A Queen's Bench judge decided Tuesday to take some time to think about the request of the Golubchuk family to maintain life support for their father. It is a difficult case, as most of these kind are, because it pits the belief of a family against the ethics and medical opinion of a doctor -- both parties believe they are acting in the patient's interest. The conflict has dropped the life-and-death decision in the hands of an independent arbiter.
But Mr. Justice Perry Schulman's decision is unlikely to be entirely satisfactory because one party will "lose" and that is a rough way to resolve a conflict. The fact that the case reached the courts shows that sometimes, despite honest efforts, the decision to withdraw medical care from a person must be taken out of the hands of those most intimately involved. Judge Schulman is wise to take time in exercising his authority.
There have been similar legal cases in Canada and in other jurisdictions that have upheld the doctor's authority to decide on withholding or withdrawing treatment. They respected the doctor's medical expertise, acting within a professional code of conduct. A physician should not be forced to deliver care he or she believes contrary to a duty of care. The doctor in this case makes the express point that, while sensitive to the family's needs, his duty is to his patient, Samuel Golubchuk, who he says is in the process of dying, but whose death, rather than life, is being prolonged by a respirator. But doctors can and have been wrong, as shown by similar cases in which patients "return" to life after being declared dead or dying. That highlights the critical value of alternative medical opinions and judicial oversight.
The Golubchuk family has had three medical opinions now, according to the Grace General Hospital, one of which came from a physician the family itself solicited. Those opinions are in agreement. What Judge Schulman is being asked to determine here is whether the end is near for Mr. Golubchuk or whether it is being held up by artificial means that are without benefit to the patient and are drawing out the inevitable.
The College of Physicians and Surgeons of Manitoba is about to adopt a formal statement on a doctor's responsibility to patients in situations such as this. Hospitals have informal processes that point patients or their families to other resources, such as advocates, to help them weigh the opinions and resolve their concerns. Despite the refinement of policy and the developing jurisprudence, some disputes will continue to land in court. Loved ones remain hopeful and doctors are fallible. That may not take the decision out of a doctor's hands, but it allows for a necessary impartial review of the care and opinions as to whether medical treatment is benefiting a life or drawing out a sure death.
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