MetaCatholic

I must, I think, disagree with Claude Mariottini on the facts as he cites them about a particular medical case. Although I hope you will read Claude’s post in full, I quote the story as he cites it from the Jewish World Review.

A Winnipeg case currently winding its way to its grim conclusion pits the children of Samuel Golubchuk against doctors at the Salvation Army Grace General Hospital. According to the leadings, Golubchuk’s doctors informed his children that their 84-year-old father is “in the process of dying” and that they intended to hasten the process by removing his ventilation, and if that proved insufficient to kill him quickly, to also remove his feeding tube. In the event that the patient showed discomfort during these procedures, the chief of the hospital’s ICU unit stated in his affidavit that he would administer morphine.
Golubchuk is an Orthodox Jew, as are his children. The latter have adamantly opposed his removal from the ventilator and feeding tube, on the grounds that Jewish law expressly forbids any action designed to shorten life, and that if their father could express his wishes, he would oppose the doctors acting to deliberately terminate his life.
In response, the director of the ICU informed Golubchuk’s children that neither their father’s wishes nor their own are relevant, and he would do whatever he decided was appropriate. Bill Olson, counsel for the ICU director, told the Canadian Broadcasting Company that physicians have the sole right to make decisions about treatment — even if it goes against a patient’s religious beliefs — and that “there is no right to a continuation of treatment.”

I make these comments provisionally, since there may be much more to the story than is apparent in either the report or this citation.

First, the doctor sounds (or is made to sound), shall we say, highly insensitive. That granted, I see two clear stories or perspectives going on here. The director of the ICU is talking about ceasing treatment, not about terminating the patient’s life. The family, the reporter, and Claude discussing the report are talking about “terminating life”, and giving the doctors absolute power to terminate life. These are, however, two entirely different things, especially when considered in their moral aspect.

The story (which does appear to me to be written tendentiously) seems, at heart, about a man who would not be alive without artificial intervention, whom no amount of artificial intervention can any longer cure, or even render conscious, and whose natural life is being unnaturally extended. It does seem to me to be within the bounds of clinical decision making to state that further treatment is pointless. This is not, in any respect a “life or death” decision, since the outcome is known to be death. It is not euthanasia, but rather ceasing to “strive officiously to keep alive”.

It does sound, from this story, that there is a serious breakdown of communication between medical staff and the patient’s family. Equally, I don’t feel equipped or prepared to comment further on that, since I have some questions about the bias of the reporting. However, it does seem to me that wherever possible a doctor’s duty of care for a patient must be presumed to include the family unless and until the doctor becomes convinced that the family are not acting in the best interests of the patient’s care. Then of course, it is a case of “First, do no harm.”

The advances of science and technology have created new dilemmas here. Without ventilation and incubation, and high class medical care, it seems relatively clear that the patient would have been dead before this point. This is increasingly a common situation. We need to find a clear way of thinking about our responses, especially in the face of ultimately limited resources (limited for all but the more wealthy). But what I believe we must ensure if we are seriously to debate healthcare of the terminally ill, is the moral distinction between the withdrawing of treatment on the one hand, and medical intervention to end life on the other. They may appear to have the same consequence, but they are very different things, and if we fail to make that distinction we will serve neither the patients and their families, nor the medical profession.