Samuel Golubchuk is an orthodox Jewish man who is on life-support at Grace Hospital in Winnipeg.Grace Hospital believes it has the right to end this life-sustaining care against the wishes of the Golubchuk family. Samuel is currently dependent on a respirator and receives fluids and food through a feeding tube.

On March 14, Neil Kravetsky and the lawyers for Grace Hospital met to discuss a suitable court date. Due to demands on the legal system, it is unlikely the Golubchuk case will be heard until later this year.

In the meantime, the temporary injunction granted by Justice Perry Schulman maintaining life-sustaining care for Samuel will be upheld until the trial.

The crux of the issue is who has the right to decide when to withhold or withdraw life-sustaining treatment or care. In the case of Golubchuk, the physicians believe they have the right to withdraw his care, even if it results in his death. Golubchuk’s children, Percy Golubchuk and Miriam Geller, share their father’s orthodox Jewish faith and are convinced it is morally wrong to withdraw their father’s respirator, fluids and food.

The College of Physicians and Surgeons of Manitoba issued a Statement on the withholding and withdrawing of life-sustaining Treatment on Feb. 1, 2008. It said: “Where a physician concludes that the minimum goal is not realistically achievable and that life-sustaining treatment should be withheld or withdrawn and there is no consensus with the patient/proxy/representative, the physician is not obligated to continue to reach a consensus before withholding or withdrawing treatment, but must meet the implementation requirements … before treatment can be withheld or withdrawn.”

This means that if a physician determines a patient is unlikely to achieve the minimum goal related to cognitive ability, the physician will decide, without need for consent, when to pull all life-sustaining treatment or care, including fluids and food.

The Manitoba statement also said that: “Where the physician concludes that the minimum goal is realistically achievable, but that treatment should be withheld or withdrawn, and the patient/proxy/representative does not agree and/or demands life-sustaining treatment,” that a second physician must be consulted. If the second physician agrees that “treatment should be withheld or withdrawn and there is no consensus reached with the patient/proxy/representative, then the physician must provide at least 96 hours advance notice to the patient or proxy.

In other words, even if a physician determines that a patient is likely to achieve the minimum goal related to cognitive ability, the physician will also decide, without need for consent, when to pull all life-sustaining treatment or care, including fluids and food. If the patient/proxy/representative does not agree with the decision of the physician, the physician must consult a second physician. If the second physician agrees with the decision of the first decision, then the first physician must provide at least 96 hours advance notice to the patient or proxy before withholding or withdrawing all life-sustaining treatment or care.

Section 25 of the decision by Schulman included an important precedent-setting statement. Schulman stated that: “Contrary to the assertion by the defendants (Grace Hospital), it is not settled law that, in the event of disagreement between a physician and his patient as to withdrawal of life supports, the physician has the final say.” This statement represents the real question, which is: who decides when to withdraw life-sustaining treatment or care that may result in the death of the patient? This will also settle the question of who has the right to decide the withdrawal fluids and food.

The decision of Schulman not only maintained the medical care for Samuel Golubchuk, but also brought into question the validity of the statement on withholding and withdrawing of life-sustaining treatment by the College of Physicians and Surgeons of Manitoba.

The issues that will be decided by the Golubchuk trial in Winnipeg could set a precedent that will affect all medical care decisions across Canada. The Euthanasia Prevention Coalition has agreed to work with the Golubchuk family’s lawyer to build a case that will effectively establish important precedents.

Alex Schadenberg is executive director of the Euthanasia Prevention Coalition.