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Fri 14 Dec, 2007 02:39 pm
Life-support case a risky precedent, MDs warn
JOE FRIESEN
From Thursday's Globe and Mail
December 13, 2007 at 5:05 AM EST
WINNIPEG ?- The Canadian Medical Association says the case of a Winnipeg man being kept on life support by a court injunction could set a dangerous precedent that would force physicians to provide futile or even potentially harmful medical care when a family demands it.
The debate revolves around Samuel Golubchuk, an 84-year-old man whose doctors say has limited brain function, can't walk or eat, breathes only with the help of a respirator and, barring divine intervention, is unlikely to recover. His family says it's a violation of their Orthodox Jewish faith to remove him from life support, and their lawyer, Neil Kravetsky, argued in court this week that to do so would constitute assault and battery. The family believes it would be murder.
A judge is currently considering whether to extend the temporary injunction that is keeping Mr. Golubchuk on life support in the intensive-care unit at Winnipeg's Grace Hospital. Mr. Golubchuk has been in that state of limbo since Nov. 30. In an affidavit filed with the court, a nurse said he was retaining 45 litres of water and was swollen to the point of bursting.
Jeff Blackmer, the CMA's executive director of medical ethics, said physicians are paying close attention to the case to see whether the court will side with the family in dictating the level of care that will be provided. It could set an important precedent, he said.
"Physicians may feel that they're being placed in a position where they're required to [provide futile or potentially harmful treatment] when the patient or family demands it," he said. "We don't want to see physicians making decisions with one eye on the lawyers."
According to documents filed in court, the physicians at Grace Hospital concluded Mr. Golubchuk could not recover from his ailments, and that rather than extending his life, they were prolonging his death.
"When a clinician makes that determination then the ethical standard is that physicians do not have an obligation to offer care that has been deemed futile," Dr. Blackmer said.
It would be worrisome if society chose to take those decisions out of the hands of physicians and place them with the courts, he said.
Arthur Schafer, the director of the University of Manitoba's Centre for Professional and Applied Ethics, said the case, if it goes against the hospital, could have a potentially harmful effect on the practice of medicine.
"If you bring someone into the emergency department you assume that their life may be worth saving and you get them on everything that could be needed," he said, adding that would include putting them on medication, dialysis or a respirator.
"If the case goes against the hospital on the grounds that once you plug in you can't unplug, I think people will be a lot slower to plug in, and some people may die who should have been plugged in. So the social implications of a victory for Mr. Golubchuk, his children and their lawyer would, I think, make Canadian hospitals deviate from good medical ethics."
They want to keep the plug in, they should pay. Show them the bill. See if that changes their minds!
Yeah, well - from the family's perspective doing all you can to stay alive means keeping him plugged in.
The problem is that being plugged in doesn't mean the poor old fart isn't suffering, losing dignity, or costing tax payers money or that in a society with some sense of desperation, or connection to reality that it would even happen.
To me it's just one of the many problems with socialized medicine.
hanno wrote:To me it's just one of the many problems with socialized medicine.
Well, stay out of Britain, then, or if you go there, don't fall sick. And leave us to run our own health systems.
hanno wrote:To me it's just one of the many problems with socialized medicine.
This isn't a problem with socialized medicine. It's sad regaurdless of the state or the family payig for it.
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In the US the family would get it's way. Remember the Terry Scivo case.{spelling?] She was in much worse state than this individual. As to the families contention it is religiouly unaceptable. That is bunk. There is nothing in the religion that asks that one be kept alive by artificial means.
Quote:His family says it's a violation of their Orthodox Jewish faith to remove him from life support
That was as far as I got before I unknowingly started shaking my head.
What did orthodox jewish people do before we invented lifesupport? Did they violate their faith by allowing people to die naturally?
I wonder what these people would say to the fact that some countries have stopped giving aid to children born before the 22nd week of the pregnancy, on the basis of studies that have revealed that nine in ten of these children grow up suffering from ailments so severe that it prohibits any quality of life for them, and lowers the quality of life for everyone who has to take care of them...
Cyracuz wrote:Quote:His family says it's a violation of their Orthodox Jewish faith to remove him from life support
That was as far as I got before I unknowingly started shaking my head.
What did orthodox jewish people do before we invented lifesupport? Did they violate their faith by allowing people to die naturally?
I wonder what these people would say to the fact that some countries have stopped giving aid to children born before the 22nd week of the pregnancy, on the basis of studies that have revealed that nine in ten of these children grow up suffering from ailments so severe that it prohibits any quality of life for them, and lowers the quality of life for everyone who has to take care of them...
As I said I know of no such requirement in Jewish law.
Regarding the stopping of aid to children born before the 22 week. That would never fly in the US. The evangelicals and anti abortion crowd would fight that tooth and nail.
Yeah, isn't that backwards? You got millions of healthy individuals forced to survive on what they can find in the garbage while millions are spent to take care of folks who cannot close their mouths and do not know it themselves.
au1929 wrote:... There is nothing in the religion that asks that one be kept alive by artificial means.
Is this man really being kept alive while on the respirator? It's obvious his kidneys are shutting down and it's likewise obvious that this patient is dying while on the respirator.
Let him live outthe remainder of his life on the respirator and when his kidneys totally stop functioning and his HR descends to zero, he will be dead. This is as natural as it can be, given the circumstances.
Diest TKO wrote:hanno wrote:To me it's just one of the many problems with socialized medicine.
This isn't a problem with socialized medicine. It's sad regaurdless of the state or the family payig for it.
Damn right. But I didn't say it had to get payed for. If I were to say reality were sacred it would mean nothing to you - you'd probably think that since you had a job when you were 14 and you took it hard when grampa died that you wrote the book on it. But you kids don't even treat reality like part of the equation. Let me spell it out.
Exotic treatments, those that relate to irregular and particularly desperate conditions and entail methods of unconfirmed or even unlikely effect, tend to be expensive and produce a spectrum of effects which may or may not be desirable. If people don't have a communal blank check when it comes to treatment they won't end up burdened with the possibility of the exotic stuff (as it may relate to religious ideas) or paying for someone else to get it.
contrex wrote:hanno wrote:To me it's just one of the many problems with socialized medicine.
Well, stay out of Britain, then, or if you go there, don't fall sick. And leave us to run our own health systems.
I wouldn't waste my managerial vision orchestrating the wiping of noses among you whiners, and I don't 'fall' sick because I'm made of American Midwestern stock little darlin'. If I need medical attention it's because something made me need it and there aren't many things that can do that.
As for your health care systems - you, as a group, can't decide where what covers your sweet ass ends and whatever is frivolous and fanatical begins except that you do it with such little decorum as to say 'pull the plug - let them pay for that' so don't knock the free market.
Oh, damn I'm good.
So what you seem to hypothosize is that if a family doesn't have to foot the bill, they will just keep their elderly (or comatose) plugged in indefinately and let their health get even worse? Am I understanding you correctly?
If so, ou're making poor assumptions. I have lost both of my grandparents in the last 6 months. both of which had artificial life support before they died. Their suffering was intolerable, and my family was able to do little.
The problem has no relation to socialized health care.
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If the family can't pay, and the society won't then treatment won't occur.
hanno wrote:If the family can't pay, and the society won't then treatment won't occur.
Sounds more like an argument for socialized medicine.
What happened when our ansestors said "If the family can't pay, and the society won't then education won't occur?" They made public schools. Remember, an education is not a garanteed right, but perhaps, in our finer moments, we know that we should do more than the bare minimum.
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Here it is- the quote of the millennium:
I don't got no finer moments.
Education is guaranteed because minors have rights they can't exercise for themselves. You could say it's a matter of national (not social or communal) concern as well, where in the same light vegetative patients - if we were all thinking with our heads not our hearts would go out on icebergs or flaming boats full of posessions.
I'm fairly positive that this will not be the quote of the millenium. Your ego seems to be firmly attached to your opinion. This is understandable, but ultimately a distracting element in your posts.
Again, education is NOT garanteed, but our country (like others) sees education as being a service we should be able to offer. I don't see why this should not apply for healthcare.
Ultimately, we've kind of derailed this thread topic. I can appreciate your thoughts on socialized health care, I hope you can appreciate mine.
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I don't think I've derailed the thread - I'm pointing out a distinction that you seem to think the absence-to-your-understanding of mandates socialized medicine.
You seem to be intelligent and contemplative - but I think you're projecting crude, self-pleasing speculation into things you haven't bothered to understand. I mean, 'a service we should be able to offer'? Do you really think the government is guided by some moral compass that transcends reason? Or are you generalizing and missing some of the more functional aspects of the point? We do education because we think it's necessary to keep the country in business, for reasons I'd be glad to run down, just like we do nuclear deterrents and highways for various reasons rooted in practicality, necessity, and governmental theory.
And 'should be able to' isn't even the best thing socialized medicine has going for it. Proponents who aren't content to play-to-emotion say stuff like it could give people more confidence and make them more productive, or save some amount of GDP if it could be run more efficiently outside the free market, or that people without it are being treated unreasonably for some of a couple dozen reasons. That stuffs all a bunch of crap but at least it doesn't seek to impose one particular line of blue-eyed sentiment or a one-sided co opt of utilitatianism on people at their own expense and potentially to their detriment.
au1929 wrote: There is nothing in the religion that asks that one be kept alive by artificial means.
Which religion are you referring to? The children of the patient are Jewish and according to their beliefs and probably also their Rabbi's they're doing the moral thing by letting their father die while on the respirator and while his kidneys fail.
In my opinion they're dong the correct thing.
Would it be better that the patient die, off the respirator while his kidney's fail and he's suffering in pain?
hanno wrote:I don't think I've derailed the thread - I'm pointing out a distinction that you seem to think the absence-to-your-understanding of mandates socialized medicine.
You seem to be intelligent and contemplative - but I think you're projecting crude, self-pleasing speculation into things you haven't bothered to understand. I mean, 'a service we should be able to offer'? Do you really think the government is guided by some moral compass that transcends reason? Or are you generalizing and missing some of the more functional aspects of the point? We do education because we think it's necessary to keep the country in business, for reasons I'd be glad to run down, just like we do nuclear deterrents and highways for various reasons rooted in practicality, necessity, and governmental theory.
And 'should be able to' isn't even the best thing socialized medicine has going for it. Proponents who aren't content to play-to-emotion say stuff like it could give people more confidence and make them more productive, or save some amount of GDP if it could be run more efficiently outside the free market, or that people without it are being treated unreasonably for some of a couple dozen reasons. That stuffs all a bunch of crap but at least it doesn't seek to impose one particular line of blue-eyed sentiment or a one-sided co opt of utilitatianism on people at their own expense and potentially to their detriment.
Before I address your statements, could you clarify the above post. I am having difficulty with understanding some of your points. The wording is confusing. please repost.
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