isn't an excuse and they don't usually die all that quick if you do (accidental extubations aren't that uncommon). We move patients with all sorts of lines and tubes all the time. There are loads of specialty equipment to help nurses move patients and to help them prevent bedsores. I'm usually going to give nurses the benefit of the doubt since I am a nurse, but bedsores aren't ok. Wound care teams will usually tell you the same thing. Get an air matress, get some telfa or put on duoderm, keep them dry, change their position often... Bedsores happen way more often than they should.

 

[L Gilbert]

My aunt's M-I-L spent 8 YEARS on some form of physiological support and every single day she told someone that all she wanted was to die. Her quality of life was nil. Keeping someone like that alive is absolutely cruel. Keeping someone alive that is essentially brain dead and has no hope of consciousness is simply idiotic. Better to give the care to someone who could actually USE it.

 

[Praxius]

Well that's the end of that:

Winnipeg man at centre of end-of-life controversy dies
http://www.cbc.ca/canada/manitoba/story/2008/06/25/golubchuk.html

An elderly Manitoba patient who was at the centre of a debate over whether doctors have the right to end a life died of natural causes Tuesday.

Samuel Golubchuk, 85, of Winnipeg had been on life-support since last fall. He died around 11:30 a.m. Tuesday at the Grace Hospital.

"We don't know the exact cause, but I think he died a natural death, and that's what he wanted. And he was with competent medical people who wanted to be there and wanted to help him," family lawyer Neil Kravetsky told CBC News Wednesday morning.

"As far as we are concerned, Sam Golubchuk didn't die for nothing. He died for what he believed in, and he died naturally."

Golubchuk's controversial case made national headlines when the elderly man's family, who are Orthodox Jews, took the hospital to court earlier this year and got an injunction forcing doctors to keep him on life-support.

Doctors wanted to remove support systems, including a ventilator and feeding tube, because he showed no chance of improving, but his family argued that would hasten his death, an act that goes against their religious beliefs.

Three doctors chose to resign from their duties at the hospital over the case, with one commenting in a letter that he felt keeping the elderly man alive was "tantamount to torture."

Dr. Anand Kumar, who made the original decision to end life-support, said continuing court-ordered efforts to keep Golubchuk alive were "grotesque" and "immoral," citing newly developed ulcers and other problems.

A trial over the matter had been set to begin in mid-September. Kravetsky said he did not yet know if any aspects of the court case would proceed.

"One of the major issues in this case probably cannot be tried, and that is the issue of the injunction," he said.

"The court is not going to make an order that he be kept on life-support, so it becomes academic. And that really was the most important question, because intrinsic in that question was whose right is it to make that decision."

The portions of the claim that would be viable would include claims for damages, breach of contract, assault and negligent treatment, Kravetsky said.

"That will be up to the family and the defendants, but I am not optimistic," he said.

A funeral is planned for Tuesday afternoon at 1:30 at the Chesed Shel Emes Chapel on Main Street. The service is open to the public, Kravetsky said.

Well there you go, they kept him on those machines for further suffering in which he died in the end anyways.

 

[shadowshiv]

At least now he can finally rest in peace.

 

[karrie]

BTW, bedsores really piss me off. That's just a sign of bad nursing care.

With my great gran, when it hit the point that they were concerned about bedsores, they put her on an 'air' mattress, constantly flowing air against the skin. Problem solved.

 

[shadowshiv]

With my great gran, when it hit the point that they were concerned about bedsores, they put her on an 'air' mattress, constantly flowing air against the skin. Problem solved.

It is amazing how deadly bedsores can turn out to be. Christopher Reeve passed away due to complications from bedsores.:-(