Not a Doctor’s Decision

letter-447577_1280

A Winnipeg case currently winding its way to its grim conclusion pits the children of Samuel Golubchuk against doctors at the Salvation Army Grace General Hospital. According to the pleadings, Golubchuk’s doctors informed his children that their 84-year-old father is “in the process of dying” and that they intended to hasten the process by removing his ventilation, and if that proved insufficient to kill him quickly, to also remove his feeding tube. In the event that the patient showed discomfort during these procedures, the chief of the hospital’s ICU unit stated in his affidavit that he would administer morphine.

Golubchuk is an Orthodox Jew, as are his children. The latter have adamantly opposed his removal from the ventilator and feeding tube, on the grounds that Jewish law expressly forbids any action designed to shorten life, and that if their father could express his wishes, he would oppose the doctors acting to deliberately terminate his life.

In response, the director of the ICU informed Golubchuk’s children that neither their father’s wishes nor their own are relevant, and he would do whatever he decided was appropriate. Bill Olson, counsel for the ICU director, told the Canadian Broadcasting Company that physicians have the sole right to make decisions about treatment – even if it goes against a patient’s religious beliefs – and that “there is no right to a continuation of treatment.”

That position was supported by Dr. Jeff Blackner, executive director of the office of ethics of the Canadian Medical Association. He told Reuters: “[W]e want to make sure that clinical decisions are left to physicians and not judges.” Doctors’ decisions are made only with the “best interest of the individual patient at heart,” he said, though he did not explain how that could be squared with the undisputed claim that this patient would oppose the doctors’ decision. Meanwhile, an Angus Reid poll of Canadians showed that 68% supported leaving the final decision with the family.

The claim of absolute physician discretion to withdraw life-support advanced by the Canadian doctors would spell the end of any patient autonomy over end-of-life decisions. So-called living wills, which are recognized in many American states, and which allow a person to specify in advance who should make such decisions in the event of their incapacity, would be rendered nugatory.

EVEN THOSE who would not wish to be maintained in a state of unconsciousness, and who do not share the religious beliefs of the Golubchuk family should fear the claim of moral omniscience made by Canadian doctors – and not just because Josef Mengele was a doctor. As Professor Richard Weikart chillingly details in From Darwin to Hitler: Evolutionary Ethics, Eugenics, and Racism in Germany, Mengele’s experiments on “inferior” Jewish children for the benefit of the Master Race have to be viewed in the context of German Social Darwinism in the seven decades leading up to the Nazi takeover.

In Weikart’s estimate, a majority of German physicians and scientists subscribed to the naturalistic Darwinian world view and ideas that constituted a sustained assault on the traditional Judeo-Christian concept of the sanctity of life. Among those ideas are the claim that there is no fundamental distinction between humans and animals; human beings do not possess a soul that endows them with any rights or superiority to any other species; within the species homo sapiens, there are “inferior” and “superior” individuals, and inferior and superior races; and it is the iron will of nature that the species should evolve through the survival of the superior members and the death of the inferior.

Darwin’s cousin Francis Galton founded the modern eugenics movement on the basis of Darwinian arguments, and nowhere did eugenics catch on with greater enthusiasm than in Germany (though many prominent intellectuals in the United States, England and France were also enthusiastic supporters.) In Germany, many took the next step – from eugenics to involuntary euthanasia for the mentally ill and other defectives.

Ernest Haeckel, one of the most influential 19th-century German biologists, whose faked drawings of developing human embryos allegedly recapitulating the evolutionary path still feature prominently in college biology texts, argued for the killing of the mentally ill, lepers, those with incurable cancer, and cretins. As a safeguard, he too recommended a committee of physicians to pass judgment. Alfred Hoche, a professor of psychiatry at the University of Freiburg, justified shortening an inferior life if the insights gained would save better lives. “By giving up the conception of the divine image of humans under the influence of Darwinian thinkers,” writes Hans-Walter Schmuhl, mainstream German thinkers came to view human life as “a piece of property” to be weighed against other pieces of property.

JUST AS Nazism gave anti-Semitism a bad name, so too did it discredit Social Darwinism. But just as anti-Semitism has reappeared, so has the assault on the concept of the sanctity of life. That assault is not limited to Princeton ethicist Peter Singer’s defense of infanticide, euthanasia and bestiality on explicitly Darwinian grounds.

Global warming activists speak of the duty not to reproduce, and view human beings as the enemy of nature’s order. So much for the view of man as the crown of creation. In place of the sanctity of life, we now speak of the “quality of life” – a term that explicitly assumes that some lives are worth more than others.

There is even talk of the “duty to die” and clear the way for higher-quality lives, which is why the American Association of People with Disabilities has been actively involved in so many cases dealing with the doctors’ right to terminate medical care. The rage for medical rationing in Canada, of which the Golubchuk case is but one example, derives from a desire not to waste resources on low-quality lives.

It would be a bitter irony if Percy Shulman, a Jewish judge in Winnipeg, were to grant Dr. Bojan Paunovic the right to end Samuel Golubchuk’s life on the grounds that it lacks the requisite quality.

This article appeared in the Jerusalem Post on December 27 2007.

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28 Responses

  1. Shmuel says:

    The judge is reportedly set to decide on Friday afternoon, Jan. 11th whether the affidavits submitted by Mr. Golubchuk’s two medical experts, asserting that Mr. Golubchuk is now awake and alert, moving purposefully, and not imminently dying, should be admissible. Believe it or not, the hospital attorneys are trying to get this information quashed.

    [The judge has not been to the hospital to see the patient, and has not reviewed the medical records, apparently relying on the integrity of the hospital and its doctors, who have major financial incentives to see Mr. Golubchuk dead.]

    Daven for Chayim Shmuel ben Pinya.
    To offer support for the Golubchuk family, contact them at [email protected].

  2. Shlomo Zalman Jessel says:

    This article appeared in the Jpost yesterday. It is online, with links to more information, at http://www.jpost.com/servlet/Satellite?cid=1198517308975&pagename=JPost%2FJPArticle%2FShowFull

    Canadian judge to rule on Jew facing euthanasia
    Judy Siegel-Itzkovich , THE JERUSALEM POST Jan. 6, 2008

    A Canadian judge is due to decide this week whether to renew a temporary injunction against Winnipeg’s Grace General Hospital, whose doctors want to detach an 84-year-old Orthodox Jew from a respirator and hasten his death, against his family’s wishes.

    However, it was learned Sunday that the patient, Samuel Golubchuk, regained consciousness several days ago and appears to be improving.

    Although a hospital doctor treating Golubchuk wrote “Awoke” on his chart, the hospital did not disclose this to the court. The family said the hospital had been trying to make the patient appear to be dying and with minimal brain function. Grace General Hospital has received the backing of the Canadian Medical Association in its efforts to bring about active euthanasia.

    According to the chart, which the judge was apparently not shown, the supposedly “imminently dying” Golubchuk is not only awake but has interacted with people and made purposeful movements.

    The case has aroused anger and anxiety within the North American Jewish community that it will set a precedent for doctors to have exclusive power over life and death decisions. Rabbinical and community leaders worry that budget-conscious hospital systems may decide to shorten patients’ lives to save money or to free up beds.

    The US Association of Orthodox Jewish Scientists discussed the case at its annual meeting in New York two weeks ago, and passed a resolution expressing grave concern about this case. Agudath Israel of America has also expressed concern.

    Prof. Shimon Glick, a leading Israeli medical ethics expert and former dean of Ben-Gurion University’s Health Sciences Faculty, said: “From a halachic point of view, removing a feeding tube from a patient who has any brain function is active euthanasia, equivalent to murder… But here, in addition, unless the patient has specifically indicated by advance directive that such is his desire, one has a violation of the patient’s autonomy, as well.”

    A Grace General Hospital lawyer told the court that doctors “have the sole right to make decisions about treatment – even if it goes against a patient’s religious beliefs.”

  3. Neurologist (USofA) says:

    “In Canada, where medicine is socialized, medical care is by definition rationed by experts.”?! Really? If I define my dog as an “expert,” would he then by definition be an expert? Or would my dog not qualify as an “expert” because I lack the proper authority to pronounce him such?

    I can’t engage with much of what is above, or at least that which opines about the particulars of Mr. Golubchuk’s case, because I don’t know all the relevant medical facts. I don’t expect others do either, since it seems that those attending Mr.Golubchuk at Salvation Army Grace Hospital lack the expertise to assess his neurologic condition and intelligently prognosticate here. What is most shocking if true, indeed outrageous, is that the hospital and staff have effectively denied Mr. Golubchuk a proper neurologic assessment by someone suitably qualified to provide one, and yet they are determined to withdraw life support measures as soon as possible, angry that anyone, including the family, should stand in their way.

    When all the relevant medical facts are brought out about his neurologic condition, if they ever are, then this case will be ripe for discussion from various perspectives, including ethical, economic, political, etc. In the meantime, the imperative is to stop those who want to take Mr. Golubchuk off life-support without any “outside” interference, e.g., that of the family, well-qualified consultant neurologists, and the courts, whose raison d’etre is to apply the law to the facts (again, which have not be assembled!) and decide disputes like this one.

    When there are no material facts in dispute, courts can grant summary judgment to the moving party. They shouldn’t grant summary judgment or what would amount to summary judgment in Mr. Golubchuk’s case (refuse to enjoin the hospital and its staff at this time and allowing them to undertake to end his life), because the relevant facts are anything but beyond dispute at this point. Whatever differences there may be between Canada’s healthcare delivery and legal systems and the United States’ systems, I find it hard to believe that the outcome would be so radically different according to the country in which it happened.

  4. Calev says:

    Some of the comments posted here are trying to steer the argument in a political direction – private medical care versus socialised medical care. But this is missing the point: no form of institutionalised medical care can meet all society’s demands.
    The point here is one of preserving the moral core of medical care no matter how that care is provided. That is, should the goal of medical care be to save/preserve life? Are there instances (i.e. exceptions) where medical providers may veer away from that goal (wihout becoming murderers)?
    The danger highlighted by the Canadian case is that the moral imperative to save life is being institutionally eroded. Life is no longer considered to be sacred. Individuals’ existence is increasingly dependent on cold economic rationales and a morbid fear of pain.

  5. joel rich says:

    Every day Americans are refused life saving treatment by insurance companies because it gets in the way of their huge profits.
    ===================================
    Every society has a mechanism to allocate a share of the GNP to medical care and one to allocate that piece of the pie to group and individual care. I think the above quoted statement provides a convenient point of blame but the issue is much broader. How would daas torah set the 2 allocation priorities?

    KT

  6. Robert Lebovits says:

    It is easy to interpret this story of an elderly man being forced off ventilation and feeding as a reflection of the health care industry in a Social/Democratic country, and then compare it – favorably or otherwise – to the medical care offered in the US. But that would be a very narrow interpretation.
    The real issue at hand is: who speaks for the patient? Is it the family, who may know the patient best but may have a tainted interest in keeping the patient alive? Or is the doctors, claiming medical expertise and objectivity to decide what is in the patient’s best interest? We know no such objectivity in the medical establishment exists, no matter what sort of delivery system is in place. Any number of biases are present in medical decision-making as doctors use all sorts of measures to decide a course of treatment (including economic and personal considerations). Therefore, if the court rules in favor of the doctors it will be setting a precedent that essentially says “We choose to trust doctors over anyone else.” What is truly terrifying about this possibility is the next step – that the same standard will be set when a patient is conscious and capable of expressing his/her own wishes! Once doctors are given the final authority to say what is best in one circumstance, it is most probable such authority would be expanded to every situation. It is not simply a matter of rationing health care. It is truly life-threatening.

  7. Sam says:

    He Whom Remembers,

    Trust me, I am wide awake, and trying to urge others to also wake up and realize that in this very real and important legal battle in Winnipeg, either we fight for what is right, or we risk not only losing Samuel Golubchuk (who will essentially be killed by his doctors) but our legal rights to be kept alive, should any of us become disabled and in the view of some young doctor have a life that is not worth living.

    This Brave New World of corporate for-profit medicine is fast encroaching upon all of us, and here before us we each have the chance to do the right thing: to write letters to the regular and Jewish media in Canada and North America, to contact our so-called leaders and see what they will do, if anything, to make our voices heard. Let’s shine a light on this Bojan Paunovic and those who would kill a disabled man.

    Let’s not get sidetracked with the immoral ‘futile care’ theory and other obfuscations and let’s call a spade a spade — or rather, let’s call attempted murder of a disabled man what it is: attempted murder of a disabled man. A convict would not be treated like this, yet somehow we are supposed to sit by idly while beasts try to get laws passed enshrining their right to play God and kill people? Doesn’t anyone realize that the origin of much of modern ethics stems from the Nuremberg Trials?

    Let’s expose the Canadian Medical Association and all those who are supporting the hospital system against an orthodox Jewish family and its pro bono attorney.

    Or, we can just write missives here, and pat ourselves on the back that we did something, or critique one another.

    It’s your choice.

  8. He Who Remembers says:

    Sam-
    Wake up. Every day Americans are refused life saving treatment by insurance companies because it gets in the way of their huge profits. Again, I urge everyone to watch “Sicko” to see how even heroic World Trade Center rescuers are mistreated to death all in the name of the almighty millions of dollars of profit heaped unto the bosses of the insurance companies. Watch the insurance underlings cry out for slichah for all the Americans they have been forced by their employer insurance companies to slay by refusing needed health care.

  9. Sam says:

    Dr. Hall states that something in the story does not make sense, or as we might say CENTS.
    Perhaps, however, such decisions make DOLLARS for the huge healthcare industry.

    There is a strong possibility that financial concerns are playing a role in the decision of the huge socialized healthcare industry to end the lives of patients whose lives are not deemed worthwhile enough in their subjective estimation, and to seek via cases such as this to obtain the unfettered and legally protected right to serve as judge, jury, and dare I say executioner.

    Regardless of their intentions, the dangers here are enormous, not only for Samuel Golubchuk, whose life hangs on the line, but to millions of Canadians, and to millions more of us who as we age and become disabled may have our very lives threatened by bureaucrats or a doctor about to leave town for a trip and eager to end matters quickly. Did such an event play a role in this case?

    According to media reports, in the health section of www. JPost.com and elsewhere, the ICU doctors did not even obtain a neurological consultation, nor did they get an EEG or any brain scan, so how can they state with absolute certainty that this elderly man, with an old brain injury which precludes verbal communication, has “minimal” brain activity?

    Le’sheetatam:
    Did they bother to follow the NEJM protocol (which merely creates a process for a decision completely contrary to not only halacha but Shiva Mitzvot Bnai Noach)? Apparently not.

    Did they have anyone really qualified in mental or cognitive function evaluate him? Apparently not.

    Are they listening to the children and others who assert he has not only awakened but has engaged in purposeful activity? Apparently not.

    Do they really care about the well-being of Samuel Golubchuk? Apparently not.

    Do they want to keep this man alive and return him to his family or a nursing home? Apparently not.

    Le’sheetateinu:

    Has the Jewish frum community as of yet arisen to publicly protest the planned killing of an innocent, disabled Jewish man? Is there more than lip service to the mitzvah of ‘Al Ta’amod Al Dam Ray’echa’?

    Apparently not.

    Are scattered words of “concern” by this or that Jewish leader or Christian blogger enough to stop the eugenics-like movement in corporate healthcare from killing our disabled and elderly?

    Apparently not.

    After meah v’esrim, will we be able to say to the beis din shel ma’alah that we did what we could to help save a life, and perhaps save many lives, by resisting b’chol kochainu this new machalah in the healthcare industry?

    I leave that answer to each and every one of you.

  10. Charles B. Hall, PhD says:

    The hospital in this case is run by — or is at least associated with — an evangelical Christian sect. The following is from their internet site:

    “The Salvation Army Grace Hospital is a faith-based community hospital in Winnipeg, Manitoba, Canada. Located in St. James Assiniboia – just west of downtown Winnipeg, the 270-bed facility provides quality patient-centred care in an environment that reflects Christian values. The Grace provides surgical, mental health, medicine, emergency and critical care programs where staff, volunteers and physicians together create a culture that nurtures and respects the unique value of faith in health care.”

    The facility also includes a free-standing hospice for terminally ill patients. Something in this story just doesn’t make sense.

    Also of interest is this recent editorial in the New England Journal of Medicine:

    http://content.nejm.org/cgi/content/full/357/1/1

  11. One Christian's perspective says:

    Golubchuk’s doctors informed his children that their 84-year-old father is “in the process of dying” and that they intended to hasten the process by removing his ventilation, and if that proved insufficient to kill him quickly, to also remove his feeding tube. In the event that the patient showed discomfort during these procedures, the chief of the hospital’s ICU unit stated in his affidavit that he would administer morphine.
    Filed by Jonathan Rosenblum

    May I share another perspective. My mother-in-law has been residing in an Assisted Living Home for 3 1/2 years now. This home is a gift from G-d. The primary care giver is a loving advocate for those in her care. She is like a mother lion with her cubs. However, over the years, I have seen these cubs – some came in their 90’s with a few months to live and actually lived 3 more years with such good care – reach the end of their time on earth. Often the family requests Hospice care to come in and come along side the care givers. We all have learned much from these kind workers and it is that we can observe the sometimes orderly process of dying. In Job, I read this morning that “Man’s days are determined; G-d has decreed the number of his months and has set limits he cannot exceed”. When a person is in the process of dying, their body is shuting down in a process designed by G-d. Hospice has compiled a listing of what they have observed in these wonderful folks who are leaving this world for a better one with the ALmighty. Truly, it is a process. To offer food and drink in amounts the body cannot process is painful and very often the dying person expresses “No food, drink or meds”. It is not the doctors who initiate the process, it is HaShem. And it is HaShem who sees it to its end according to His timing. Seek His wisdom, counsel and mercy. Pray for wisdom for doctors and caregivers. Trust in the L-RD.
    I am writing as one who watched her mother-in-law begin these steps last Friday. She had refused all meds, food and drink for a number of days before being admitted to the hospital and upon return from the hsopital. In the hospital, she received IV fluids and antibiotics for her infection. When they released her to go home, she was offered food, drink and meds but said No and clenched her mouth shut. Her request was honored. It is the law that patients cannot be forced to do what they do not want (for Assistant Living Homes – that is the extent of my knowledge). We spent quality time with her loving her, wiping her mouth with a cool wet cloth, touching her forehead gently and trusting in the L-RD’s timing and wisdom and praying for His mercy to not let her suffer long. Saturday morning found her sitting up in bed asking for nourishment and the TV to be on. She was given what she requested with love. Sunday she was even better; her feet were dancing in bed. Monday she was out of her bed and room and laughing with her fellow room mates. Her primary caregiver was amazed and she has been with the elderly, sick and dying for 15 years. I can offer no wisdom as to what happened other than to say HaSHem wasn’t ready for her at that time. In the interim, we have requested Hospice nursing care for her at the home. When the time comes, by G-d’s grace and mercy, she will not die is a hospital bed.

  12. He Who Remembers says:

    Insurance companies are criminal enterprises that instruct their employees to kill people rather than spend the profits that make their top people billionaires. There is nothing more immoral by halachic and non-halachic standards. Watch “Sicko” to see the testimony of insurance company employees with guilty consciences confessing their sins before Congress. Americans live shorter lives than the citizens of countries with single payer health systems.

  13. Sam says:

    I respectfully suggest that the discussion has drifted away from the crux of the matter. We are dealing with people who want to end the life of a disabled Jewish man, a tzelem elokim, someone who is on death row not for being convicted of a crime but soley for the ‘crime’ of becoming sick and entering under the control of a hospital system that seems determined to discharge this patient via the morgue.

    Physicians, who are all employees of a nationwide medical system (and hence in many ways dependent upon this system for their parnossa) are seeking the unrestricted right to determine “who shall live, who shall die” in the case of an elderly orthodox Jewish man–and to establish Canadian case law so as to become ‘judge, jury, and you know what’ for any and all patients whose lives they deem not worth saving.

    Reportedly, this fellow is not even close to brain dead, and not even vegetative.

    His legal guardians, in this case his children, are vehemently opposed to what might be euphemistically called by some “active euthanasia”, while others, including every orthodox rabbi, would choose another term for such action.

    This is not ‘shev v’al ta’aseh’, this is a proposed act or actions designed to bring about someone’s death, because in the eyes of a doctor or doctors who only know him for days or maybe weeks, this elderly man’s life is not worth living.

    We’re talking Aseret Ha’dibrot here.

    And make no mistake: the failure of the Jewish community’s members to protest publicly and vigorously, by posting letters to the Canadian media covering this case, to the hospital’s overseers, to Jewish publications who might further publicize this outrage, etc, may be (mis)understood by those who are watching how this landmark case develops as a sign that Jews as a whole do not really care about what may happen to their elderly and disabled.

    To sit back and write missives while a Jewish man’s life hangs on the line is one thing.

    To take action based on “Al ta’amod al dam ray’echa” might be something to consider.

    To write public comments–even here–that may be used to harm this family, such as rationales for rationing care etc (in Jewish law or otherwise) is, well, not mere Talmudic hairsplitting.

    If you feel something should be done, contact your rabbis, your organizations, etc. and let them know what you think. Contact the media. Write letters in support of this Winnipeg family. Do something!

  14. Seth Gordon says:

    Several commenters have remarked that no country has infinite resources to spend on health care. While this is true, is it relevant to the case at hand? If every patient in Canada (or the US, for that matter) was given a blank check to be put on life support indefinitely, how much would that affect that average Canadian’s tax bill (or the average American’s insurance premium)?

    After all, not everybody would want to take advantage of such a service, lots of people expire in ways that make the option irrelevant, and people on life support can die (of infections, etc.) despite their doctors’ best good-faith efforts.

    Has anyone done the math here?

  15. LOberstein says:

    The case in point was a major reason why many people opposed Hillary Clinton’s health care plan in the beginning of her husband’s administration. This is like Abortion which to be a crime, but now it is a “woman’s right to choose”. In time, the morality of letting the family decide to keep a patient on life support when there is no “quality of life” may change in the public’s mind. As health care reform is a vital issue in the current election campaign, this is a very timely topic. Insurance companies and / or the government are paying the bills, not the families of the patients. What is to stop them from saying we can’t afford to “waste” limited resources on people who can’t recover and who are only alive by artificial means? It may just be a question of time until the Canadian situation is the norm in the USA.

  16. shnmuel says:

    KT “Question- a drug which might save an individual costs $10 million to produce for 1 individual to be saved. Does Daas Torah require the society to produce the drug at the cost of other public needs”
    I just raised this question with a chavrusa/friend of mine, a noted Talmud Chochom in the community and magid shiur. We do see that communal concerns at times have been given precedence over the individual. eg the mitzvah of pidyon shvuyim does have limitations. While the rationale for that particular takanah/gzeirah additionally or even primarily was to produce an environment where gentiles no longer felt it was “worthwhile” to kidnap Jews . There is a communal financial aspect as well

  17. Seth Gordon says:

    Folks who are using this case to condemn davka the Canadian health care system should read up on the Texas Futile Care Law. This law allows a hospital’s ethics committee to override the judgement of a patient’s guardian and take the patient off life support. The law was co-drafted by the National Right to Life Committee and signed into law in 1999 by then-Governor George W. Bush.

  18. Chaim Davids says:

    How gruesome. The same countries that don’t have any money to help someone live nevertheless find millions of dollars a year to spend recycling glass and aluminum garbage and other noble causes. Replacing lost beach sand. Supporting homeless cats and dogs. And so on.

  19. joel rich says:

    OK Charles, as long as you opened the can of worms let’s talk about the community priorities. The real question in a macro economy is resource allocation. Would R’ Tendler favor 100% of the GNP going to medical care? One assumes not, so of course we’re faced with allocation issues.

    I wonder why this is not an issue raised by religious parties in eretz Yisrael? Family subsidies, monies to yeshivot, settlements seem to be a higher priority in different cases so it would seem that medical care issues are not primary when compared to these.

    Question- a drug which might save an individual costs $10 million to produce for 1 individual to be saved. Does Daas Torah require the society to produce the drug at the cost of other public needs?

    KT

  20. mycroft says:

    These are non-trivial issues. The attacks on so-called “socialized medicine” are a distraction from them. Medical care is also rationed in the US; if you aren’t independently wealthy you only have the “right” to whatever care your insurer provides. And if you don’t have insurance in the US you only have the right to emergency care. Also, the long waits for some treatments in Canada do not appear to have affected objective health outcomes in the overall population. Rabbi Dr. Moshe Tendler stated last year that it is a Torah chiyuv on the community to provide health care for all.

    A similar point in Israel-the average person receives better medical care there-affordability is not a major issue in deciding medical care. Outcomes-life expectancy better than US-certainly Jewish population has much better life expectancy than US figures.

    Those who dismiss “socialized medicine” should suggest how Rabbi Dr. Tendler has erred in halachah or propose an alternative method as to how to achieve the mandate.

    There are other Orthodox Rabbis who have also discussed in Medical Ethics the major issue of lack of effective access to health casre in the US-but in general it is an ignored topic. Possibly, that many lectures about Jewish Medical Ethics are made by Physicians and frankly that is not their expertise-halacha is an issue for Rabbonim not physicians, lawyers, accountants etc.

  21. Charles B. Hall says:

    This essay raises many profound questions that go far beyond the immediate issue of obtaining this individual patient the medical care he and his family desire. I’m not a rabbi nor a physician, just a medical researcher, but here are some that come to mind:

    One major issue here is that of patient autonomy. Judaism takes a much narrower view of patient autonomy than does western culture in general: We say that one does not have the choice to abuse ones body or end ones life and that one has an obligation to seek medical treatment. Yet ironically it is only through such the application of autonomy that we are able to follow HaShem’s commandments; we see in this essay what can happen when autonomy is limited. Yet absolute application of autonomy leads to the permissibility of physician assisted suicide and other things we abhor. A balance must be struck.

    A smaller but still very significant issue is that of medical judgment and allocation of resources. A physician does have the right to say that treatment would not be worthwhile and to decline to treat. In theory, a patient could then try to find a different physician who would treat, but are there never unintended consequences? The classic example is a demand of a patient for antibiotics for an infection that would likely clear up on its own without treatment: The medication might help that patient, but at the risk of promoting the development of antibiotic-resistant bacteria that would endanger the entire community. Another classic example is a patient being treated aggressively for a disease with a very poor prognosis when there is a shortage of hospital beds. (Such shortages occur every now and then in parts of the US because our profit-maximizing system strongly discourages hospitals from maintaining extra capacity.) Can we really discharge the very sick patient to die in order to treat patients who would benefit more? I do not know the answer to this question. Free market economics says that society benefits when everyone tries to maximize his/her own economic position; that is not true in medicine.

    These are non-trivial issues. The attacks on so-called “socialized medicine” are a distraction from them. Medical care is also rationed in the US; if you aren’t independently wealthy you only have the “right” to whatever care your insurer provides. And if you don’t have insurance in the US you only have the right to emergency care. Also, the long waits for some treatments in Canada do not appear to have affected objective health outcomes in the overall population. Rabbi Dr. Moshe Tendler stated last year that it is a Torah chiyuv on the community to provide health care for all. Here is a link to that shiur:

    http://www.yutorah.org/showShiur.cfm/716090/Rabbi_Moshe_D._Tendler/Time_of_Death:_Brain_Death_in_Jewish_Law

    I think the statement I refer to comes 20 to 25 minutes into the shiur. Those who dismiss “socialized medicine” should suggest how Rabbi Dr. Tendler has erred in halachah or propose an alternative method as to how to achieve the mandate. Halachah must drive all our actions, including in areas such as this.

  22. another Mordechai says:

    This is not a case about freedom of religion;

    it is just another unfortunate example of the fact that in Canada – and other countries where “socialized medicine” is practiced – patients and their families are never accorded the right to determine the course of treatment – because socialized medical facilities have limited resources and can’t treat everybody. And – More Important: Since the government is paying for the treatment – and the patient is not paying – the patient and his family are routinely denied the right to make the necessary medical decisions – and only the government-paid doctors are accorded that right.

    As for the doctor’s statement about the “best interest” of the patient – he clearly doesn’t want to admit that he is just not concerned about that.

    But freedom of religion can still be exercised in Canada: by bringing the patient to the USA and actually paying for his treatment. This is the path which has already been chosen by many Canadians – regardless of religion – if they could afford it – because of the nightmarishly long wait for proper treatment in Canada – in which vital operations are routinely delayed for months – because too few doctors are available in the “socialized medical system” – and Canadian patients (if they couldn’t afford to come to the USA) have repeatedly died because their treatment just wasn’t available (while they were kept on a “waiting list”).

  23. Sam says:

    Avigdor’s cases had different outcomes than this test case for the Canadian courts. In this case, the doctors reportedly are going against the explicit wishes of the family of this orthodox Jewish man and trying to end his life, without obtaining much if anything in the way of neurologic testing to confirm or refute their view that this man’s care is futile or that he indeed has “minimal” brain activity.

    Why Canada’s frum community has not publicly protested the implications of such legal maneuvering is beyond me.

  24. Steve Brizel says:

    While the hashkafic POV is certainly important, it would also be equally if not important to see the various and differing halachic views of Gdolei HaPoskim mentioned on end of life issues such as brain death, etc. Would that not show that the Halacha has a POV that is profound and relevant to the issues at hand?

  25. mycroft says:

    The rage for medical rationing in Canada

    TYPICAL CONSERVATIVE ATTACK ON MEDICAL CARE THAT HAS BETTER OUTPUTS THAN THE US-BETTER LIFE EXPECTANCY ETC-IT DOES HAVE LESS INPUTS EG LOWER DOCTOR SALARIES AND FEES-BUT PEOPLE LIVE LONGER. IN THE US TOO PHYSICIANS FIND A WAY TO EXPEDITE END OF LIFE IN THE GUISE OF RELIEVING PAIN-SEE EG MORPHINE DRIP.

  26. Phil says:

    FWIW, even though Professor Weikart’s lecture was called “From Darwin to Hitler,” he makes it clear in the beginning of the lecture that the title is a little misleading, that it’s not an inevitability that Naziism should arise from Darwinism. On the other hand, he does present, in my opinion, a fairly good case for the relationship between the two.
    My heart goes out to the Golubchuk family.

  27. Ori says:

    Any situation involving limited resources, such as ICU beds, requires resource allocation. This resource allocation can either be using market forces, rationing decided by experts, or a combination of the two. To pick an extreme example, when an ambulance arrives at the scene of a suicide bombing the medics have to quickly divide the victims into three categories: those they don’t think they’ll be able to save, those they think will survive if given treatment, and those that will survive anyway. Nobody in the first and third groups will be treated until the members of the second group are stabilized. They probably make mistakes that cause people to die – but it’s the best system we have for a few medics to take care of many injured victims.

    In Canada, where medicine is socialized, medical care is by definition rationed by experts. If the hospital were honest, they’d say they don’t have enough ICU beds, nurse hours, or any other resource – and that they’d rather spend them on people likely to recover. But that would force the hospital administration to admit the failures of socialized medicine. This is probably a career killer.

    BTW, what is the Halachic position if you have a patient on a ventilator that has been unconscious for a year, and you need the ventilator to save somebody who is more likely to regain consciousness? Is taking away the ventilator from the first patient murder as it would be if there was no alternative use for it?

  28. Avigdor says:

    As a Canadian frum Jew I have to offer another perspective on the Canadian medical establishment.

    I have on two occasions been in the position of being the go-between with doctors and hospitals on behalf of my family (who are not frum) for a dying grandparent. One case took place in a semi-private Jewish hospital and the other in a public hospital (both in the Toronto area).

    In both cases the hospital staff, doctors and ethicists agreed without any problem to provide the halachicly mandated level of care for both terminally ill patients. In one case the doctor offered my grandmother (who was still cognisant at the time) the option of speeding things up if she wished (she had ALS). She declined and that was the last we heard of it.

    I think that these issues have more to do with individual hospital practices than the Canadian health care system as a whole and that it is very important for people to make their wishes known to family (in writing preferably) before these situations every arrive R”L. I do agree though, that society as a whole is becoming a little too comfortable with ending other peoples’ discomfort.