Golubchuk family drops end-of-life lawsuit against Winnipeg health authority

Over a month after the death of Samuel Golubchuk (left), his family has scrapped the legal battle it has been fighting since Winnipeg critical-care doctors were thwarted in February in their attempt to remove the brain-damaged 84-year-old from a respirator and feeding tube, reports the Winnipeg Sun.

Mr Golubchuk was hospitalized last fall at Winnipeg's Grace Hospital, with pneumonia. His condition deteriorated and physicians told the family further treatment would be futile. The Orthodox Jewish family disagreed on religious grounds and obtained an temporary injunction from a judge in February to prevent the physicians from withdrawing care until a trial could be held. Before that trial ever took place, however, several doctors resigned from providing care for Mr Golubchuk -- and then, after a new doctor was found to attend to him, Mr Golubchuk died on June 24, with the trial still months off. (Read my article here.)

For the family, abandoning the legal wrangling must be a welcome respite from the months of conflict since Mr Golubchuk was hospitalized. But for Canadian policymakers, physicians, lawyers and ethicists, the absence of any clarification on this issue -- how conflicts in end-of-life decision-making should be handled -- is a major blow.

"We need resolution on this issue," one of the three doctors who resigned told The Globe and Mail anonymously. "These cases are just occurring over and over again."

Winnipeg bioethicist Arthur Schafer, PhD, told me:

"At the human level I think one has to feel relief for Mr Golubchuk, because he was not in a vegetative state but in a near-vegetative state — he was feeling pain and discomfort. But on the other hand we won't have a court ruling that will clarify the situation."

Heidi Graham, the Winnipeg Regional Health Authority's spokesperson, told the Winnipeg Sun that their physicians are expected to follow the College of Physicians and Surgeons of Manitoba's guidelines on withholding and withdrawing life-sustaining treatment (PDF). Those guidelines, which essentially declare that the final decision on withdrawing care is to be made by a physician instead of the family, might have been thrown out by the courts if the case had continued; they are "the most insensitive, hypocritical, unfeeling document I have ever read," the Golubchuks' lawyer, Neil Kravetsky, told me.

In the absence of a decision on the Golubchuk case, many questions of national importance remain:

• Was the injunction appropriate?
• Would the family have won the right to demand continued, useless care?
• Were the doctors within their rights to make a withdrawal-0f-care decision unilaterally?
• What are the legal consequences for doctors who resign from caring for a patient because they feel providing futile care would be more harmful to the patient than helpful? Could a court jail a doctor for such a decision?
  
• Why did the Manitoba justice system initially set a trial date nine months in the future when the patient was on death's door, all but guaranteeing the case would not be heard?

Decision or no decision, Mr Kravetsky was claiming victory on all fronts not long after Mr Golubchuk died. "We won the injunction," he told me. "That is a precedent. There are no others in this kind of case. So people who are faced with what Samuel Golubchuk's family was faced with, they know there is something to rely on in the future."

But no one can know at this point what the trial would have decided. If some good could have come from the suffering and strife of Mr Golubchuk's ordeal, then it would have been a clear and purposeful ruling by a judge that would have settled our questions. That will not happen now -- at least not until the next time a dying patient is caught in the crossfire of the ongoing battle over end-of-life decision-making.

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