(Written by Dr. Leon Zacharowicz and appearing in the Winnipeg Free Press)

I was saddened to read Dr. Adrian Fine’s commentary (Demand versus conscience, Sept. 21) regarding the case of the late Samuel Golubchuk, whom doctors wanted to remove from life-support without his consent and against the adamant objections of his family (reported HERE on YWN)

I was struck by the number of errors of fact and, more disturbing, by Fine’s remarkable conviction that medical personnel should be the final arbiters of what lives are worth continuing — and which should be ended.

He claims the facts were not in dispute, then misstates the “facts,” and neglects to note that there was more than one medical expert, not just a cleric, who disputed the conclusions of the doctors seeking the death of Golubchuk. As a neurologist, I, and all those who read the chart or my affidavit (and the affidavit of an ICU expert) know that Mr. Golubchuk was not, as Fine states, suffering primarily from multi-stroke dementia, nor was he dying.

Golubchuk had impaired cognitive function due to head trauma years earlier and subsequent brain surgery, which destroyed parts of his brain that enable speech. More importantly, his death was clearly not imminent in fall 2007. The evidence suggested, rather, that he was recovering from a lung infection and had pretty much returned to his baseline cognitive condition, although he could not be weaned from the ventilator fast enough to suit his ICU doctors.

Doctors at Grace Hospital who claimed that the patient had “minimal brain function,” a term repeatedly cited in the media, did not disclose to the court that Golubchuk was awake and at times even visually tracked people, as documented repeatedly by doctors and nurses in the chart. Nor did they bother to have a neurologist evaluate the patient, themselves do a standard neurologic examination, or even rudimentary tests such as a brain-wave test (EEG) or CT scan before deciding that this disabled Second World War veteran’s life was of no worth.

It was just this sort of unilateral decision that was later decried by Prof. Jocelyn Downie, a national expert in Canadian health-care law and policy, who characterized the doctors’ actions in this case as without legal precedent and “dangerous.”

Golubchuk lived his whole life in Canada. At 16 years old, he volunteered to fight in Europe against the Nazis. Even on the battlefield, he stayed true to his beliefs, never once eating non-kosher food. He chose to live in Winnipeg because he found a job there that would not require him to work on Saturday, his Sabbath. He was steadfast in his observance of Jewish law. He would never have consented to allow doctors to end his life against his religious beliefs, nor would he have dreamt, I suspect, that such actions would be countenanced in a Western democracy.

Golubchuk’s family was informed that the ICU doctors, without consent, would be abruptly ending their father’s life by removing him from a ventilator, stopping all feedings, and giving him narcotics. (Fine calls this “palliative” care.) They dared to challenge the medical professionals — a tribute to their respect for Jewish religious law and for the sanctity of human life, even a medically compromised one. These doctors decided to serve as judge, jury, and dare I say executioner of their unilateral decision, reportedly moving up the date and time of their planned termination of his life when they learned that the family was going to seek an injunction.

Fine claims that gangrene set in, multiple surgeries were needed, and that these resulted in kidney damage. These assertions warrant investigation as they suggest a condition far worse than the skin breakdown the doctors admitted had developed under their watch, a condition that is consistent with professional neglect.

Fine’s lack of knowledge of the basic medical facts in this case are compounded by his cavalier assertion that there is “a significant division of opinion on end-of-life issues within [Jewish] Orthodoxy,” based apparently on his having done a Google search. I can speak with some more direct knowledge here. I recently participated in a New York academic conference in September on precisely that topic and in an August seminar in Jerusalem, both of which included a discussion of the Golubchuk case. With more than two decades of experience in Jewish medical ethics, I can assure Fine and readers that no Orthodox Jewish authority would have agreed to active euthanasia of the sort proposed by the doctors in this case. Indeed, I discussed the case with numerous scholars and rabbinic authorities, and the case was also discussed with leading Christian scholars, and all were aghast at what was being proposed by these doctors.

The relief of pain and suffering is a major concern in Jewish and Christian approaches to end-of-life care. However, pain was apparently not a major issue in this case. Otherwise, how could one explain the lack of significant pain medication being given to the patient? While one of the doctors claimed publicly that to debride the bedsores was “torture,” the absence of pain management for the patient raises the question as to whether the doctor simply felt tortured by having to comply with the court order.

While neither I nor the ICU expert who submitted affidavits on behalf of Goluchuk were permitted to examine the patient, an expert witness flown in by the defendants, months afterwards, concluded that Golubchuk was awake, albeit in a minimally conscious state. The doctors were thus undeniably seeking to put to death a man who was awake and who would never have consented to this act.

Even more disturbing than Fine’s multiple errors, though, is his astounding assertion that his “conscience” and the conscience of his “like-minded” colleagues should trump the consciences and religious convictions of patients and their families, and indeed the conscience of those medical professionals who obeyed the rule of law and kept Golubchuk alive — professionals whom Fine portrayed as cowards. Apparently, Fine will accept only Fine’s conscience, and perhaps that of “like-minded” colleagues, as the arbiter of who shall live, and who shall die. While in retirement, he castigates those who sought to heal, and he urges colleagues to ignore a court order and take matters into their own hands.

The sort of hubris inherent in such pronouncements is, unfortunately, not uncommon in modern medicine, many of whose practitioners worship the new religion of futile care theory. We would do well to recall that the approach’s most memorable manifestation – when doctors were legally authorized to assume the right to decide “who shall live and who shall die” — was in the 1930s, in Germany.