Navonim - The Ramblings of Garnel Ironheart

Navonim - The Ramblings of Garnel Ironheart

Monday, 31 December 2007

Deciding for Others is Wrong

I had never heard of Sam Golubchuk until this afternoon. Now I know too much about what has been happening to him and I worry about the state of medicine in Canada because of that.

I was tipped off to this by Rav Yonasan Rosenblum's latest piece which deals with the matter. WHile I think he's a bit harsh on doctors in general, I agree this is quite a concern.

Mr. Golubchuk is 84 years old and from various descriptions of his condition, he appears to be in a permanent coma, unable to feed or care for himself. He is also occupying an ICU bed, something which is a precious commodity in Canada these days.

The crux of the conflict is that his son and daughter (I presumed they've asked a Rav about this) which to keep him on life support so that he does not die prematurely. This would be in accordance with halachah and as Mr. Golubchuk is apparently a Torah observant Jew, what his wishes would be.

The hospital wants to turn off the respirator. Different reasons have been offered. One doctor says that he no longer "can ethically participate in the administration of this treatment any longer.” He, and some of his colleagues, feel that continued treatment is futile. Mr. Golubchuk has no chance of recovery and therefore there's no point in treating him so that he can remain vegetative.

The hospital ethicist has even weighed in with this gem:

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."

(How much do you want to bet he's pro-abortion?)

The actions of the doctors and the hospital are wrong. The first, and most important principle of the doctor-patient relationship is autonomy. In Canada, the patient is an independent consumer of health care. It is the job of the physican to provide options to the patient along with an explanation of the risks and benefits of each and then the patient decide (or in this case, his designated powers of attorney). The only exceptions are in case of mental incapacity and emergency situations where there is no time for a rational discussion. Then the physician is presumed to be acting in what his professional opinion is the best interest of the patient.

However, in a way I've always found creepy, this is also a culture in which concepts like euthanasia and assisted suicide have gained some limited acceptance. While still justly reviled by the majority of people, a significant minority, many hospital ethicists amongst them, have embraced such concepts as being enlightened. We have reached a point in society where living in pain or with disability, if it enough of either, is unacceptable and death has become preferable.

Years ago I sat in a class on palliative care and listened to the presenter talking about withdrawal of care or possibly giving a little too much morphine at the right time. We went around the table and the general consensus was "Well, if he's really suffering and there's no way out, then I guess it can't be bad." When it was my turn, I answered with what I believe is the proper halachic answer based on my understanding of the sources: "Deliberately shortened a person's life by even one second is murder, no matter how humane it might sound."

Naturally the others were shocked at the absolute stand I took but I reminded them that an absolute stand is infinitely better in this case than something undefined. Exactly how intractible must the pain be before euthanasia is no longer immoral? What if a person knows they're going to be in pain? Can they ask to die before it starts to avoid suffering? If shortening life by a few seconds is all right, where's the limit: a day, a month, a year?

It is an interesting irony that while halachah is very clear on the limits of patient autonomy - a person's body is given to him as a trust from God and he is obligated to take the best care of it possible irregardless of his lack of interest in doing so - compared to flexible, open Western secular thought, it is Western secular thought that would wind up murdering Mr. Golubchuk while constricting, supposedly archaic halachah still sees him as a human being with infinite value worth preserving.

No comments: