The case of Samuel Golubchuk and the right to live.
Samuel Golubchuk was unwittingly at the center of a medical controversy with important ethical ramifications. Mr. Golubchuk, an 84-year-old patient whose precise neurological level of function was open to debate, was being artificially ventilated and fed by a gastrostomy tube prior to his death. According to all reports he was neither brain dead nor in a vegetative state. The physicians directly responsible for his care had requested that they be allowed to remove the patient from life support against the wishes of the patient's family. Concurrently the Manitoba College of Physicians and Surgeons released a statement which states that the final decision to withdraw life support lies with the physician. In our opinion the statement is ethically problematic for a number of reasons. 1. It is an affront to the guiding principles of Western medical ethics: patient autonomy and human freedom. 2. The position of Samuel Golubchuk's physicians and the new statement lack cultural sensitivity towards other traditions. 3. In modern society there exists an erosion of a basic attitude towards the value of life. 4. The ability of physicians to predict life expectancy in terminally ill patients has been shown repeatedly to be quite limited.
Ben-Gurion University of the Negev, Beer-Sheva, Israel. ajotkowitz@hotmail.com
Alan
A
Jotkowitz
Shimon
S
Glick
Ari Z
AZ
Zivotofsky
D000369:Aged, 80 and over; D002170:Canada; D002755:Choice Behavior / Q000941:ethics; D003466:Cultural Characteristics; D003657:Decision Making / Q000941:ethics*; D034462:Dissent and Disputes; D004750:Enteral Nutrition / Q000941:ethics; D026690:Ethics, Clinical; D004992:Ethics, Medical; D005610:Freedom; D015276:Health Care Rationing / Q000941:ethics; D006801:Humans; D007585:Jews; D008017:Life Expectancy; D008020:Life Support Care / Q000941:ethics*; D008297:Male; D008350:Manitoba; D018447:Medical Futility / Q000941:ethics*; D018458:Persistent Vegetative State; D026684:Personal Autonomy; D010819:Physician's Role; D017410:Practice Guidelines as Topic; D012955:Societies, Medical; D013727:Terminal Care / Q000941:ethics* / Q000379:methods; D019452:Terminally Ill; D026712:Value of Life; D028761:Withholding Treatment / Q000941:ethics*