Winnipeg Free Press

Winnipeg Free Press (Newspaper) - December 28, 2008, Winnipeg, Manitoba C m y k Page b4 l Ying in an intensive care bed hooked up to a ventilator and feeding tubes Samuel Golubchyk Likely had Little idea How his fight to die his Way would rattle the pillars of the medical system and land him in the International spotlight. But his eight month Battle did just that. His orthodox jewish beliefs were pitted against Winnipeg physicians who argued that continuing to treat the elderly Man was tantamount to torture. It captured headlines across the Globe and sparked Public debate about How patients in their final stages of life should be treated. Golubchyk died june 24, just Days after his children Miriam Geller and Percy Golubchyk Sang to him in the Grace Hospital intensive care unit to celebrate his 85th birthday. The court injunction Golub Chukes children sought to keep him alive died with him and the question of who gets to decide when someone Dies a snot been fully answered. Six months after his death the medical system is still Abuzz health officials Are Only Halfway through a review of Golub Chukes Case that they Hope will shed Light on How to better handle conflict Between patients and physicians. An Independent arbitrator is an option they might consider. Miriam and Percy Arentt included in that review and said physicians brushed off their concerns the first Day their father was admitted in the ice. They allege the medical system failed and set a dangerous precedent for patients and families. When doctors and patients clash Percy said patients rights Are overruled. The main Issue is human rights and Freedom of religion he said. Golubchyk was admitted to the Grace Hospital ice in october 2007, suffering from pneumonia and pulmonary hypertension. He was put on life support nov. 3. Within a week doctors said further treatment of Golubchyk would be futile. His children disagreed. Golub Chukes children said their father was still responsive he speak but he was awake and would squeeze their hands blink and twitch his feet. Doctors said these were reflexes and that Golubchyk had no Hope of recovery or Quality of life. Critical care specialists drs. Anand Kumar and Bojan Paunovic said Golubchyk had no self awareness and that their decision to terminate support is in no Way biased against disabled persons. The fact is that a very Large portion of patients admitted to every ice Are disabled in some Way said an e mail statement from the doctors. Will the ice stay result in survival or Hospital discharge if not then All we Are doing is extending the process of someones death. It was a Story his children had heard before. Five years earlier Golubchyk suffered a brain injury when he fell but he could still communicate and understand. Miriam said she remembers being told her father would have no Quality of life which turned out to be untrue she and her brother were Able to take him Bowling to Bingo and even to the Casino. Golub Chukes children said communication with Hospital staff ended the moment the two sides agree. No patient advocate ethicist or mediator was brought in to facilitate discussion Between physicians and Golub Chukes family. Miriam and Percy got a lawyer who advised them a court injunction could Stop doctors from withdrawing their fathers life support. Friends described Golubchyk As a Man of unwavering Faith who kept Kosher even As a Young Soldier in the second world War. His children said no one should be Able to dictate when someone Dies. We did not have any say in the matter Percy said. Thatus Why we had to go to court. Justice Perry Schulman of Manitoba court of Queens Bench set a new precedent when he ordered Hospital staff to do everything necessary to keep Golubchyk alive. It was a Victory for Golubchyk and a blow to some medical professionals who were outraged they May have to undertake treatment they thought would cause undue suffering and harm to a frail Man on the verge of death. Kumar and Paunovic Call the judges initial decision illogic since it forced doctors to continue treatment based on the fact that doctors started life support in the first place. After several weeks of assessment in the ice the doctors said there was enough evidence Golubchyk would never recover. It was the refusal of any other physician to accept the patient in Transfer that forced the Warha to arrange a form of therapy never previously offered at Grace an arrangement that is unique in the history of the hospitals in the City the doctors said in an e mail. Patients requiring such support Are normally transferred to either Hsc or st. Boniface Hospital. W weeks later the College of physicians and surgeons released a new position statement that said in the event physicians and families dont agree the ultimate decision to withdraw life support lies with the physician. Golub Chukes children suspect the statement was timed to legitimize the argument made by Grace Hospital staff and to Sway Public opinion against them. Or. Brian Postl ceo and president of the Winnipeg regional health authority said the court decision put the health care system and some medical staff in a stressful and uncomfortable position. Certainly the judicial involvement was a precedent since there was a court injunction saying things had to continue that quite frankly were quite difficult to continue he said. How Many More interventions were undertaken that might not have been without the Legal injunction and what Impact did that have on staff and other resources things turned heated when critical care specialist Kumar resigned from Grace Hospital saying continuing to treat Golub Chukes deteriorating condition was a grotesque abomination. His resignation letter read aloud in court in a bid to persuade the judge to move Golub Chukes trial up by two months painted a disturbing picture of medical staff forced to surgically Hack away at Golub Chukes infected flesh. Two More specialists Paunovic and or. David Easton followed suit leaving the Community Hospital intensive care unit Short half their physicians. Physicians said treating the ailing Man would go against the medical principle of do no harm and All three refused to Cross the ethical line in the Sand. Golub Chukes children said the allegations that their father was covered in bedsores was a lie. Miriam alleges doctors spoke publicly about their fathers condition to vilify their crusade. On their daily visits to the ice it was like you had the plague. You get these dirty looks from the doctors from the nurses she said. It did not make us feel very Good. Complicating matters was the fear that cases like Golub Chukes could Strain limited health care resources and take critical Beds from patients with a Chance of getting better. Clearly if this kind of thing were to be a frequent event it would have an Impact on our capacity to care for others who have needs or arrived after our resources Are tied up Postl said. Two intensive care Beds at the cit yes biggest trauma Centre had to be closed so nurses could scramble to Grace to provide Golubchyk with kidney dialysis. Health officials have said it costs about $ 2,200 a Day for a patient to be cared for in an ice. That Means Golub Chukes stay in Hospital May have Cost More than $ 450,000. Miriam said doctors were unabashed in telling the family their father would be a Drain on the Short Supply of Beds and Money the Region needs to treat other patients. She said everyone who wants medical treatment should be entitled to receive it. C ollege of physicians and surgeons registrar Bill Pope said there Are no plans in the Wake of Golub Chukes Case to alter the colleges position statement that gives doctors the authority to withdraw life support. Pope said revisit it in five years or if a court ruling strikes it Down or if the government introduces legislation. The colleges statement has a clause naming court As a place where doctors and patients could Settle end of life disputes. Pope said legislation would Likely be too Broad for any specific patient Case and the dispute would wind up in court anyway. However he admits that most patients who Are gravely ill would die before their Case goes to trial making a court ruling on the matter unlikely. Often in these situations the patient does die before it can be resolved Pope said. There Are no Canada wide guidelines on withdrawing life support but four years ago the Law Reform commission released a report saying the Manitoba health care system needed to establish Clear and uniform guidelines. Other jurisdictions like Ontario have a consent and capacity review Board established to Deal with end of life cases quickly. Instead of waiting months for a court trial a three member panel is convened within a week. They hear both sides try to mediate and if no Compromise can be reached the panel makes a ruling. I n the end Golubchyk won. He died on his terms and opened the door for other patients to seek court injunctions if they disagree with a doctors decision. Postl said thatus a concern too particularly since those conflicts could spill Over into other areas of Medicine. He wonders if a doctor tells a patient he has an inoperable brain Tumour could someone seek an injunction to Force a surgeon to operate one medical source who wanted to remain Anonymous said the heart of the debate surrounding Golubchyk a snot really about end of life issues at All it was about the inability of doctors to communicate with patients. Instead of conducting internal review and promising to do better the source said the Warha needs to get at the Root of the problem and determine Why a communication failure spiralled to extremes. If the Warha wants to do something interesting innovative and bold they would look at this As a system failure he said. Its really about figuring out Why the plane crashes not How to do better next time. Doctors and patients Why cant they talk to one another Why do arguments happen what Are the bad choices that made this intractable Postl admits the Warha is trying to find ways to facilitate More balanced and shared discussions Between patients and families. Thatus Little Comfort for Golub Chukes children who a vent had any Contact with health officials since their father died. Miriam believes the College needs to change their position statement so doctors dont have free rein to have the final say in end of life issues and doctors need to Start listening to what patients and families have to say. They re not listening to us she said. A doctor is not god. Jen. Skerritt free press. My. Ca b4 sunday december 28, 2008 Winnipeg repress. Com unshakeable Faith friends and family describe Sam Golubchyk As a stubborn Man who was unwavering in his Devotion to his family Community and Faith. He was born in Vegreville alta., where he grew up before spending some of his Early years in Edmonton and several jewish colonies in Saskatchewan. When the second world War broke out Golubchyk enlisted at 16, and served overseas in Holland and England. He kept Kosher throughout the War. Golubchyk returned to Canada and ran a Small grocery store in Portage la Prairie and also worked in Winnipeg for Joseph Wolinsky Dominion electric and a local Industrial Supply store before retiring. His wife Dora died in 1974, and he raised his children Miriam and Percy As a single father for More than 30 years. When his children were Young Golubchyk spoke to them Only in yiddish. He was Active in the jewish Community and helped run the talmud torah Beth Jacob synagogue. Death was a Battle Samuel Golob Chukes ordeal raised questions still to be answered Samuel Golub Chukes funeral above in june. Right his children Miriam Geller and Percy Golubchyk who fought with the health care system to keep their father on life support. Mike Aporius / Winnipeg free press archives Joe Bryksa / Winnipeg free press archives Jen Skerritt. Update 08. A 04_ dec 28 08. Ind b4 12/ 27/ 08 6 34 25 pm ;