U.S. doctors weigh in on right-to-life case

Samuel Golubchuk, the 84-year-old Orthodox Jewish man whose life has become the subject of a court battle over his family's right to demand he be kept on a life-sustaining ventilator, has shown signs of improvement in recent weeks and may not be near death at all, his lawyer said in court yesterday.

Neil Kravetsky, who represents Mr. Golubchuk's adult children, said he has obtained affidavits from two prominent American physicians that question the decision made by doctors at Winnipeg's Grace Hospital to remove Mr. Golubchuk's ventilator tube.

The new affidavits, from critical-care doctor Daniel Rosenblatt and neurologist Leon Zacharowicz, were the focus of legal arguments over admissibility yesterday. They say Mr. Golubchuk's medical charts show he was never examined by a neurologist, that he hasn't been shown to be dying and that his condition may be no worse now than it was before he was admitted to hospital, Mr. Kravetsky said.

"The chart says his eyes follow sound and movement, that he is much more responsive and awake," Mr. Kravetsky said. "What does awake mean to you?"How can you say that someone has minimal brain [function] or is vegetative without doing the appropriate tests?"

When the case first landed in court last month, lawyers for the hospital said doctors had determined Mr. Golubchuk couldn't eat, breathe or walk on his own, had minimal brain function and no chance of recovery. To continue treatment would be unethical, they said.

But Mr. Kravetsky obtained a temporary injunction that has kept Mr. Golubchuk in the intensive-care unit ever since. The family argued that it was an assault to commit an act that would result in their father's death, and that to hasten his death was a violation of their Jewish faith.

Bill Olson, lawyer for the Grace Hospital, said the affidavits should be thrown out because the judge has already ruled the time for evidence is over. A patient's condition can change from day to day, and doctors can have differing views on the appropriate course of treatment, but hospitals shouldn't be forced to seek out every differing medical opinion before making decisions about care, he said.

"If that's the test in these types of cases, then decisions on treatment will never be made because everybody will have to go to court and then you have competing experts and the judge makes the decision," he said.

"The issue is, does this treating physician have the right to make the judgment call?"

Mr. Olson said it's not as though doctors would immediately pull the plug on Mr. Golubchuk should the court rule in their favour. He said Mr. Golubchuk's condition will have to be re-evaluated at that point.

Mr. Kravetsky was skeptical of that position.

"What they're saying is 'Judge, lift the order so we can make the determination, and if we think the man should live we'll let him live, and if we don't we'll let him die,' " he said.

The Canadian Medical Association waded into the debate last month, saying it could set a dangerous precedent if the judge rules in favour of the family. They said it could force doctors to practise with one eye on the lawyers, and might push them to provide futile or harmful care whenever a patient's family demands it.

Mr. Golubchuk was admitted to the hospital on Oct. 26. He had a pre-existing brain injury caused by a fall in 2003, which forced him to have part of his brain removed. When he arrived in hospital, he had pneumonia and his heart was struggling to beat regularly. He also had MRSA, an antibiotic-resistant infection, and his kidney function was poor.

In retrospect, according to an affidavit filed by the hospital's chief of medicine, it may not have been a good decision to admit him to the intensive-care unit in the first place.

Mr. Golubchuk became grossly swollen, according to one nurse, and was retaining 45 litres of water, 10 times the normal amount. She said she was appalled by his condition.

Mr. Golubchuk's children were in court yesterday but did not speak to the media.

Mr. Justice Perry Schulman said he would return with either a decision or further direction on the case at some point next week.

Source:www.theglobeandmail.com