[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 SGolubchuk@shaw.ca.

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.”

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.

KT

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.

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 http://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.

“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

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.

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!

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?

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

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.

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.

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”).

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

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.