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Author Topic: Interesting case about religious rights in healthcare
Indiana Jones
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posted 16 December 2007 11:29 AM      Profile for Indiana Jones        Edit/Delete Post  Reply With Quote 
Anyone seen this? Any thoughts?

http://uk.reuters.com/article/worldNews/idUKN1321757620071214

TORONTO (Reuters) - Medical science and religion clashed this week over whether to switch off life-support equipment that is keeping an 84-year-old man alive in a Canadian hospital.

In a court case in Winnipeg, Manitoba, which doctors say could set a legal precedent, the family of Samuel Golubchuk argues it would be a sin under their Orthodox Jewish faith for doctors to halt treatment and "hasten death."


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Robo
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posted 16 December 2007 11:56 AM      Profile for Robo     Send New Private Message      Edit/Delete Post  Reply With Quote 
Yes. This has nothing to do with religion. This has to do with what should be done when a family believes (in the absence of any "living will" from the comatose patient, presumbaly) that a medical treatment should occue when the doctors believe that it should not.

Suppose the story had been titled with something like "Doctors propose to end treatment as waste of money". I doubt that's what the doctors siad in this case, but it would attract a totally different spin on the coverage. The media has the capacity to define the news, and is not limited to reporting it.

In this case, there is a family that wants treatment to continue, and doctors that want it not to continue. Had the family been atheists, they still may have wanted the treatment in question to continue, and would have been in conflict with the doctors. I think that is a more reasonable focus for the story, but less easy to explain.

What is unclear, and thus troubling, is why the doctors in this case are seeking to impose or withdraw a treatment for a patient over the objections of the family.


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Proaxiom
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posted 16 December 2007 12:01 PM      Profile for Proaxiom     Send New Private Message      Edit/Delete Post  Reply With Quote 
If they consider a sin, they shouldn't have to flip the switch.

The doctors, on the other hand, are presumably not Orthodox Jews, and should have no trouble 'sinning' without any help from the family.


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Indiana Jones
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posted 16 December 2007 12:10 PM      Profile for Indiana Jones        Edit/Delete Post  Reply With Quote 
I'm not a lawyer, but my understanding is that if a person has no will, decisions on their medical care are elft to their next of kin - presumably, a spouse or child.

If the next of kin is insisting that they stay on life support, i don't see how the doctors can refuse that, unless it really is only about trying to save money, which I think is sick.

Just like in the Terri Schiavo case, the next of kin wanted the patient taken OFF life support, I supported that decision and I would be a hypocrite not to support this family's decision to keep the patient ON support.


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N.Beltov
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posted 16 December 2007 12:37 PM      Profile for N.Beltov   Author's Homepage     Send New Private Message      Edit/Delete Post  Reply With Quote 
Here is the CBC story.

Winnipeg bio-medical ethical specialist Arthur Schafer has appeared on the CBC a couple of time on this matter. The first time on radio I think - was longer and more detailed - and the second time was on TV with the lawyer representing the family. The reference to the CBC above has very little from Schafer.

Schafer noted that this case relates to the question of quality of life. He's a bit clearer than the ethicist that the Reuters' report quotes. It is a question of whether or not the care given to Samuel Golubchuk is actually of value at all, whether his condition will ever improve from his current state of minimal brain function, whether the money spent prolonging the automatic functioning of a lifeless body through sophisticated and expensive techniques are a worthwhile use of public money that might better be spent elsewhere, and so on. The CBC article above only has Schafer noting that the laws and policies regarding this sort of situation varies from province to province.

This case is very rare. In most cases, after consultation with the medical staff, families are convinced that continuation of treatment is pointless and would make no difference to the quality of life of the patient. This is not a case of someone who might come out of a coma.


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unionist
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posted 16 December 2007 12:49 PM      Profile for unionist     Send New Private Message      Edit/Delete Post  Reply With Quote 
I don't think patients, or their families, have the legal or moral right to insist ad infinitum on medical procedures that the medical authorities consider will not successfully treat the patient.

They have the right to veto any particular treatment, but not to demand it.

Frankly, I see no moral issue here.


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Michael Hardner
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posted 16 December 2007 02:44 PM      Profile for Michael Hardner   Author's Homepage     Send New Private Message      Edit/Delete Post  Reply With Quote 
quote:
They have the right to veto any particular treatment, but not to demand it.

That's an interesting take, when the 'treatment' involves having the janitor kick out the plug.

The healthcare system needs to respect the wishes and emotional needs of families, in my opinion.


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unionist
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posted 16 December 2007 03:01 PM      Profile for unionist     Send New Private Message      Edit/Delete Post  Reply With Quote 
quote:
Originally posted by Michael Hardner:

The healthcare system needs to respect the wishes and emotional needs of families, in my opinion.


Like, a patient coming to see their doctor with the latest internet cures and the doctor must comply?

Or telling the doctor which medications to prescribe?

In this case, it appears the family's wish is based, not on any prospect of meaningful improvement of the patient, but rather the family's religious belief in the sanctity of human life.

I think we should respect their right to their belief. But expending health care resources, against medical advice, is way beyond respect.


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Indiana Jones
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posted 16 December 2007 03:59 PM      Profile for Indiana Jones        Edit/Delete Post  Reply With Quote 
See? But therein lies the problem with our public healthcare system. It's rationed to the point that doctors want to end someone's life because it's taking up too much money but the family of that patient is prhibited from paying out of pocket to keep their loved one alive. If you're gonna have a public system, you need to respect families' wishes to keep their loved ones alived. No one should ever die because of cost or because they're taking up too much space.
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Michael Hardner
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posted 16 December 2007 04:05 PM      Profile for Michael Hardner   Author's Homepage     Send New Private Message      Edit/Delete Post  Reply With Quote 
u,

quote:
Like, a patient coming to see their doctor with the latest internet cures and the doctor must comply?

Or telling the doctor which medications to prescribe?

In this case, it appears the family's wish is based, not on any prospect of meaningful improvement of the patient, but rather the family's religious belief in the sanctity of human life.


Therefore, it's invalid right ?

quote:

I think we should respect their right to their belief. But expending health care resources, against medical advice, is way beyond respect.

But if they just felt that way, then it would be ok. Gotcha.


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unionist
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posted 16 December 2007 05:10 PM      Profile for unionist     Send New Private Message      Edit/Delete Post  Reply With Quote 
quote:
Originally posted by Indiana Jones:
No one should ever die because of cost or because they're taking up too much space.

Only the poor, according to your scenario.


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unionist
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posted 16 December 2007 05:12 PM      Profile for unionist     Send New Private Message      Edit/Delete Post  Reply With Quote 
quote:
Originally posted by Michael Hardner:
But if they just felt that way, then it would be ok. Gotcha.

I don't understand your comment. But how about addressing mine? Do you believe patients' families should be able to dictate medications and procedures? Or only if they can pay for them themselves?


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Michael Hardner
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posted 16 December 2007 05:29 PM      Profile for Michael Hardner   Author's Homepage     Send New Private Message      Edit/Delete Post  Reply With Quote 
How did you get from having the system demand the death of a loved one to people dictating their own treatment ?
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Indiana Jones
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posted 16 December 2007 05:31 PM      Profile for Indiana Jones        Edit/Delete Post  Reply With Quote 
I think that has to be the case, unionist. I can't support a system that denies people to choose what course they think is best for their loved ones because the public system is trying to save money and it's cheaper to let someone die. Nor can I support a two-tier system in which some families get to keep their loved ones alive because they are willing and able to pay out of pocket whereas lower income people won't have that option. If we're gonna have a public system like this, it should reflect the desires of the public who are paying to support it.
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unionist
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posted 16 December 2007 05:41 PM      Profile for unionist     Send New Private Message      Edit/Delete Post  Reply With Quote 
quote:
Originally posted by Indiana Jones:
I think that has to be the case, unionist. I can't support a system that denies people to choose what course they think is best for their loved ones because the public system is trying to save money and it's cheaper to let someone die.

You read somewhere that they want to kill the guy because it's cheaper?

Interesting method of drawing conclusions.

This case is about a family who wants medically futile treatment continued because of their religious convictions. The medical staff, on the other hand, has determined the treatment is futile, that it is causing pain to the patient, and that it constitutes abuse.

I agree with these sentiments, not with yours:

quote:
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."



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Indiana Jones
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posted 16 December 2007 05:45 PM      Profile for Indiana Jones        Edit/Delete Post  Reply With Quote 
And as an Orthodox Jew, if I were in that situation, I would want my life extended as long as possible. My family would know that. It should be up to my family and I, not to some doctors to decide things of that importance.
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unionist
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posted 16 December 2007 05:56 PM      Profile for unionist     Send New Private Message      Edit/Delete Post  Reply With Quote 
quote:
Originally posted by Indiana Jones:
And as an Orthodox Jew, if I were in that situation, I would want my life extended as long as possible. My family would know that. It should be up to my family and I, not to some doctors to decide things of that importance.

And if you and/or your family were convinced some particular medication could prolong your life, and the doctors disagreed - should they be forced by law to administer it anyway?

How about surgery, which the doctors estimate as 1 chance in a 1000 of success. Up to you and/or your family?


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500_Apples
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posted 16 December 2007 06:16 PM      Profile for 500_Apples   Author's Homepage     Send New Private Message      Edit/Delete Post  Reply With Quote 
It's good this medical issue is coming up now, as it's going to be more and more frequent in the future. The number of elderly is increasing quite drastically and will keep on doing so for a few decades. Additionally, as medical technology improves, it takes longer for people to die. It's easy to foresee a scenario where we might have hundreds or thousands of people on permanent life support. Say, some artificial hearts pumping but the patient brain dead, or other such things. I personally don't think it's wise to move to a syetem which encourages vegetative zombiism. It's a huge waste of resources, creates false hopes, and yields nothing of value. Anyone who entertains the same view on death as Ted Williams should be free to do so - with their own money.

The money argument is not irrelevant, because a dollar spent on keeping a zombie going is a dollar not going to preventive medicine, to schools, to public safety, et cetera.


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Indiana Jones
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posted 16 December 2007 06:47 PM      Profile for Indiana Jones        Edit/Delete Post  Reply With Quote 
quote:
Originally posted by unionist:

And if you and/or your family were convinced some particular medication could prolong your life, and the doctors disagreed - should they be forced by law to administer it anyway?

How about surgery, which the doctors estimate as 1 chance in a 1000 of success. Up to you and/or your family?


Ideally, yes. At the very least, I should ahve the option of paying for it myself.

But this isn't about trying to save his life through surgery or medication. This is about trying to prevent doctors from purposefully ending it.


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unionist
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posted 16 December 2007 06:53 PM      Profile for unionist     Send New Private Message      Edit/Delete Post  Reply With Quote 
quote:
Originally posted by Indiana Jones:
At the very least, I should ahve the option of paying for it myself.

Which is why I replied before, when you said "no one should die because of cost":

quote:
Only the poor, according to your scenario.

quote:
But this isn't about trying to save his life through surgery or medication. This is about trying to prevent doctors from purposefully ending it.

No it's not. Read the story. It's about ceasing abusive and painful treatment which the doctors have determined has no medical purpose.

Are we reading the same story? It's Latimer who killed his loved one, not the Winnipeg doctors.


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Michael Hardner
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posted 16 December 2007 06:55 PM      Profile for Michael Hardner   Author's Homepage     Send New Private Message      Edit/Delete Post  Reply With Quote 
Unionist,

quote:
You read somewhere that they want to kill the guy because it's cheaper?

Yes - here:

quote:
But expending health care resources, against medical advice, is way beyond respect.

They, meaning you.


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unionist
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posted 16 December 2007 07:10 PM      Profile for unionist     Send New Private Message      Edit/Delete Post  Reply With Quote 
quote:
Originally posted by Michael Hardner:
They, meaning you.

Your sophistry is beneath response.


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Michael Hardner
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posted 16 December 2007 07:12 PM      Profile for Michael Hardner   Author's Homepage     Send New Private Message      Edit/Delete Post  Reply With Quote 
Well, did you say it or not ?

I suppose you're just trying to apply healthcare as an efficient 'system' but the coldness... I find it just plain creepy.


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unionist
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posted 16 December 2007 07:13 PM      Profile for unionist     Send New Private Message      Edit/Delete Post  Reply With Quote 
quote:
Originally posted by Indiana Jones:
And as an Orthodox Jew, ...

What difference does that make? Should the health care system gear its medical decisions to the religious beliefs of its clients?

Just out of curiosity, do you believe parents, acting on sincerely held religious beliefs, have the right to withhold blood transfusions from their infant children if it will mean certain death?

And do you believe that pregnant women have the right to abortion on demand?


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Aristotleded24
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posted 16 December 2007 09:16 PM      Profile for Aristotleded24   Author's Homepage     Send New Private Message      Edit/Delete Post  Reply With Quote 
quote:
Originally posted by Indiana Jones:
And as an Orthodox Jew, if I were in that situation, I would want my life extended as long as possible. My family would know that. It should be up to my family and I, not to some doctors to decide things of that importance.

On the religiuos aspect:

If the only thing keeping a person's body alive is being hooked up to machines, to the point that the body is incapable of surviving on its own without them, then I would argue that God is trying to call this person home, and that such medical intervention is opposed to God's will. That is fundamentlay different from someone coming out of a coma or having a severe brain injury and having severe impariments in mobility and/or cognition. In these cases, the body is still functioning on its own, albeit in a limited capacity. If the body relies on machines, there is no hope of recovery, and it's time to let go.


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Proaxiom
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posted 17 December 2007 06:24 AM      Profile for Proaxiom     Send New Private Message      Edit/Delete Post  Reply With Quote 
Making religious arguments is useless because you can't actually win. To paraphrase Dr. House: religious people are impervious to rational argument, otherwise there wouldn't be any religious people.

You can't have a real debate if people get to make up arbitrary premises.

Unionist is right. Religious tolerance doesn't mean unlimited accommodation of others' religious beliefs. Our health care system can't allocate resources based on what some people view as sin.

As for allowing other people to pay for their treatment, it's not just about money. It's also about resources. If the family is willing to pay the expenses of keeping their loved one alive, that's well and good, but they can't add a new hospital bed and more doctors' time to the system. Their request still creates a burden.


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Michelle
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posted 17 December 2007 06:34 AM      Profile for Michelle   Author's Homepage     Send New Private Message      Edit/Delete Post  Reply With Quote 
quote:
Originally posted by Proaxiom:
To paraphrase Dr. House: religious people are impervious to rational argument, otherwise there wouldn't be any religious people.

Finally, a place where one can PROPERLY use the phrase "begs the question"!

Not that I disagree with Dr. House's suggestion.


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Sineed
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posted 17 December 2007 07:06 AM      Profile for Sineed     Send New Private Message      Edit/Delete Post  Reply With Quote 
My mother was a nurse for 35 years, and I've been a pharmacist for twenty. Truth is, these sorts of cases are rare because a sort of under the radar "euthanasia" goes on all the time, where people are allowed to die.

In my first full-time job, a 95 year old woman came in with pneumonia to the hospital from a nursing home, so they started her on antibiotics. Then her bloodwork came back, showing leukemia. So they discontinued the antibiotics and started a tiny dose of morphine, and she died peacefully within 24 hours. I'm not sure if the family was consulted, but everybody agreed they'd want this same treatment if it was them.

My mother also remembers a Jehovah's Witness receiving a unit of blood. The doctor said to hang the IV where the patient couldn't see it, and the patient recovered and left the hospital none the wiser. I'm not advocating this sort of disrespect for religious beliefs, but I'm saying medical people have been known to treat patients according to what they think is best without being totally forthcoming to the patient or the family. And is that unethical? At first glance, yes, but if you allow someone comatose or suffering greatly who will not recover to die instead of keeping them alive in accordance with the religious beliefs of the family, I don't know if that's a bad thing.

There are some who say that suffering sanctifies the soul, easing its passage to the afterlife, Heaven, whatever you believe in. I don't disrespect this belief, but in my experience, folks who expound at length on the nobility of suffering are not themselves in any pain.

No easy answers, though. I'd say, get a living will.


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N.Beltov
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posted 17 December 2007 07:07 AM      Profile for N.Beltov   Author's Homepage     Send New Private Message      Edit/Delete Post  Reply With Quote 
quote:
G&M article: 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.

A very disturbing kind of sudden death might be in the cards for Mr. Golubchuk.


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unionist
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posted 17 December 2007 08:26 AM      Profile for unionist     Send New Private Message      Edit/Delete Post  Reply With Quote 
quote:
Originally posted by Sineed:
I'd say, get a living will.

Great post Sineed, thanks for sharing your experiences.

As for a living will, that's a prudent suggestion no doubt - but if my will states:

"I hereby mandate the health care system to spare no effort, however wild, expensive, or improbable, to keep my body somewhat 'alive' irrespective of brain death or prospect of non-vegetative recovery."

Then I humbly suggest that the health care system is not bound by such a mandate.


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unionist
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posted 17 December 2007 08:27 AM      Profile for unionist     Send New Private Message      Edit/Delete Post  Reply With Quote 
quote:
Originally posted by N.Beltov:

A very disturbing kind of sudden death might be in the cards for Mr. Golubchuk.


Ah, but where there's life, there's hope.


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N.Beltov
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posted 17 December 2007 08:30 AM      Profile for N.Beltov   Author's Homepage     Send New Private Message      Edit/Delete Post  Reply With Quote 
Living wills are important and I think it's worth it to underline that. But from what I can gather it's quite a bit of work, a lengthy checklist is involved, and it's easy to miss something important.
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Michael Hardner
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posted 17 December 2007 10:53 AM      Profile for Michael Hardner   Author's Homepage     Send New Private Message      Edit/Delete Post  Reply With Quote 
quote:
What difference does that make? Should the health care system gear its medical decisions to the religious beliefs of its clients?

Yes, of course they should. In fact, they don't have a choice. It's a requirement of the Charter of Rights.


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Proaxiom
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posted 17 December 2007 10:55 AM      Profile for Proaxiom     Send New Private Message      Edit/Delete Post  Reply With Quote 
quote:
Originally posted by Michael Hardner:

Yes, of course they should. In fact, they don't have a choice. It's a requirement of the Charter of Rights.


No it's not.

Religious freedom doesn't mean we have to do everything religious people want.


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unionist
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posted 17 December 2007 10:57 AM      Profile for unionist     Send New Private Message      Edit/Delete Post  Reply With Quote 
quote:
Originally posted by Michael Hardner:

Yes, of course they should. In fact, they don't have a choice. It's a requirement of the Charter of Rights.


More sophistry. If that's what "faith" does to your capacity to argue, Health Canada should issue a warning.


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Indiana Jones
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posted 17 December 2007 10:59 AM      Profile for Indiana Jones        Edit/Delete Post  Reply With Quote 
quote:
Originally posted by unionist:

Just out of curiosity, do you believe parents, acting on sincerely held religious beliefs, have the right to withhold blood transfusions from their infant children if it will mean certain death?

And do you believe that pregnant women have the right to abortion on demand?


No, I don't believe parents can withold treatment from their children. Children are minors and don't ahve the same capacity to make important medical decisions as adults. If someone over 18 wants to refuse blood transfusions, they have every right to.

Yes, women should ahve access to abortions if that's what they choose. It's their body and their choice. Just like it's the body of this patient lying in the hospital and it should be his choice what happens to it.


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Michael Hardner
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posted 17 December 2007 11:13 AM      Profile for Michael Hardner   Author's Homepage     Send New Private Message      Edit/Delete Post  Reply With Quote 
unionist,

quote:
More sophistry. If that's what "faith" does to your capacity to argue, Health Canada should issue a warning.

When I called your approach to healthcare 'creepy' above, I was referring to your argument not to you personally.

I guess you're commenting on my ability to argue here. I'd say it's better to stick to the facts.

I'm guessing that you wouldn't tell a Sikh to not wear a turban with his RCMP uniform, would you ? Then why do you think it's ok to tell Jews to kill their relatives ?

I'd like to hear your argument on that...


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Proaxiom
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posted 17 December 2007 11:18 AM      Profile for Proaxiom     Send New Private Message      Edit/Delete Post  Reply With Quote 
quote:
Originally posted by Michael Hardner:
unionist,

When I called your approach to healthcare 'creepy' above, I was referring to your argument not to you personally.

I guess you're commenting on my ability to argue here. I'd say it's better to stick to the facts.

I'm guessing that you wouldn't tell a Sikh to not wear a turban with his RCMP uniform, would you ? Then why do you think it's ok to tell Jews to kill their relatives ?

I'd like to hear your argument on that...


At the risk of cross-posting unionist again, I'll offer this:

A sikh wearing a turban doesn't harm anybody, or meaningfully impose on anybody else.

A person consuming scarce medical resources that could be in use saving other people's lives, is harmful and imposing.


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Sineed
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posted 17 December 2007 11:18 AM      Profile for Sineed     Send New Private Message      Edit/Delete Post  Reply With Quote 
There comes a point when you have to be humble in the face of mortality, when more medical intervention is nothing short of pointless cruelty. And you have to ask yourself: are you doing this for your loved one, or to prove your own piety?
From: # 668 - neighbour of the beast | Registered: Dec 2005  |  IP: Logged
Michael Hardner
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posted 17 December 2007 11:44 AM      Profile for Michael Hardner   Author's Homepage     Send New Private Message      Edit/Delete Post  Reply With Quote 
quote:
A sikh wearing a turban doesn't harm anybody, or meaningfully impose on anybody else.

A person consuming scarce medical resources that could be in use saving other people's lives, is harmful and imposing.


Proaxiom,

The system isn't designed to have scarce resources, such that one person is waiting on another person to stop using a machine.

'Consuming resources' is code for 'using taxpayer's money' which is a right-wing argument that was indeed used to justify denying the wearing of a turban for RCMP officers.


From: Toronto | Registered: May 2002  |  IP: Logged
J. Arthur
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posted 17 December 2007 12:01 PM      Profile for J. Arthur     Send New Private Message      Edit/Delete Post  Reply With Quote 
I agree. This is a dangerous road to go down.

Moreover, why the hell are we talking about Sikhs, turbans, and the RCMP? Do all roads lead there?

[ 17 December 2007: Message edited by: J. Arthur ]


From: Vancouver | Registered: Nov 2007  |  IP: Logged
Proaxiom
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posted 17 December 2007 12:03 PM      Profile for Proaxiom     Send New Private Message      Edit/Delete Post  Reply With Quote 
quote:
Originally posted by Michael Hardner:

Proaxiom,

The system isn't designed to have scarce resources, such that one person is waiting on another person to stop using a machine.

'Consuming resources' is code for 'using taxpayer's money' which is a right-wing argument that was indeed used to justify denying the wearing of a turban for RCMP officers.


And yet resources are still scarce. Among other things, we have a doctor shortage.

Ideally, the health care system would have all the necessary capacity to take care of everyone's health needs. If you start redefining 'needs' to include care that people don't really need but want because of religious beliefs, then that increases necessary capacity.

If it were simply a matter of money, and the patient or his family was willing to pay the cost of the additional care, it would be reasonable to allow it. But it's not just money.

If you are suggesting that the government should plan the health care system and bear the cost of cases such as this, then you are overstepping the bounds of religious freedom. That freedom means we should not prevent a person from acting in accordance with his or her own beliefs. It does not place a positive obligation on the government or other citizens to go out of their way to accomodate him or her. Wearing a turban on the job does not place any sort of burden on other people. Forcing someone else to provide an unnecessary service does.

I could as easily say that it is my belief as a Pastafarian that all municipal trees should be decorated with spaghetti once a year. This does not mean the government has to do that. It doesn't even mean the government has to allow me to do it. My right to swing my fist ends where your nose begins.

From: East of the Sun, West of the Moon | Registered: Jun 2004  |  IP: Logged

unionist
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posted 17 December 2007 12:22 PM      Profile for unionist     Send New Private Message      Edit/Delete Post  Reply With Quote 
quote:
Originally posted by Michael Hardner:
I'm guessing that you wouldn't tell a Sikh to not wear a turban with his RCMP uniform, would you ?

Of course not. What kind of question is that?

quote:
Then why do you think it's ok to tell Jews to kill their relatives ?

I'm a Jew, and all my relatives were killed by the Nazis (except my parents). But you knew that, so I'll presume it's just your arguing skills.

There is no Jewish law, whatsoever, that requires artificially keeping a person alive in this manner. If there were, issues like this would arise every day in hospitals around the world. Guess what - they don't.

These are just some people with their own personal belief, apparently including that "life" must be preserved regardless of the suffering of the victim or the futility of the treatment, by technological means. Everyone is entitled to their own beliefs, but please don't label them as "Jewish". We don't tar other communities with the extremist brush of the radical fundamentalist few, do we?

If the norms of our judicial and health care system don't accord with their personal beliefs, they will have to ponder where they will get health care. One approach is to try home care. Or find a society which will permit them to train/hire their own practitioners at their own expense (not Canada, thank you very much).

Or, they could try something called "accommodation" - that is, accommodate their fringe belief system to the values of our society. Accommodation is a two-way street.

Or, they can wait for the court to render its decision. If they're lucky, they'll win, and they can keep subjecting the victim to their ministrations. We may have to fine-tune our laws in that case to ensure we understand who makes which decisions in our health-care system.


From: Vote QS! | Registered: Dec 2005  |  IP: Logged
Michael Hardner
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posted 17 December 2007 01:17 PM      Profile for Michael Hardner   Author's Homepage     Send New Private Message      Edit/Delete Post  Reply With Quote 
Proaxiom,

quote:
That freedom means we should not prevent a person from acting in accordance with his or her own beliefs. It does not place a positive obligation on the government or other citizens to go out of their way to accomodate him or her. Wearing a turban on the job does not place any sort of burden on other people. Forcing someone else to provide an unnecessary service does.

I'm pretty sure that the courts have ordered the government to provide 'unnecessary' services to ensure that our laws comply with the Charter.
Allowing same-sex couples to marry would be one example that comes to mind.

As for 'unnecessary EXTRA services', I don't have an example at my fingertips but there are undoubtedly some examples.

Providing meals that are in accordance with religious regulations, perhaps.


From: Toronto | Registered: May 2002  |  IP: Logged
Michael Hardner
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posted 17 December 2007 01:18 PM      Profile for Michael Hardner   Author's Homepage     Send New Private Message      Edit/Delete Post  Reply With Quote 
Also,

quote:
I could as easily say that it is my belief as a Pastafarian that all municipal trees should be decorated with spaghetti once a year. This does not mean the government has to do that. It doesn't even mean the government has to allow me to do it. My right to swing my fist ends where your nose begins.

The FSM is a cute idea, but ultimately it's just a cartoon version of intolerance made palatable with a fun twist.


From: Toronto | Registered: May 2002  |  IP: Logged
Michael Hardner
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posted 17 December 2007 01:23 PM      Profile for Michael Hardner   Author's Homepage     Send New Private Message      Edit/Delete Post  Reply With Quote 
u,

quote:
Of course not. What kind of question is that?

We're talking about what is being called 'reasonable accommodation'. I reject the notion that tax concerns should govern such decisions when the money involved is so tiny.

quote:

I'm a Jew, and all my relatives were killed by the Nazis (except my parents). But you knew that, so I'll presume it's just your arguing skills.


No, I did not know that. I'm sorry.

quote:

There is no Jewish law, whatsoever, that requires artificially keeping a person alive in this manner. If there were, issues like this would arise every day in hospitals around the world. Guess what - they don't.

So, these people are lying then ?

quote:

These are just some people with their own personal belief, apparently including that "life" must be preserved regardless of the suffering of the victim or the futility of the treatment, by technological means. Everyone is entitled to their own beliefs, but please don't label them as "Jewish". We don't tar other communities with the extremist brush of the radical fundamentalist few, do we?

If the norms of our judicial and health care system don't accord with their personal beliefs, they will have to ponder where they will get health care. One approach is to try home care. Or find a society which will permit them to train/hire their own practitioners at their own expense (not Canada, thank you very much).

Or, they could try something called "accommodation" - that is, accommodate their fringe belief system to the values of our society. Accommodation is a two-way street.

Or, they can wait for the court to render its decision. If they're lucky, they'll win, and they can keep subjecting the victim to their ministrations. We may have to fine-tune our laws in that case to ensure we understand who makes which decisions in our health-care system.


This is all well said.

Certainly your revelation that this is not actually a held belief of the Jewish religion does impact my opinion.

Ultimately, though, I think it comes down to the fact that I feel terrible that people are going to be forced - forced - to let go of the hope that their relative will never come back.


From: Toronto | Registered: May 2002  |  IP: Logged
unionist
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posted 17 December 2007 04:05 PM      Profile for unionist     Send New Private Message      Edit/Delete Post  Reply With Quote 
quote:
Originally posted by Michael Hardner:
So, these people are lying then ?

No, not at all. If a Jehovah's Witness says, "My Christian beliefs require letting my child die rather than be transfused", is s/he "lying" about Christian law? Trouble with religion is, nothing is true, so there are no lies either.

quote:
Ultimately, though, I think it comes down to the fact that I feel terrible that people are going to be forced - forced - to let go of the hope that their relative will never come back.

I suggested alternatives for them. But that doesn't include dictating to our medical care system.


From: Vote QS! | Registered: Dec 2005  |  IP: Logged
Proaxiom
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posted 17 December 2007 08:11 PM      Profile for Proaxiom     Send New Private Message      Edit/Delete Post  Reply With Quote 
quote:
Originally posted by Michael Hardner:

I'm pretty sure that the courts have ordered the government to provide 'unnecessary' services to ensure that our laws comply with the Charter.
Allowing same-sex couples to marry would be one example that comes to mind.

As for 'unnecessary EXTRA services', I don't have an example at my fingertips but there are undoubtedly some examples.

Providing meals that are in accordance with religious regulations, perhaps.


Same-sex marriage is an equality issue. If the government didn't have marriage for straight people, it wouldn't be required to have marriage for gays also. You can't make the case that not getting special accommodation is discriminatory unless others are already getting it.

I don't think the law requires anyone to provide meals according to religious requirements. When done, it is voluntary.

quote:
The FSM is a cute idea, but ultimately it's just a cartoon version of intolerance made palatable with a fun twist.

It's a pretty good parody of religion, which makes it amusing that you refer to it as intolerance.

quote:
I think it comes down to the fact that I feel terrible that people are going to be forced - forced - to let go of the hope that their relative will never come back.

False hope is not an essential government service.


From: East of the Sun, West of the Moon | Registered: Jun 2004  |  IP: Logged
Aristotleded24
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posted 18 December 2007 06:07 PM      Profile for Aristotleded24   Author's Homepage     Send New Private Message      Edit/Delete Post  Reply With Quote 
quote:
Originally posted by Proaxiom:
Making religious arguments is useless because you can't actually win.

I did not make that argument as an absolute reference point that people should use in their decision making. I was using religious terminology to refute the idea that removing someone from life support is a sin, which is in essence what Hardiner was arguing.


From: Winnipeg | Registered: May 2005  |  IP: Logged
Proaxiom
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posted 18 December 2007 06:23 PM      Profile for Proaxiom     Send New Private Message      Edit/Delete Post  Reply With Quote 
I know. I just don't think that's a very productive approach, because it is all completely subjective.
From: East of the Sun, West of the Moon | Registered: Jun 2004  |  IP: Logged
WhoMe
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posted 18 December 2007 10:10 PM      Profile for WhoMe     Send New Private Message      Edit/Delete Post  Reply With Quote 
This is one of those discussions that can go dancing around the issues with no resolution and no end. Why religion gets a free pass to impose it’s irrationality on society is beyond comprehension. In medical matters, the health service generally and the individual practitioners are dedicated to serving the patient in their care, not the family. For instance, I don’t get to discuss, review or impact the treatment of my wife concerning her breast cancer. In fact, I am not ever consulted about it. Does that bother me? No, since I am not remotely qualified to pass opinions. We were both counseled together, which is another issue totally and which was really appreciated. The expectation that life can be prolonged indefinitely in the face of massive bodily failure by some treatment or other is absurd. As for the impact of religious beliefs, this is one huge red herring. There are more religions than one can shake a stick at, each with their own take on what is supposed to happen and within those groupings more sects and splinter cults than can be counted. So what’s the reasonable course? The medical profession should simply be allowed to do what they are trained to do and to treat the patient’s earthly body for the patients own benefit in a rational manner, and receive the state’s full support in carrying out that remit. Religious belief should be parked with the car when visiting the hospital or doctor’s office. In any case, since just about all religions profess some form of afterlife which is marvelously more blissful than the present one, why all the fuss about a few days/weeks/months of delay in getting there? Shouldn’t the families involved be thankful that their relative is about to go to a much better place?
From: hereand there | Registered: Aug 2007  |  IP: Logged
M. Spector
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posted 18 December 2007 11:30 PM      Profile for M. Spector   Author's Homepage     Send New Private Message      Edit/Delete Post  Reply With Quote 
quote:
Originally posted by N.Beltov:
Living wills are important and I think it's worth it to underline that. But from what I can gather it's quite a bit of work, a lengthy checklist is involved, and it's easy to miss something important.
The so-called living will is a much-misunderstood instrument.

It's not helped by the fact that every province has its own laws on the subject.

All it does is prescribe in advance the kind of medical treatment you wish to receive, to take effect if you are no longer able to make and communicate decisions to your medical providers. Obviously, it must be phrased in general terms, in order to cover many unforeseen contingencies.

In some provinces, it's just a form of power of attorney, giving someone else the right to consent to, or withhold consent from, medical procedures on your behalf. You can (but don't have to) specify how you would like their discretion to be exercised.

In the absence of a "living will" your next-of-kin get to decide for you anyway, so giving a power of attorney to your next-of-kin is kind of redundant. You can make your general wishes known to them in advance either orally or in writing, and trust them to follow your wishes.

One thing a living will does not do is compel the medical system to provide unlimited resources to keep you alive. Decisions of that nature are made in accordance with medical ethics. The fact that you may have expressed your wishes in advance in writing does not give them any greater power to command medical resources.


From: One millihelen: The amount of beauty required to launch one ship. | Registered: Feb 2005  |  IP: Logged
M. Spector
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posted 18 December 2007 11:34 PM      Profile for M. Spector   Author's Homepage     Send New Private Message      Edit/Delete Post  Reply With Quote 
quote:
Originally posted by WhoMe:
...just about all religions profess some form of afterlife which is marvelously more blissful than the present one...
But some of them may have stiff entrance requirements.

From: One millihelen: The amount of beauty required to launch one ship. | Registered: Feb 2005  |  IP: Logged
unionist
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posted 18 June 2008 03:49 AM      Profile for unionist     Send New Private Message      Edit/Delete Post  Reply With Quote 
Amazing development - three ICU physicians have now resigned from the Grace Hospital rather than continue to torture this patient at the behest of the family and the court:

quote:
Two critical-care doctors this week followed in the footsteps of another colleague and resigned from the Grace Hospital rather than keep Mr. Golubchuk on life support.

Their departure halved the hospital's ICU physician roll. Local authorities said other specialists will be rotated to the Grace to compensate for the loss of the three doctors. ...

In a resignation letter read in court earlier this year, Anand Kumar, the first specialist who resigned, said continuing care for the elderly man was painful and "grotesque."

"To inflict this kind of assault on him without a reasonable hope of benefit is an abomination," Dr. Kumar wrote, describing having to continue to "hack away at his infected flesh."


Meantime, the court system has cynically scheduled the trial for September, guaranteeing that this farce will continue almost one year past the time when medical staff determined that no further treatment was indicated.

ETA: Link inserted - thanks Michelle.

[ 18 June 2008: Message edited by: unionist ]


From: Vote QS! | Registered: Dec 2005  |  IP: Logged
Michelle
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posted 18 June 2008 03:54 AM      Profile for Michelle   Author's Homepage     Send New Private Message      Edit/Delete Post  Reply With Quote 
Link?
From: I've got a fever, and the only prescription is more cowbell. | Registered: May 2001  |  IP: Logged
Michelle
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posted 18 June 2008 04:02 AM      Profile for Michelle   Author's Homepage     Send New Private Message      Edit/Delete Post  Reply With Quote 
Thanks!

I worry about cases like this. This one seems kind of open and shut, but at the same time...I don't think doctors should decide or pressure families about life support. I just don't. I worry about slippery slopes.

This concerns me too:

quote:
The family says he has not been properly examined for aphasia or other conditions that could explain his unresponsiveness.

Why not find out from the family what they consider to be a "proper examination" for aphasia, and do it, for their peace of mind?


From: I've got a fever, and the only prescription is more cowbell. | Registered: May 2001  |  IP: Logged
unionist
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posted 18 June 2008 04:18 AM      Profile for unionist     Send New Private Message      Edit/Delete Post  Reply With Quote 
quote:
Originally posted by Michelle:
Why not find out from the family what they consider to be a "proper examination" for aphasia, and do it, for their peace of mind?

Why not run double-blind trials on peach pit cancer therapy just to satisfy the family of a terminally ill cancer patient?

Families and patients can refuse treatment. They can't enforce treatment - unless, of course, there is negligence or malpractice, in which case the courts and other authorities must definitely intervene. In this case, it is solely the religious beliefs of the family members that has created this crisis.

Our society recognizes that individuals may worship just as they please. They do not, however, have the right to treat illness just as they please. Nor do they have the right to school their children just as they please. We have public systems (and mandatory public standards for private systems) that regulate those issues.

Here is a story about a letter to the Winnipeg Free Press by one of the physicians. It's worth reading.


From: Vote QS! | Registered: Dec 2005  |  IP: Logged
Michelle
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posted 18 June 2008 04:23 AM      Profile for Michelle   Author's Homepage     Send New Private Message      Edit/Delete Post  Reply With Quote 
Don't you think that examining the patient according to the family's wishes would take less time and money than spending a year in court?
From: I've got a fever, and the only prescription is more cowbell. | Registered: May 2001  |  IP: Logged
unionist
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posted 18 June 2008 04:33 AM      Profile for unionist     Send New Private Message      Edit/Delete Post  Reply With Quote 
quote:
Originally posted by Michelle:
Don't you think that examining the patient according to the family's wishes would take less time and money than spending a year in court?

That's just diversionary comments on their part. They've been in court at least twice since last year, and won both times. Don't you think they could have got a court order to examine him for aphasia if that was really an issue? Do you think the medical staff is so incompetent or uncaring that they need medical advice from these people, who have stated publicly that only God can determine when their father should die?

Having said that, let them sign a contract stating that if the hospital agrees to conduct these examinations and they prove negative, they will leave all further medical decisions in the hands of (...shudder...) the medical staff.

Don't hold your breath on that one.


From: Vote QS! | Registered: Dec 2005  |  IP: Logged
scooter
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posted 18 June 2008 06:04 AM      Profile for scooter     Send New Private Message      Edit/Delete Post  Reply With Quote 
quote:
Originally posted by Michelle:
Don't you think that examining the patient according to the family's wishes would take less time and money than spending a year in court?

Not in this case. The hospital has now lost three doctors. I wonder how many nurses have transfered out of the unit in protest while Samuel Golubchuk is slowly behind hacked away to fight to keep infections at bay.

I wonder how the quality of care in the ICU unit has been reduced now they have only one full time doctor in the unit.

When does the medical treatment become grotesque torture to the orthodox jewish faith?

I find it ironic that you support this family's wishes for grotesque medical treatment yet you attack popular chiropractic treatments.


From: High River | Registered: Apr 2004  |  IP: Logged
remind
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posted 18 June 2008 06:25 AM      Profile for remind     Send New Private Message      Edit/Delete Post  Reply With Quote 
The case is autrocious.

First inconsistancy is that they, his children, say "God" should determine when he dies. Hello, they have him on life support, it seems that "God" determined long ago now, that he should have died, they are the ones keeping him alive. Medicine can keep a body alive indefinitely on life support systems, and his life support system needs are increasing, as his kidneys are now failing, which means constant dialysis.

Secondly, is their insistence that NO proper aphasia diagnosis has been done. Um, the test for aphasia specifically requires that the patient be able to respond to a neurologists questions, the man in question is un-responsive to stimulus. There can be no other "aphasia" testing done.

Thirdly, he is in a physically vegetative state and has been for almost a year, and his bed sores are now requiring surgery.

ETA "physically" as my statement caused confusion.

[ 18 June 2008: Message edited by: remind ]


From: "watching the tide roll away" | Registered: Jun 2004  |  IP: Logged
scooter
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posted 18 June 2008 06:39 AM      Profile for scooter     Send New Private Message      Edit/Delete Post  Reply With Quote 
quote:
Originally posted by remind:
Thirdly, he is in a vegatative state and has been for almost a year, and his bed sores are now requiring surgery.

Do a google image search on bed sores. Do a bit of reading. It is a real eye opener.

From: High River | Registered: Apr 2004  |  IP: Logged
remind
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posted 18 June 2008 06:53 AM      Profile for remind     Send New Private Message      Edit/Delete Post  Reply With Quote 
quote:
Originally posted by scooter:
Do a google image search on bed sores. Do a bit of reading. It is a real eye opener.

Well, I do not really need my eyes opened in respect to bed sore, or were you stating that for the benefit of others?


From: "watching the tide roll away" | Registered: Jun 2004  |  IP: Logged
N.Beltov
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posted 18 June 2008 06:55 AM      Profile for N.Beltov   Author's Homepage     Send New Private Message      Edit/Delete Post  Reply With Quote 
quote:
Several weeks ago, Dr. Anand Kumar refused to "torture" Golubchuk by hacking away at his flesh infected by bedsores. Dr. Bojan Paunovic and Easton have followed suit. Easton explained:

This week, I have come to the 'ethical line in the sand' that I had previously said I would never cross. This was in the form of an escalation of care in my patient who is in a permanent 'minimally conscious state,' dependent on a ventilator, with no hope of ever leaving intensive care.


The provincial Health Minister has been advised to "stay out of it", so we have the disgusting prospect of the medical staff hacking off chunks of flesh from a ventilator-dependent, non-responsive patient until there's nothing left of him.

quote:
"This man is in very fragile health and, in order to keep him alive if his heart stops, doctors have been ordered to give CPR," said Schafer. "That means cracking every bone in his chest.

"He's being fed through tubes in his nose, his heart is kept going by electrodes. The person who was Mr. Golubchuk ceased to exist a long time ago, while the body of Mr. Golubchuk is still alive."



Maybe there will be something left to fight over, come September, when the courts get around to it. (Actually, the date for the trial was moved up to September from December.)

quote:
Schafer made what he called a "whimsical and black" suggestion to resolve the impasse.

"Perhaps, since it's a violation of medical ethics for doctors to treat Mr. Golubchuk, . . . then maybe the family's lawyer and the judge should be there to hack away at his flesh and crush his ribs," he said.


The family's lawyer, Neil Kravetsky, responded by suggesting that it is unethical for the ethicist to say anything about what a lawyer or judge should do. Well, that's one way to avoid scrutiny, eh?

quote:
Prof. Arthur Schafer, director of the University of Manitoba's Centre for Professional and Applied Ethics, said he expects more doctors and nurses will withdraw their services rather than violate their professional oath to do no harm.

"It always trumps the courts," said Schafer. "This is true for any doctor or any professional.

"A professional isn't simply a technician servicing the instructions of the clients or patients. The courts can't order a doctor to behave unprofessionally."

"I wonder about the nurses," Schafer added. "Their code of professional ethics also causes them not to cause harm."


[ 18 June 2008: Message edited by: N.Beltov ]


From: Vancouver Island | Registered: May 2003  |  IP: Logged
Michelle
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posted 18 June 2008 07:00 AM      Profile for Michelle   Author's Homepage     Send New Private Message      Edit/Delete Post  Reply With Quote 
quote:
Originally posted by remind:

Well, I do not really need my eyes opened in respect to bed sore, or were you stating that for the benefit of others?


I had the impression that he meant that as a supplement to your post, not as a counter to it.

Yeah, you're right, scooter, I don't know, I just feel like I know I want to be kept alive just in case, and I feel uncomfortable about the "slippery slope" aspect where doctors might get to the point where they can tell families that their loved ones aren't feeling anything or that their quality of life isn't worth being kept alive in more borderline cases than this one.

Also: if the doctors are saying this guy is in a vegetative state and isn't feeling anything, then how can they claim that he's being "tortured"?

I agree that it is certainly an undignified existence, but it's not like the patient himself knows any better. So I think claiming that he is being "tortured" is a bit melodramatic.


From: I've got a fever, and the only prescription is more cowbell. | Registered: May 2001  |  IP: Logged
N.Beltov
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posted 18 June 2008 07:07 AM      Profile for N.Beltov   Author's Homepage     Send New Private Message      Edit/Delete Post  Reply With Quote 
Lopping off chunks of flesh to forestall the onset of gangrene and such, as a result of bedsores from the unmoving patient, and facing the grim prospect of breaking every brittle bone in Mr. Golubchuk's chest should CPR have to be administered is getting pretty damn close to torture, don't cha think?

Edited to add: if Mr. Golubchuk isn't feeling the effects of this Monty Python-esque scenario, and has no prospects of an improved condition, what's the point anyway? Buying a smaller coffin for "stumpy"?

[ 18 June 2008: Message edited by: N.Beltov ]


From: Vancouver Island | Registered: May 2003  |  IP: Logged
Stargazer
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posted 18 June 2008 07:09 AM      Profile for Stargazer     Send New Private Message      Edit/Delete Post  Reply With Quote 
Michelle, for once, I totally disagree with you.

This man's children should be fined and expelled from the hospital. The man IS being tortured, whether he can feel it or not.

His chest bones would break from CPR. His bed sores are so bad they are being removed. He has extremely limited functioning. He CANNOT breath on his own.

This is no way to live and these religious nuts are just that - nuts with zero compassion.

All they care about is the man in the sky.


From: Inside every cynical person, there is a disappointed idealist. | Registered: Jun 2004  |  IP: Logged
Trevormkidd
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posted 18 June 2008 07:15 AM      Profile for Trevormkidd     Send New Private Message      Edit/Delete Post  Reply With Quote 
quote:
Originally posted by N.Beltov:

The family's lawyer, Neil Kravetsky, responded by suggesting that it is unethical for the ethicist to say anything about what a lawyer or judge should do.


But apparently it is fine for a lawyer and a judge to tell doctors what they must do.


From: SL | Registered: Jun 2006  |  IP: Logged
remind
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posted 18 June 2008 07:20 AM      Profile for remind     Send New Private Message      Edit/Delete Post  Reply With Quote 
Michelle, point of clarification, they did not say he is not "feeling" anything, pain receptors in the brain still work even with brain injuries. I have observed patients in a unconcious, or barely responsive state, who have obviously felt a great deal of pain from bed sores and who will even flinch/moan when a suppository, or enema, to evacuate the bowels was inserted.

Having said that, I hear and understand what you are saying about the "slippery slope" having faced it with respect to my mother. However, in this case it appears he is a shell, being kept alive on life support, and has been for a year. he has zero quality of life, and I would imagine he only feels pain, without even understanding why.


From: "watching the tide roll away" | Registered: Jun 2004  |  IP: Logged
unionist
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posted 18 June 2008 07:24 AM      Profile for unionist     Send New Private Message      Edit/Delete Post  Reply With Quote 
quote:
Originally posted by Michelle:
Also: if the doctors are saying this guy is in a vegetative state and isn't feeling anything, then how can they claim that he's being "tortured"?

I haven't seen any doctors say he is in a vegetative state.

quote:
I agree that it is certainly an undignified existence, but it's not like the patient himself knows any better.

What evidence do you have for that?


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N.Beltov
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posted 18 June 2008 07:27 AM      Profile for N.Beltov   Author's Homepage     Send New Private Message      Edit/Delete Post  Reply With Quote 
re TrevorMKidd's remark: Addressing public bio-ethical issues is Schafer's academic and professional specialty. He's so good at it that he often gets invited to be the main speaker on Sunday morning at at least one Winnipeg church. The family's lawyer, Kravetsky, seems to be defending a compartmentalization of knowledge approach, so loved by the idiots of the academic world, in which those in one silo of knowledge ought to mind their own business and keep out of other silos.

In any case, I thought it rather amusing for a lawyer to be scolding an ethicist for speaking about a public issue as something unethical on the latter's part. "What a maroon!" as Bugs used to say.

[ 18 June 2008: Message edited by: N.Beltov ]


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remind
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posted 18 June 2008 07:31 AM      Profile for remind     Send New Private Message      Edit/Delete Post  Reply With Quote 
unionist, they said he does not respond to stimuli in the broadcast I heard, which means such things as not responding to verbal communication in any way, opening mouth for feeding, not moving his own body and extremities, etc. His eyes may be open slightly, but that means little.
From: "watching the tide roll away" | Registered: Jun 2004  |  IP: Logged
Michelle
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posted 18 June 2008 07:41 AM      Profile for Michelle   Author's Homepage     Send New Private Message      Edit/Delete Post  Reply With Quote 
My mistake, I'm sorry. I was under the impression that he was in a vegetative state and therefore couldn't feel anything.

The horror.

[ 18 June 2008: Message edited by: Michelle ]


From: I've got a fever, and the only prescription is more cowbell. | Registered: May 2001  |  IP: Logged
unionist
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posted 18 June 2008 08:19 AM      Profile for unionist     Send New Private Message      Edit/Delete Post  Reply With Quote 
quote:
Originally posted by remind:
unionist, they said he does not respond to stimuli in the broadcast I heard, which means such things as not responding to verbal communication in any way, opening mouth for feeding, not moving his own body and extremities, etc. His eyes may be open slightly, but that means little.

Remind, I agree with you and obviously I agree that the question of further intervention in this matter should be a medical decision, not that of the family, as I've said forcefully from the start of the thread.

I justed wanted to correct the statement about "vegetative", because I don't believe that a person has to be in a "vegetative state" before a decision can be made to stop treatment.


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remind
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posted 18 June 2008 08:19 AM      Profile for remind     Send New Private Message      Edit/Delete Post  Reply With Quote 
quote:
Originally posted by Michelle:
My mistake, I'm sorry. I was under the impression that he was in a vegetative state and therefore couldn't feel anything.

The horror.



No, Michelle it was my fault, sorry that I did not clarify that I did not mean a "persistent" vegetative state. Which is an actual clinical diagnosis which is differentiated from a "minimally conscious state" diagnosis. I was speaking his physically vegetative state where there is no movement controlled by a cognative decision.

He has been diagnosed with a minimally conscious state which means that he is sometimes cognatively aware, or appears to be cognatively aware sometimes. Which, IMV, is probably indicated by his being aware of pain and reacting to it.


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scooter
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posted 18 June 2008 11:58 AM      Profile for scooter     Send New Private Message      Edit/Delete Post  Reply With Quote 
quote:
Originally posted by remind:
He has been diagnosed with a minimally conscious state which means that he is sometimes cognatively aware, or appears to be cognatively aware sometimes. Which, IMV, is probably indicated by his being aware of pain and reacting to it.

I assume that he is on pain medication? Depending on what he being given, that can hasten his death. Doesn't that contradict the family wish not to hasten his death.

As for my bed sore comment, it was for the benefit of others who seem to think that Mr. Golubchuk is lying peacefully in his bed without a care in the world.


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remind
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posted 18 June 2008 12:20 PM      Profile for remind     Send New Private Message      Edit/Delete Post  Reply With Quote 
Really he can't "die", he is on life support. And apparently about to be put on dialysis even, which will slow the liver failure.

They would have to give him a continued overdose amount of morphine/opiate based pain medication, in order for them to hasten his demise. And that is against the law.

Other than that he would have to have massive heart failure, but even then they have a order to recessitate.


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scooter
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posted 18 June 2008 12:36 PM      Profile for scooter     Send New Private Message      Edit/Delete Post  Reply With Quote 
quote:
Originally posted by remind:
They would have to give him a continued overdose amount of morphine/opiate based pain medication, in order for them to hasten his demise. And that is against the law.

You are confusing overdosing and prescribing high dose pain medication which is not against the law and does hasten death. Otherwise a few of my friends would be doing serious jail time for their work in various palliative care units across Canada.

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remind
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posted 18 June 2008 12:47 PM      Profile for remind     Send New Private Message      Edit/Delete Post  Reply With Quote 
quote:
Originally posted by scooter:
You are confusing overdosing and prescribing high dose pain medication which is not against the law and does hasten death. Otherwise a few of my friends would be doing serious jail time for their work in various palliative care units across Canada.

No actually, I am not confusing anything. And I was a palliative home care nurse for over a decade. I know exactly what goes on, and the difference between necessary high dose and continued over dosage that is not required.

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Sineed
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posted 18 June 2008 02:50 PM      Profile for Sineed     Send New Private Message      Edit/Delete Post  Reply With Quote 
Relatively low doses of morphine would hasten his demise, which begs the question: is the family refusing such medication?

I have a question for unionist: does orthodox Jewish faith really demand this level of fanaticism around end-of-life care or is this family making up their own orthodoxy on the fly?

I'm thinking the family is having trouble letting go for personal reasons/problems, and they're using religion as an excuse. Otherwise, wouldn't ICUs across the country be filled with orthodox Jewish gomers?


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Michelle
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posted 18 June 2008 02:52 PM      Profile for Michelle   Author's Homepage     Send New Private Message      Edit/Delete Post  Reply With Quote 
unionist answered that up the thread:

quote:
Originally posted by unionist:
There is no Jewish law, whatsoever, that requires artificially keeping a person alive in this manner. If there were, issues like this would arise every day in hospitals around the world. Guess what - they don't.

These are just some people with their own personal belief, apparently including that "life" must be preserved regardless of the suffering of the victim or the futility of the treatment, by technological means. Everyone is entitled to their own beliefs, but please don't label them as "Jewish". We don't tar other communities with the extremist brush of the radical fundamentalist few, do we?



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scooter
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posted 18 June 2008 03:05 PM      Profile for scooter     Send New Private Message      Edit/Delete Post  Reply With Quote 
quote:
Originally posted by Sineed:
Otherwise, wouldn't ICUs across the country be filled with orthodox Jewish gomers?

Don't you mean goses.

Interesting link about Jewish faith and Euthanasia that compliments unionists earlier post about religion vs. personal belief.

Bioethics


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Sineed
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posted 18 June 2008 04:04 PM      Profile for Sineed     Send New Private Message      Edit/Delete Post  Reply With Quote 
Thanks for that; I hadn't noticed unionist had already addressed this. And good link, scooter. From that link;

quote:
The Talmud forbids all acts that might hasten death, and this ruling was upheld by the medieval Jewish law codes. However, in a famous passage, the 13th-century Rabbi Judah the Pious ruled that one should remove obstacles which prevent death. Rabbi Moshe Isserles codified this ruling in his commentary on the authoritative 16th-century law code the Shulchan Arukh, writing that, "if there is anything which causes a hindrance to the departure of the soul…it is permissible to remove [it] from there because there is no act involved, only the removal of the impediment."
So this family, by refusing to allow the doctors to institute a DNR, may actually be in violation of Jewish law.

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unionist
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posted 18 June 2008 05:50 PM      Profile for unionist     Send New Private Message      Edit/Delete Post  Reply With Quote 
Folks, there is no uniform "Jewish law". There is no single authority. All I said upthread was that to attribute to "Orthodox Judaism" the disturbing actions and stances of the family in question is wrong. These are their beliefs, and for all I know they may even be able to identify some sect to which they belong that espouses those extreme views. But Judaism, including Orthodox Judaism, is much more diverse than that, and I also appreciate scooter citing that overview article.
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jas
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posted 18 June 2008 06:35 PM      Profile for jas     Send New Private Message      Edit/Delete Post  Reply With Quote 
I'm just wondering, as the original links are not working, how the case even managed to progress to this point. What law or code of ethics states that a publicly funded medical intervention be continued against all medical advice? in other words, on what did the judge base his/her original decision that ultimately forced these doctors to walk?

quote:
A professional isn't simply a technician servicing the instructions of the clients or patients. The courts can't order a doctor to behave unprofessionally.

Awesome.


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unionist
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posted 18 June 2008 06:47 PM      Profile for unionist     Send New Private Message      Edit/Delete Post  Reply With Quote 
quote:
Originally posted by jas:
in other words, on what did the judge base his/her original decision that ultimately forced these doctors to walk?

Here, why not read the full decision for yourself.

It should be kept in mind that this is not a "final" decision on whether the medical staff should be restrained from pulling the plug - it was only a decision to continue the initial, emergency injunction until the matter can be tried in full. So, the criteria aren't who is "right" or "wrong", but things like "balance of convenience".

Having said that, the decision is remarkable in some of the value judgments it makes. Here's one:

quote:
The physicians placed the plaintiff in the ICU and on the ventilator, although they complain now that they were talked into it. We must assume that their doing so squared with their ethical obligations at the time. Further, although the physicians now say that their position to withdraw the support is mandated by their ethical obligations, as Beard J. observed in Sawatzky at ¶31(v): “The treatment does not, in and of itself, raise the same type of ethical problems for the doctor that could be associated with controversial procedures like abortions.” The status quo favours the plaintiff’s position.

In other words, a doctor who has "ethical" issues with performing abortions will carry a lot more weight than these doctors who have an ethical issue with abusing and assaulting the victim patient and violating their Hippocratic oath to "do no harm".

That is unbelievably offensive IMO.


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Bacchus
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posted 18 June 2008 08:18 PM      Profile for Bacchus     Send New Private Message      Edit/Delete Post  Reply With Quote 
quote:
We don't tar other communities with the extremist brush of the radical fundamentalist few, do we?

Only the Christians


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unionist
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posted 18 June 2008 08:44 PM      Profile for unionist     Send New Private Message      Edit/Delete Post  Reply With Quote 
quote:
Originally posted by Bacchus:

Only the Christians


No, the overwhelming majority of Christians don't support the views of the tiny fringe radical sects which oppose divorce, birth control, women's equality, reproductive choice, queers' rights, etc. - thank God.


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N.Beltov
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posted 25 June 2008 04:57 AM      Profile for N.Beltov   Author's Homepage     Send New Private Message      Edit/Delete Post  Reply With Quote 
Samuel Golubchuk died last night. The injunction, which was the key legal issue according to the family's lawyer Neil Krevetsky, is now academic.

His funeral will be today at 1:30.

[ 25 June 2008: Message edited by: N.Beltov ]


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scooter
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posted 25 June 2008 08:25 AM      Profile for scooter     Send New Private Message      Edit/Delete Post  Reply With Quote 
quote:
Originally posted by N.Beltov:
Samuel Golubchuk died last night.

Actually, he died last year and they have been keeping him alive ever since.

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N.Beltov
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posted 25 June 2008 08:34 AM      Profile for N.Beltov   Author's Homepage     Send New Private Message      Edit/Delete Post  Reply With Quote 
Argg. Even those who argued for discontinuing treatment didn't say Golubchuk was dead. They just said that with such minimal brain function, and no hope of improvement, further treatment was pointless and did not improve the quality of LIFE for the late Mr. Golubchuk.

If you want a story about the living dead, try reading Edgar Allan Poe's The Facts in the Case of M. Valdemar. As professor George Edward Woodberry said, the story "for mere physical disgust and foul horror, has no rival in literature." Creee-peeee!

[ 25 June 2008: Message edited by: N.Beltov ]


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scooter
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posted 25 June 2008 08:39 AM      Profile for scooter     Send New Private Message      Edit/Delete Post  Reply With Quote 
Ok, my comment about being dead was a bit flipant. But you must admit that he was being kept unnaturally alive.
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N.Beltov
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posted 25 June 2008 08:47 AM      Profile for N.Beltov   Author's Homepage     Send New Private Message      Edit/Delete Post  Reply With Quote 
A gruesome end was actually possible for the late Mr. Golubchuk who, last December, swelled up like a football or something. "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."

Blam! Ever seen the Monty Python movie, The Meaning of Life?

Anyway, all gruesome silliness aside, the legal issue of the injunction was not resolved so this sort of case could be before the courts again.


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N.Beltov
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posted 25 June 2008 01:20 PM      Profile for N.Beltov   Author's Homepage     Send New Private Message      Edit/Delete Post  Reply With Quote 
The CPS of Manitoba issued a Statement much earlier this year, "WITHHOLDING AND WITHDRAWING
LIFE-SUSTAINING TREATMENT" that I had missed up to now. It is a .pdf file and may be of interest to readers of this thread.

see Statement on Witholding, etc.


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unionist
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posted 25 June 2008 07:20 PM      Profile for unionist     Send New Private Message      Edit/Delete Post  Reply With Quote 
quote:
Originally posted by N.Beltov:
Samuel Golubchuk died last night. The injunction ... is now academic.

Not so fast. What do you mean, "academic"? Are you saying they've unplugged him!? They are in violation of the judge's orders!!

quote:
I make the following orders:

1. that the defendants, Grace General Hospital Facilities Limited, Dr. Anand Kumar, Dr. Bojan Paunovic and Dr. Elizabeth Cowden, are hereby restrained from removing the plaintiff, Samuel Golubchuk, from life support care, ventilation, tube feeding and medication and that, if one or more of the defendants has removed Samuel Golubchuk from such support they are to immediately place him back on life support;

2. that this order is to continue in effect until a decision is rendered after a trial of this action unless, in the meantime, the plaintiff’s committee consents to a variation of the order;

3. that the defendant Hospital take measures to ensure that any physician or other medical personnel involved in care of the plaintiff be aware of the existence of this order, including, without restricting the generality of the order, that the Hospital attach a copy of this order to the plaintiff’s medical chart.


This is plain English. Do you see anything that says: ... unless the patient dies? I don't.

The hospital is in contempt of court. If they have unplugged Mr. Golubchuk, I trust their lawyers will advise them to reconnect him, on an urgent basis, while approaching the court to apply for a variance in the order.

How dare they take the law into their own hands??

[ 25 June 2008: Message edited by: unionist ]


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Trevormkidd
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posted 25 June 2008 08:10 PM      Profile for Trevormkidd     Send New Private Message      Edit/Delete Post  Reply With Quote 
quote:
Originally posted by scooter:
But you must admit that he was being kept unnaturally alive.

I think we should be careful here. Someone with a pacemaker is being kept alive through unnatural means. Dialysis patients too, the list could go on and on. And many others have much better lives than nature intended with their artificial hips, insulin injections and laser eye surgery (and again this list could go on and on).

There were many good reasons to discontinue the life support of this patient. Life support being unnatural is not one of them, in my opinion.


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unionist
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posted 25 June 2008 08:14 PM      Profile for unionist     Send New Private Message      Edit/Delete Post  Reply With Quote 
quote:
Originally posted by Trevormkidd:

There were many good reasons to discontinue the life support of this patient. Life support being unnatural is not one of them, in my opinion.


Very important distinction - thanks for that. The issue is not "unnatural" extension of life. That's what medical science and progress is all about. The issue is whether individuals have the right to demand medical treatment which medical professionals deem to be useless or harmful. Individuals have the right to refuse recommended treatment - not to demand it based on their faith or whims etc. If they want useless treatment, let them proceed to the Land of the Free where money can buy happiness.


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scooter
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posted 27 June 2008 11:23 AM      Profile for scooter     Send New Private Message      Edit/Delete Post  Reply With Quote 
quote:
Originally posted by Trevormkidd:
I think we should be careful here. Someone with a pacemaker is being kept alive through unnatural means...

Ok?! You realize that Mr. Golubchuk was enduring treatment involving: "surgically hack away at his infected flesh at the bedside in order to keep the infection at bay", to quote Dr. Kumar's resignation letter.

I don't remember doctors using words "grotesque" or "torture" or enduring emotional and ethical turmoil in describing any of the treatments you listed.


From: High River | Registered: Apr 2004  |  IP: Logged
jas
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posted 27 June 2008 04:00 PM      Profile for jas     Send New Private Message      Edit/Delete Post  Reply With Quote 
quote:
Originally posted by unionist:
[QB]

This is plain English. Do you see anything that says: ... unless the patient dies? I don't.



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Trevormkidd
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posted 27 June 2008 06:34 PM      Profile for Trevormkidd     Send New Private Message      Edit/Delete Post  Reply With Quote 
quote:
Originally posted by scooter:
Ok?! You realize that Mr. Golubchuk was enduring treatment involving: "surgically hack away at his infected flesh at the bedside in order to keep the infection at bay", to quote Dr. Kumar's resignation letter.

I don't remember doctors using words "grotesque" or "torture" or enduring emotional and ethical turmoil in describing any of the treatments you listed.


Yes, I realize exactly what was going on in this case and I have seen others like it. I wouldn't have had issue if you had said that a reason to end his lifesupport was due to him being tortured, enduring grotesque treatments, etc. The doctors in question who were refusing to treat this man were doing so based on their ethical position that what was occuring was torture and grotesque etc, they were not refusing to treat him because they felt he was being kept alive unnaturally. If that was the case then their jobs in the ICU would become a whole lot easier as almost every patient in there is being kept alive through unnatural means.


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