ICU - END OF LIFE ISSUES

[drlynch]

First let me say that I find this appalling and outside the bounds of what any self respecting “ethicists” might be involved in. The world is indeed dangerous from all angles. In other places I have written at length about the Schiavo case.

I would first say that it is unfortunate to even bring up that name. The press again muddles the waters by comparing the two cases . Each case is different with common elements. The common elements are what “Medical Ethics” have tried to and pretty much succeeded in parsing out over nearly forty years. Here none of that is being paid attention to.

This seems to be pure autocracy. It is also unfortunately the logical conclusion for some of the thinking of some people like Leon Kass who is a self respecting “ethicist” who has long supported a “duty to die” or at least suggested it.I may be being unfair to him because if he is only bringing it up as a serious philosophical point to discuss then he should, rather than wholeheartedly supporting it.

But I return to my ever present issue of what is motivating everyone? What is motivating the system and these doctors to act this way? Why is there an utter breakdown in communication? My work, again, emphasizes that most problems are problems of communication and then problems of emotional commutations. Nevermore so than in the highly charged atmosphere of the confines of the hospital. And I wish I could offer some of my thoughts about that here but here we have something truly frightening and that is, again, an autocracy. No negotiating. Why? Ok, that said emotion is motivating everyone, even the doctors but what is it, again?

Now having said all the above could it not be “simply” gross incompetence in emotional communication on the part of the doctors and the system? After all why this patient, why now? Again, these situations take place multiple times daily without problem. I say this on the basis of what is said in the article “That position was supported by Dr. Jeff Blackner, executive director of the office of ethics of the Canadian Medical Association. He told Reuters “[W]e want to make sure that clinical decisions are left to physicians and not judges.” Doctors’ decisions are made only with the “best interest of the individual patient at heart.

“Of course we scratch our heads and say “best interest of whom?” But it actually could it be that these docs are simply totally incompetent emotionally and got themselves caught in a corner and now will not budge. “Medically” it all seems “reasonable” under many a protocol to do what they want. But then again why are they doing it? Out of “false pride”? Fear? It seems that is a good candidate. From the quote it seems that they feel this is the way now to “handle such cases” so that “we can show the courts who’s in control”. A rather pathetic solution and way to go about it I would say.

But the quote is not from the hospital or the attending doctors so who knows their real motivation?

Again each case is separate. Medically this is really nothing like the Schiavo case except it is an “end of life case”. Each involves removing end of life care and the consent to do it. So, yes they are very similar in that sense. Why I say they should not be compared is that it is so easy to confuse all the emotionality of Schiavo case and the complexities of the court situation (Which was really not that complex as the courts always upheld the removal of care.) with, again, the bottom line situation in each of these cases and that is can people come together and make a reasonable decision?

My own view is that it was more than reasonable on all levels to remove care in the Schiavo case. It seems very plausible that it is very reasonable to do so in this case but I would say that a protocol is not the end all and be all. In the end all we have is some dignity and that comes through family, culture and values no matter how wrong headed that they may be. If we can’t have say over our death it seems the ultimate humiliation.

Initial impressions.

Brian Lynch


Aticle:

In Canada, the Schiavo case with an outrageous twist

By Jonathan Rosenblum

An elderly Orthodox Jew is on life support. His children have adamantly opposed his removal from the ventilator and feeding tube, on the grounds that Jewish law expressly forbids any action designed to shorten life. If their father could express his wishes, they say, he would certainly oppose the doctors acting to deliberately terminate his life. The director of the ICU told the children that neither their father's wishes nor their own are relevant, and he would do whatever he decided was appropriate



http://www.JewishWorldReview.com | A Winnipeg case currently winding its way to its grim conclusion pits the children of Samuel Golubchuk against doctors at the Salvation Army Grace General Hospital. According to the pleadings, Golubchuk's doctors informed his children that their 84-year-old father is "in the process of dying" and that they intended to hasten the process by removing his ventilation, and if that proved insufficient to kill him quickly, to also remove his feeding tube. In the event that the patient showed discomfort during these procedures, the chief of the hospital's ICU unit stated in his affidavit that he would administer morphine.


Golubchuk is an Orthodox Jew, as are his children. The latter have adamantly opposed his removal from the ventilator and feeding tube, on the grounds that Jewish law expressly forbids any action designed to shorten life, and that if their father could express his wishes, he would oppose the doctors acting to deliberately terminate his life.


In response, the director of the ICU informed Golubchuk's children that neither their father's wishes nor their own are relevant, and he would do whatever he decided was appropriate. Bill Olson, counsel for the ICU director, told the Canadian Broadcasting Company that physicians have the sole right to make decisions about treatment — even if it goes against a patient's religious beliefs — and that "there is no right to a continuation of treatment."


That position was supported by Dr. Jeff Blackner, executive director of the office of ethics of the Canadian Medical Association. He told Reuters: "[W]e want to make sure that clinical decisions are left to physicians and not judges." Doctors' decisions are made only with the "best interest of the individual patient at heart," he said, though he did not explain how that could be squared with the undisputed claim that this patient would oppose the doctors' decision. Meanwhile, an Angus Reid poll of Canadians showed that 68% supported leaving the final decision with the family.


The claim of absolute physician discretion to withdraw life-support advanced by the Canadian doctors would spell the end of any patient autonomy over end-of-life decisions. So-called living wills, which are recognized in many American states, and which allow a person to specify in advance who should make such decisions in the event of their incapacity, would be rendered nugatory.


EVEN THOSE who would not wish to be maintained in a state of unconsciousness, and who do not share the religious beliefs of the Golubchuk family should fear the claim of moral omniscience made by Canadian doctors — and not just because Josef Mengele was a doctor. As Professor Richard Weikart chillingly details in "From Darwin to Hitler: Evolutionary Ethics, Eugenics, and Racism in Germany", Mengele's experiments on "inferior" Jewish children for the benefit of the Master Race have to be viewed in the context of German Social Darwinism in the seven decades leading up to the Nazi takeover.


In Weikart's estimate, a majority of German physicians and scientists subscribed to the naturalistic Darwinian world view and ideas that constituted a sustained assault on the traditional Judeo-Christian concept of the sanctity of life. Among those ideas are the claim that there is no fundamental distinction between humans and animals; human beings do not possess a soul that endows them with any rights or superiority to any other species; within the species homo sapiens, there are "inferior" and "superior" individuals, and inferior and superior races; and it is the iron will of nature that the species should evolve through the survival of the superior members and the death of the inferior.


Darwin's cousin Francis Galton founded the modern eugenics movement on the basis of Darwinian arguments, and nowhere did eugenics catch on with greater enthusiasm than in Germany (though many prominent intellectuals in the United States, England and France were also enthusiastic supporters.) In Germany, many took the next step — from eugenics to involuntary euthanasia for the mentally ill and other defectives.



Ernest Haeckel, one of the most influential 19th-century German biologists, whose faked drawings of developing human embryos allegedly recapitulating the evolutionary path still feature prominently in college biology texts, argued for the killing of the mentally ill, lepers, those with incurable cancer, and cretins. As a safeguard, he too recommended a committee of physicians to pass judgment. Alfred Hoche, a professor of psychiatry at the University of Freiburg, justified shortening an inferior life if the insights gained would save better lives. "By giving up the conception of the divine image of humans under the influence of Darwinian thinkers," writes Hans-Walter Schmuhl, mainstream German thinkers came to view human life as "a piece of property" to be weighed against other pieces of property.


JUST AS Nazism gave anti-Semitism a bad name, so too did it discredit Social Darwinism. But just as anti-Semitism has reappeared, so has the assault on the concept of the sanctity of life. That assault is not limited to Princeton ethicist Peter Singer's defense of infanticide, euthanasia and bestiality on explicitly Darwinian grounds.


Global warming activists speak of the duty not to reproduce, and view human beings as the enemy of nature's order. So much for the view of man as the crown of creation. In place of the sanctity of life, we now speak of the "quality of life" — a term that explicitly assumes that some lives are worth more than others.


There is even talk of the "duty to die" and clear the way for higher-quality lives, which is why the American Association of People with Disabilities has been actively involved in so many cases dealing with the doctors' right to terminate medical care. The rage for medical rationing in Canada, of which the Golubchuk case is but one example, derives from a desire not to waste resources on low-quality lives.


It would be a bitter irony if Percy Shulman, a Jewish judge in Winnipeg, were to grant Dr. Bojan Paunovic the right to end Samuel Golubchuk's life on the grounds that it lacks the requisite quality.