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Monday, June 30, 2008

Who Should Make End-of-Life Decisions?

Back in December, we told you about the case of Samuel Golubchuk of Winnipeg, Manitoba, whose family members were fighting a hospital decision to take the 84-year-old off life support because they said it violated the family's Orthodox Jewish religious beliefs. In February, a judge ruled in their favor, sending the case to trial.
Golubchuk died last week, "but the larger issue remains relevant," says Rabbi Dow Marmur, who writes about the case in his biweekly column in the Toronto Star. The case, which caused one doctor to resign and two others to withdraw from Golubchuk's care, not only set medical science and religion against each other in the courtroom, but also kick-started a larger discussion about the rights of the old and disabled, and the ethics (and cost) of caring for those who doctors say will never recover.
First, Marmur explains, from "the point of view of Jewish tradition, viewed in the abstract, they had a case. Judaism forbids humans to play God, however urgent the cause. Life, it's argued, is qualitative not quantitative—you're either alive or you're dead. Therefore, it's improper to assert, as the doctors at the Grace Hospital in Winnipeg seem to have done, that as Golubchuk only had minimal brain functions with no prospect of recovery, treatment should be discontinued, even though in some sense he was still alive." But he also addresses the issue of taking patients off of life support in general. "Though the general principle should be open to public debate, each individual case must be judged on its own merits," he writes. The decision, he says, should be based solely on what's best for the patient and what the patient would have wanted, and the process of making that decision "is usually more authentic than citing religious beliefs," he writes. "In most cases, medical opinion and religious convictions need not contradict each other. Recently, Orthodox rabbis in Israel have determined that medically determined brain death be regarded as the end of life. Turning cases like that of Samuel Golubchuk's into battles between science and religion to be adjudicated by law is a poor way of dealing with a human problem of immense consequences not only for the distressed family but also for society at large." —Heather Wax