Winnipeg, Canada – End of life: Who Should Decide To Stop Treatment?

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      Dr. Joel Zivot, top right, raised eyebrows when he acted as a pallbearer for his patient, Samuel Golubchuk, who died in 2008. [Mike Aporius, Canwest News Service].Winnipeg, Canada – The doctor for a dying Jewish man at the heart of an emotional court battle has spoken out about the case for the first time, calling for a public inquiry to help clear up the growing debate over who should decide the care of gravely ill patients.

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    Dr. Joel Zivot suggests in a journal article that it is wrong to give physicians the final say over whether to halt life-extending treatment of such patients, and argues that ICU doctors are in a conflict of interest, since they both try to save people and provide palliative care when they consider treatment hopeless.

    Dr. Zivot volunteered to care for Samuel Golubchuk in 2008 when a Winnipeg court ordered Grace Hospital to keep the 84-year-old on life-support systems–and three intensive-care doctors originally involved in his care quit in protest. Dr. Zivot also raised eyebrows when he acted as a pallbearer at his patient’s funeral.

    “As a practising critical care physician, my ethical role is to save lives, not take them,” the doctor wrote in the American Journal of Bioethics. “The struggle by patients to live should be encouraged…. We should always admire the struggle, not vilify it.”

    Mr. Golubchuk’s adult children had fought for him to be kept alive as long as possible, citing in part his orthodox Jewish beliefs, while the original Grace doctors said he was so deathly ill, it was actually cruel to extend treatment.

    About the same time, the province’s medical regulator issued a statement saying that doctors should have the last word when such disagreements cannot be resolved.

    Dr. Zivot said he saw no evidence to support the view of the ICU specialists who cared for Mr. Golubchuk earlier that keeping him on life support was “tantamount to torture.”

    But Dr. Anand Kumar, one of the initial ICU physicians, said in an interview that he remains convinced the patient was being subjected to painful, uncomfortable treatment for no good reason, a situation that he said was shattering for the unit’s staff. While patients and relatives should have considerable say over medical care, there comes a point when doctors have to be able to put a stop to fruitless treatment, he said.

    “If I’m going to inflict pain or discomfort on somebody, I better feel I’m doing it for a good reason,” said Dr. Kumar. “If we’re not benefiting the patient, then all we’re doing is tormenting somebody.”

    Meanwhile, the increasing number of disputes that end up in court are having an impact on intensive-care staff, much as malpractice suits in the United States prompt inappropriate medicine there, said Dr. Kumar.

    “The younger generation are kind of leery of these kind of issues and we’re getting into a mentality of ‘Whatever the family wants…. It doesn’t matter whether I think it’s right or wrong, if that’s what they want, that’s what I’ll provide,’ ” he said.

    “The perception among the older physicians in the Winnipeg critical care community is that these kind of things are having an adverse effect.”

    The latest edition of the U.S. bioethics journal contains 12 commentaries on the case and issues around it, with one American academic saying it “raises profound questions” about how much authority doctors should have over end-of-life treatment.


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    12 Comments
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    manhattan md
    manhattan md
    13 years ago

    doctors should decide life and death.

    MazelKGH
    MazelKGH
    13 years ago

    Generally, the Agudah should decide but being this is Canada anyone with a French passport has the right.

    almana
    almana
    13 years ago

    to #1 i fought doctors like you for my husband`s life.
    you are no good.

    mp
    mp
    13 years ago

    its hard to live like a jew . its even harder to die like a jew

    BRO
    BRO
    13 years ago

    We are headed toward Euthenasia. But don’t worry. It’s nothing new. The nazi’s practiced it too, prior to killing Jews.