Thursday, December 20, 2007

Courts Grapple with Life-Support Removal Applications.

CNN reports that a 29 year old Australian man has died after a Northern Territory Supreme Court judge ruled against his family's request for the continuation of artificial life support.

The court found that continuation of life support for the man, who had been in a coma since a December 5 motor vehicle accident, was futile.

The Canadian Jewish News reports on a similar case, now pending in Winnipeg, Manitoba:

WINNIPEG — The family of an Orthodox Jewish man, 84-year-old Sam Golubchuk, has gone to court to require Winnipeg’s Grace Hospital to continue giving him life-support, including a ventilator and tube feeding in accordance with their religious beliefs.

Sam Golubchuk’s son and daughter, Percy Golubchuk and Miriam Geller retained legal counsel to prevent the hospital from violating their father’s religious beliefs and hastening his death by pulling the plug.

However, the hospital has taken the position that it wants to disconnect Golubchuk’s ventilator and pull his feeding tube because Golubchuck has minimal brain function and there is no hope of recovery.

CTV News also addressed the Golubchuk case:

The court's decision could have a far-reaching impact on Canadians trying to make decisions about their relatives at the end of their lives, said Arthur Shafer, director of the University of Manitoba Ethics Centre.

"Mr. Golubchuk was plugged into life support when they weren't sure whether he would benefit or not -- and once they discovered that he wouldn't benefit, what this family is saying is that if they disconnect him, they're committing murder," Shafer said.

"That means we have thousands of murders every year in Canada done by doctors, which I think is a completely untenable position."

In the majority of cases, Shafer said, decisions are made through dialogue and discussion between family members and physicians. In some cases, hospitals will keep a patient on life support long after it is justified medically to do so, simply to accommodate the family, he said.

But there comes a point, Shafer said, when families must realize that with a shortage of hospital beds, "one person's provision is another person's deprivation."

...There is no word on when the court will hand down its decision.

- Garry J. Wise, Toronto

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Anonymous said...

I'll repeat here what I just said on another blogsite about Mr. Golubchuck's case:

“The doctors say the patient in question is brain dead.” That is not true and reflects the media’s failure to ascertain and report accurately all of the relevant medical facts, as well as unquestioning reliance on testimony of physicians without neurologic training.

Mr. Golubchuck has been described as “comatose” or “unconscious,” but an ICU physician noted in the chart that he was “awake.” This man with a history of a serious traumatic brain injury and probable aphasia (inability to communicate verbally) has not been evaluated by a neurologist during the course of his hospital stay, though he is said to show “minimal brain function,” a term of no precise meaning and the standard of care would demand such under the circumstances.

Mr. Golubchuck was admitted to the hospital from a nursing home with pneumonia and has required the ventilatory support of a respirator. He triggers the respirator with his own respiratory efforts, and he has been off the respirator for as long as a day before a falling blood oxygen level required him to be re-connected to the respirator.

A nurse has been quoted as saying that she was appalled by Mr. Golubchuck’s condition (empathy?), and that “he was retaining 45 liters of water, and his skin was swollen to the point of bursting…’he was rotting from the inside out.’” “Rotting from the inside out” is certainly colorful imagery but medically meaningless. (If he was literally “rotting from the inside out,” e.g., a gangrenous bowel, he would not have survived for days, let alone the two months that he has been in the hospital. 45 liters of water weighs 45 kilos or 100 pounds, so is this nurse claiming that Golubchuck weighs 45 kilos/100 pounds more than before he came to the hospital? Hard to believe and would certainly cause an informed person to wonder how they were managing Mr. Golubchuck’s fluids and whether they were otherwise treating him properly, e.g., use diuretics.

It is scandalous that the question of whether this man should live or die is being bandied about when the basic medical data has not been obtained and shared. Those who think the ICU physician should be fully empowered to decide the issue with no “interference” by the family or a court, should entrust themselves to Grace Hospital and its staff. I certainly wouldn’t

James Hill said...

Six weeks after the hospital wanted to pull the plug, Sam Golobchuck is recovering!

Remember for whom the bell tolls.