Can't live without your old man's pension cheque or what?
Two more MDs quit Grace unit
By: Carol Sanders
Updated: June 17 at 12:25 AM CDT
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Two more critical-care doctors at Winnipeg's Grace Hospital have followed the lead of one of their colleagues who quit his shift rather than obey a court order to treat an elderly man on life-support, and more may follow suit.
Doctors Bojan Paunovic and David Easton have cancelled their shifts in the hospital's intensive-care unit, where 84-year-old Samuel Golubchuk is on life-support. The resignations cut the hospital's critical-care complement of doctors by half.
After the resignation a few weeks ago of Dr. Anand Kumar -- who refused to "torture" the man by hacking away at his flesh infected by bedsores -- there are now just three critical-care physicians remaining.
Prof. Arthur Schafer, director of the University of Manitoba's Centre for Professional and Applied Ethics, said he expects more doctors and nurses will withdraw their services rather than violate their professional oath to do no harm.
"It always trumps the courts," said Schafer.
"This is true for any doctor or any professional," he said.
"I wonder about the nurses," said Schafer. "Their code of professional ethics also causes them not to cause harm," he said.
"A professional isn't simply a technician servicing the instructions of the clients or patients." He gave the example of an engineer who can't put a stamp on blueprints that don't meet professional standards even if a client or a judge orders it.
"The courts can't order a doctor to behave unprofessionally," Schafer said.
In February, a judge ordered the hospital to continue treating Golubchuk until a trial can be held. The trial date was moved up to September from December, if Golubchuk lives that long.
"This man is in very fragile health and in order to keep him alive if his heart stops, doctors have been ordered to give CPR," Schafer said. "That means cracking every bone in his chest. He's being fed through tubes in his nose, his heart is kept going by electrodes. The person who was Mr. Golubchuk ceased to exist a long time ago, while the body of Mr. Golubchuk is still alive."
Golubchuk's family lawyer said Schafer's argument is missing something.
"Consent is a major issue," Neil Kravetsky said. "Why is it not required, ethically, when you're going to remove someone from life-support?" he asked.
"Many doctors would disagree with Arthur Schafer as would many ethicists."
The Winnipeg Regional Health Authority won't say why two more doctors at the Grace have resigned. The critical-care unit had six intensive-care doctors before the three resigned from their shifts, said spokeswoman Heidi Graham. Kravetsky said he wasn't surprised by the doctors' decision. Two of the three doctors were sued for not providing proper or ethical care to Golubchuk, he said.
"What they're doing is consistent with their conduct... by not continuing to treat him."
Doctors at the hospital have said they are unhappy that Golubchuk is being kept alive on life-support, but his family says taking him off would violate his beliefs as an Orthodox Jew.
"These doctors each have judged these distressing, aggressive procedures are not warranted -- he can't be cured and he can't benefit," said Schafer. "...They are acting according to professional ethics... In this case, the court has ordered treatment and the doctors had no recourse but to resign," said Schafer.
"These three doctors understand what the courts may not understand, or at least the judge who heard the case may not understand."
When Kumar resigned from caring for Golubchuk, he wrote an open letter to the public saying he felt keeping the elderly man alive was "tantamount to torture."
Schafer had a "whimsical and black" suggestion.
"Perhaps since it's a violation of medical ethics for doctors to treat Mr. Golubchuk... then maybe the family's lawyer and the judge should be there to hack away at his flesh and crush his ribs."
Kravetsky was appalled when told of Schafer's remark.
"That's totally disrespectful to court and counsel and it's unethical for him to say anything about what a judge or lawyer ought to do."
Meanwhile, the doctors who've resigned from their critical-care shifts at the Grace may still work elsewhere.
"Doctors can have privileges at more than one hospital," Graham said. She said the health authority is working with Winnipeg's critical-care physicians to "ensure there is adequate coverage."
"So far, we are being able to achieve that," she added.
carol.sanders@freepress.mb.ca
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