BS: To Pull Or Not To Pull The Plug

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: bobad
Date: 21 Jun 08 - 09:38 AM

Winnipeg hospitals divert key resources to care for dying man
Winnipeg Free Press
Published: Friday, June 20, 2008

WINNIPEG - A Winnipeg hospital has been forced to close two intensive-care beds and transfer nursing staff to a sister hospital in order to keep alive a dying 84-year-old man, whose case has become the latest flashpoint in the debate over end-of-life care in Canada.

Samuel Golubchuk, an Orthodox Jew, was admitted to Grace Hospital in Winnipeg last fall, suffering from pneumonia and pulmonary hypertension. He was put on life support Nov. 3.

When doctors said further treatment was futile, Golubchuk's family disagreed and, arguing that cutting off his life support would violate his religious beliefs, sought a court injunction in December to keep him alive. The case comes back to court in September.

In the meantime, staff at the Grace are under a court order to do everything in their power to keep Golubchuk alive.

As a result, the city's Health Sciences Centre - the city's biggest trauma centre - was recently forced to transfer two intensive care nurses with "specialized skills" to the Grace intensive care unit. Multiple sources who did not want to be identified told the Winnipeg Free Press the nurses were sent to the Grace so Golubchuk could have dialysis needed to keep him alive.

Experts say patients such as Golubchuk, who are in a minimally conscious state, can still feel pain - and they can't receive as much pain-relieving medication if they are on dialysis.

Already, three of the Grace's critical-care doctors have refused to treat Golubchuk, saying to do so would only prolong his suffering, an ethical line they say they won't cross.

One source said the nurses at Grace Hospital feel as though they are "flogging" someone who has no hope of getting better and that closing ICU beds could put other critically ill patients in jeopardy.

http://www.canada.com/topics/news/national/story.html?id=9c5d6629-64f2-4b57-86fc-496be65c2664

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: GUEST,Guest
Date: 09 Mar 08 - 06:16 PM

That is the case in question. The doctors and hospital that are being forced to keep this man alive are the ones who said there is no hope of medical recovery in this case, and that life support is futile.

The reality is, it means that the Canadian taxpayers ARE paying to keep a person alive, who wouldn't be if his family wasn't playing the religion card.

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: GUEST,dianavan
Date: 09 Mar 08 - 05:01 PM

I agree when you say if it is a choice only for the rich then it is no choice.

If, however, it was the doctors educated opinion that determined whether or not the person had a resonable chance of meaningful recovery and life support should end, it would be a medical decision, not a choice. No personal preference, no religion involved.

The only choice would be whether or not the family wanted to pay to keep the person alive. That is where choice would enter into the picture. If religion influences that choice, then the church or synagogue can offer assistance to those in need of financial help.

It should have nothing to do with tax-payer funded medical care.

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: GUEST,Guest
Date: 09 Mar 08 - 11:30 AM

Do not go gentle into that good night           
by Dylan Thomas

Do not go gentle into that good night,
Old age should burn and rave at close of day;
Rage, rage against the dying of the light.


Though wise men at their end know dark is right,
Because their words had forked no lightning they
Do not go gentle into that good night.

Good men, the last wave by, crying how bright
Their frail deeds might have danced in a green bay,
Rage, rage against the dying of the light.

Wild men who caught and sang the sun in flight,
And learn, too late, they grieved it on its way,
Do not go gentle into that good night.

Grave men, near death, who see with blinding sight
Blind eyes could blaze like meteors and be gay,
Rage, rage against the dying of the light.

And you, my father, there on the sad height,
Curse, bless, me now with your fierce tears, I pray.
Do not go gentle into that good night.
Rage, rage against the dying of the light.

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: GUEST,Guest
Date: 09 Mar 08 - 11:24 AM

But this sort of case doesn't just occur with religion, so it is bogus to claim religious bias or discrimination as the cause of it.

It happens when next of kin aren't willing to let go of their loved ones who would be dead were it not for the medical intervention to keep them artificially alive.

How many years should we be required to keep people artificially alive, before we pull the plug or they die of complications from being kept artificially alive?

And let me remind one and all, the instances of people reawakening and being able to speak, walk, and resume life on even a marginal basis, as so extremely rare, any instance of it is widely reported in the news as 'a miracle'.

The largest generation in history is coming into the picture, and very few of them are willing to go gently into that good night. So the reality is, there is a tremendous risk that many in the generation will be neglected, abused, abandoned to the state...all with a shrinking pool of caretakers and adequately trained medical staff to provide for them.

So, we should bankrupt our children, and torture our survivors?

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: bobad
Date: 09 Mar 08 - 11:09 AM

The story is being covered on CBC Radio right now.

http://www.cbc.ca/montreal/#

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: freightdawg
Date: 04 Mar 08 - 08:25 PM

Thanks for the clarification, Dianavan...

It's hard down south here to get the full picture of what the system is like.

Kat makes a profound point. If only the rich can make the decision, then there really is no choice.

Is that not exactly the argument that pro-choice people use to demand tax money be spent to pay for abortions?

Freightdawg

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: catspaw49
Date: 04 Mar 08 - 04:51 PM

Yeah kat and once again, that is the problem. The legal system and our laws (and religions for that matter) have not kept pace with medicine.    I doubt they could in any case. Our technology has moved and continues to move so quickly that it would be damn near impossible.

I was talking to my Doc this morning about this very subject. She too has no idea how the moral and legal issues will play out or even if they can before the next jump. If medicine were 20 years behind where it is now, I'd be dead. So would a lot of others both older and younger.

Think about the issues of the aging and the similar issues of children now alive who would, without the advances, be dead. I have no idea what the answer is on this one myself. But I am sure that one helluva lot of families are thinking of themselves and NOT the dying relative. Somewhere along the line someone will be playing god and for me I would like that to be someone who is less emotionally involved or at least rational.

A year before my great friend Denny died we were drinking coffee and he said that he knew when the end came, his wife (Sue) would have a tough time making a decision as to what to do. Denny had a living will but it was going to be tough on Sue and he knew it.He figured he had a year or so (Cancer) but wanted this clear with me. Denny had these piercing blue eyes and he looked at me and said, "Sue will come to you I know and I expect you to tell her what to do." A year or so later I fulfilled his request when in the hallway she asked what she should do and I said, "Let him go Susie."

Trying to apply religious tags to medical conditions is full of pitfalls and the case Sol describes makes that obvious. We have no idea what a "meaningful recovery" is and is it different for me than for you? What is "quality of life?" At what level does brain function really become the determining factor? And where does pain and suffering come in? In life, would this gentleman Sol tells us about have enjoyed laying in a bed like a piece of meat? If not, how cruel are we to allow it to happen now? Years will pass and no one will come anymore or perhaps they'll play "Battleship" on either side of his body. Can this possibly be what anyone would want?

Maybe it is.........But just so everyone knows, when I am in such a state, punch my ticket.....Its the wise and merciful thing to do.

Spaw

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: katlaughing
Date: 04 Mar 08 - 03:53 PM

So what criteria would you use? What about the person who is brain-dead from drunk driving whose family wants him kept alive, no matter what? The state will pay for that, but NOT if they claim a religious belief in keeping him alive?

That's just one example. I am not saying it should be up to just the family or the doctors, but I don't think we can discriminate against people because of the financial means and religious beliefs. Mainly I am saying, it cannot be so cut-and-dried. Each case will have to stand on its own merits, probably and, unfortunately, in a court of law.

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: GUEST,dianavan
Date: 04 Mar 08 - 03:18 PM

You're right about that, Kat. It would mean that only the rich would be able to keep a brain-dead body, alive for religious reasons.

In the case of a govt. funded health care system, its really a case of separation of religion and state.


freightdawg, you say, "And since, as I understand it, in Canada your health care is paid for "cradle to grave" then the state should pay for it." Its not quite like that. Some procedures are considered "elective" and you have to pay out of pocket.

For example: One of my eyelids (due to nerve damage in the past) has drooped and is interferring with my peripheral vision. The medical system will pay for the surgery. If, however, I want the other done at the same time (so they will match) I must pay for that eye. Only one eye is a medical necessity. The other eye is elective.

It is not a medical necessity to keep a body alive when the doctor says there is no hope. The religious belief of an individual does not come into play. You might put it into the Jehovah Witness category but in reverse. Jehovahs do not have the right to deny their child a life-saving blood transfusion, regardless of their religious beliefs.

I am disappointed in you Rabbi-Sol. To compare Mudcatters with Jack Kevorkian and Josef Mengele is to end any further discussion with you. You can believe whatever you want to believe but that does not mean I have to pay for it. You should pay for your own belief system, not me.

Perhaps you will find that your so-called, living, breathing religion will change if it starts costing you money.

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: katlaughing
Date: 04 Mar 08 - 11:56 AM

I think it is problematic to tell people of any certain belief they will have to foot the bill in cases such as this, esp. if they do not have the means. It smacks of the wealthier having more say in their own lives, while the poor suffer whatever is available. What of an elderly person who has been poor all of their lives and may not have anyone to help with bills? Are we not to try to honour their beliefs? We can take over in cases of abuse and foot the bill, but not for the poor who are trying to do the right thing, by their belief system? There is something illogical about that which bothers me.

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: GUEST,Guest
Date: 04 Mar 08 - 09:03 AM

I guess you really aren't interested in a serious dialogue Rabbi Sol, which is what I've suspected all along.

When you start accusing people who are thoughtful and concerned of acting like Joseph Mengele, you yourself have put an end on the conversation.

Must be those of us who disagree that a person claiming religious belief should be given separate, special, and EXTRAORDIINARY treatment by playing the religious card, are quite offensive to you.

Which begs the question I have been asking all along here: what is YOUR agenda here Rabbi Sol?

And what is it with so many here who are anti-doctor and anti-medicine? Sure our health care system sucks. But it is also terrific in so many ways. It isn't the medical ethicist community that hasn't caught up with the times, it is the public and ESPECIALLY the religious communities, who believes the and their faith community ought to be able to dictate life and death treatment, cradle to the grave, for the rest of us in a pluralist, democratic society.

Sorry, but that idea goes against the grain of everything I believe in democracy and pluralism.

As I said, if people have special religious views they want to drive the method of care for loved ones at the end of life, let them take out the long term care insurance, and care for their loved ones on their own, their way. No one will stop them from doing that, unless of course, the state needs to intervene in a case because of neglect, abuse, etc.

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: Grab
Date: 04 Mar 08 - 07:45 AM

Rabbi Sol, Kevorkian allowed people who were dying in pain and shame to choose to die on their own terms. For having the courage to stand by those beliefs in a legal system which doesn't recognise the possibility of a "good death", he deserves to be honoured in the same way as Sir Thomas More, who similarly died for his beliefs in a legal system that didn't allow for recognition of certain basic rights.

"Do unto others as you would have others do unto you." If I'm dying with no chance of recovery, and I am unable to kill myself, then I would like someone to kill me. Sol, if you're the nearest, I would like you to put a knife through my heart, and I would bless you for doing it.

As I said, kudos to Judaism for trying to keep up with medical advances. The problem is that this rule on ventilators seems to have been conceived when ventilators and other similar systems could only be used as temporary measures. For some years now, it's been possible to keep bodies physically alive indefinitely with ventilators and pacemakers, so this rule is clearly now outdated and needs to be rethought.

Graham.

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: catspaw49
Date: 04 Mar 08 - 12:37 AM

Maybe you could define for some of us just exactly what shape this man was in that would give a reasonable person some semblance of proof that this is premature?

How can you consider a vent as a "natural" means of staying alive? Its not natural til you're hooked up and then it is? Gimmee a break.....That's ludicrous. Only advances in medicine over the past 20 years have kept him alive to this point. Hellfire, those same advances have kept ME alive.......but I'm still functional (I think).

No brain function and a frail body...............Its so nice that a religion values life so greatly that you don't have to be warm or breathing to be alive......Where are y'all on abortion anyway?......................

The whole Kevorkian/Mengele thing is tripe Sol. Two entirely different situations......But I can see how you'd have it wrong as obviously the concept of mercy has not reached the Jewish religion yet.........

Spaw

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: Rabbi-Sol
Date: 04 Mar 08 - 12:16 AM

It looks like Jack Kevorkian and Josef Mengele are very much alive and well on Mudcat. It is a sad day indeed when human life has to be measured in dollars and cents. What old people need today is a special insurance policy. They will be forced to deposit $200,000 with their local Mafia godfather to take out a contract on the CEO of any insurance company or HMO that seeks to terminate their life prematurely. When these bean counter low lifes are faced with the possibility of their own premature demise, perhaps they will get to value the lives of others. "Do unto others as you would have others do unto you." It may be the golden rule but it can work 2 ways.

                                                    SOL

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: freightdawg
Date: 04 Mar 08 - 12:11 AM

GuestGuest and Dianavan,

I really do agree with both of your last posts. If it were up to me there would be far less "heroic" measures taken at the end of a person's life. I have seen enough tragically horrible decisions to last me the rest of my life, and probably beyond that. I really do not wish to see anyone kept on life support by a medical world that has lost its sense of direction. And, I agree, if a family wishes to keep someone "existing" by those means then they should pay for it.

HOWEVER,

My wishes are not in play here. It is the wishes of a Jewish family, and it is not just their personal opinion but their faith that is educating their decision. And since, as I understand it, in Canada your health care is paid for "cradle to grave" then the state should pay for it. If you create a single payer system then the system is liable for all costs, not just the costs it deems to be expedient.

That is one reason why, in my mind, we in the United States need to think way more carefully than we are about instituting a single payer (government pays all) system of health care.

This is really a sad situation...out of control for everyone once the media picks it up. Its Terri Schiavo all over again, almost in reverse though.

This is another story of science out pacing ethics. We can just do more medically than we have properly thought out. Unfortunately, its the weakest and those in the worst situations that have to pay the price.

After my experience with the hospice my advice to everyone is GET A LIVING WILL or some other legal document that states clearly what your wishes are. Don't leave it to the local board of physicians, the HMO, and, especially not the congress of the US.

Freightdawg

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: GUEST,dianavan
Date: 03 Mar 08 - 10:25 PM

My post may have been callous, freightdawg, but it was not meant to put a price on human life. Unfortunately, sometimes family want to keep a person on life support against a doctor's advice. Seems to me that the doctor is in the best position to judge if a person has no chance of recovery or is in so much pain that it would be cruel to prolong medical care.

If the family is keeping a person alive based only on religious beliefs and against a doctor's advice, they can do it at their own expense, not mine. If this was Canadian healthcare, I'd definitely consider it elective.

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: GUEST,Guest
Date: 03 Mar 08 - 10:08 PM

Freightdawg, here is the conundrum. Today's medicine can keep people breathing and their hearts going for a really, really, really long time without them ever regaining consciousness.

So what are you really suggesting is "right" in these circumstances. Are you prepared to have the state take over, in order to force families who wish to have loved ones removed from all life support, to keep their loved ones alive against everyone's wishes?

And if you wouldn't approve of the state making those decisions for everyone, even stephen, so money would never be the issue, how do you propose we care for all of them? Where will there be housed? Who will provide their round the clock care?

Considering that long term care facilities are chronically short of staff, underfunded, and already have desperate problems caring for people who are still quite alive, but in need of assistance?

It isn't just about money. It is about coming to grips with the medical 'miracle' of being able to keep elderly people alive, when we should allow natural death to take it's course.

None of us will live forever, even with god on our side. So you better think about what the quality of life in an understaffed nursing home is for people as it is now. You put far greater burdens on this system, and it will collapse--as it is already teetering on the brink.

No, we ALL need that system to be sustainable, not just those who think grandpa or mom should be kept alive as long as possible, in any awful condition, at the taxpayers expense.

Either the family should be required to provide the care themselves in their own homes, and/or pay out of their own pockets/insurance to keep their loved one artificially alive for as long as they would like to continue the torture, according to their beliefs.

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: freightdawg
Date: 03 Mar 08 - 07:42 PM

As I understand (and this coming from a Rabbi who worked with the hopice I was associated with), the Jewish belief is that all life is given by God and connected to God. To artificially and "heroically" extend life, when natural causes would have ended it, is to go against God and therefore cannot be used. However, in a situation where death is not imminent and life support is used, it cannot then be removed if the patient fails because to do so would be to end the life, therefore violating the prohibition against the taking of human life.

As expressed by this Rabbi the teaching is marvelously coherent and beats many "christian" practices to pieces.

So, while we may argue ad nauseum as to whether the artificial means of support should have been used in the first place, the fact is it is in place and cannot be removed without causing these family members to violate their conscience and their faith.

And, while I may be in the absolute minority here, I just simply cannot believe that the human race has sunk so low that we measure the worth of a human in dollar signs. If we have, maybe we don't deserve to exist any more. To do a little cross threading here, I have another thread where I tell the story of trying to save a Red Tail hawk and finding out that I lost. I have been deeply touched by the posts in that thread. It just seems ironic that so much compassion can be, and often is, demonstrated to creatures in the wild, and we are so callous about human life.

I think that hawk lived in much closer relationship with its maker than we do with ours.

Freightdawg

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: PoppaGator
Date: 03 Mar 08 - 03:10 PM

All due respect and all that, but I disagree with the contemporry interpretation of Torah that recognizes the respirator as an device providing an artificial means of prolonging life only until the time that it is used, but then treats it as a "natural" element of the patient's existance that may not be removed once it has been employed.

The more logical interpretation, it seems to be, is that removal of the patient from any such device would not be considered active "killing," but rather simply "allowing" the natural course of events to ensue.

I also think it bears repeating that we do not and cannot KNOW whether an unresponsive patient is suffering pain or not. The person may indeed be in great physical and/or psychic pain, while unable to communicate their distress to anyone. The position that artificial means of prolonging respiration can be removed if the patient is visibly suffering, but not if he/she is comatose, begs a question that we truly cannot answer.

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: GUEST,dianavan
Date: 03 Mar 08 - 12:41 PM

I totally agree that a person's religious beliefs should be respected...

however, the taxpayer should not have to pay the bill.

Since health care is paid for by the taxpayer, it is the doctor who should decide when life support will lead to a beneficial outcome. If the family does not agree, they should have to pay for the medical procedures. It should be in the same category as elective surgery.

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: Donuel
Date: 03 Mar 08 - 10:25 AM

Life is, for better or worse, an econmomic decision.

If money is no object, leave the plug alone.
If hardship will result by continuing "heroic" measures, pull that plug twice.

We seem to think that life is beyond the measure of money but sadly it is not. In a sense it is heroic to stop

See the US Army regulations for health care benefits.
There is a price on everything and a cap on everything.

There are coma thearpies that plunge a person into a deeper coma which sometimes results int he person emerging fro the deeper coma whereas they might not have if left alone.

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: Jeri
Date: 03 Mar 08 - 09:23 AM

It would have to be proven that the religious views weren't the man's. His should be respected to the best abilities of those involved, whether they go against his religion or with it. If he didn't want the plug pulled, it shouldn't be pulled.

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: GUEST,Guest
Date: 03 Mar 08 - 08:46 AM

And there was likely an advanced directive/living will on file with the nursing home he was in before being brought to the hospital, that likely did state his wishes at the time. But all of us needs to know we also have the right to change our mind about the advanced directive.

Again I ask this question: why isn't the solution to simply send the patient back to the nursing home he came from, instead of being kept in hospital? I'm guessing the answer to that is, because the state won't pay for the medical care in the nursing home, because it has already been decided by doctors treating in the hospital, that the current level of care is futile.

Like I said, be merciful and compassionate first, to all concerned. Anyone who has ever been on a respirator can tell you they most certainly are not painless, as Rabbi Sol keeps insisting.

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: john f weldon
Date: 03 Mar 08 - 08:40 AM

There are two questions here; one is the question of the person who is alive, but doomed and in agony. (I wrote about this earlier.)
The other, the person who is, by some definition, dead, but with some part of the body still being kept "alive".

Are we still wondering where the soul resides? Can we now agree that it is, at least in the region of the head? Imagine a person who has been beheaded, but somehow the two parts are kept alive. Which would we discard first, the head or the body? In a heart transplant, who survives: the donor, or the recipient?

And if we finally agree that it is the brain, then a dead brain is a dead person.

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: GUEST,Guest
Date: 03 Mar 08 - 08:39 AM

And if he does come back, at his age and with the medical conditions he already had when he went into the hospital (ie, he was already bed ridden & couldn't talk, as a result of what sounds like a serious traumatic brain injury), what condition do the expect him to 'come back' in?

What I would really like to know is the circumstances around the start of the respirator. Whose decision was it to put him on the respirator and administer antibiotics for the pneumonia anyway? Had they chosen not to treat at that point, he would have died.

And I'm not suggesting anywhere that the family and faith community should be excluded. I even put it in terms the good Rabbi Sol could get on board with: redemption in the Jewish tradition. I spoke of the convenant among them to follow the divine will here, if that is what floats their boats.

Yet another problem I have with imposing religious agendas on the helpless who should be allowed to die, is the living keep ignoring that divine will that is 'calling them home'. What the religious living relatives always seem to overlook is, hey--if you are looking for your god to do this, then stop demanding futile medical intervention to keep the person alive.

How about that?

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: Grab
Date: 03 Mar 08 - 08:06 AM

Sol, note also: "I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work." So under the original Hippocratic Oath, doctoring and surgery were distinctly different jobs. Thankfully we now know better. Also note the original oath's proscription against abortion - YMMV, but a clear majority of people in the West support this.

Freightdawg, this is Canada. The doctors don't benefit in any financial way from this decision. It's not based in any way on cost. Instead, it's based on the simple question of "will he ever recover?" "Minimal brain function" equals "will never recover". If his brain is toast and he's going to stay on life support in a coma without ever waking until some other bug comes along in a few years time and kills him, why bother? Why not face the fact that he's dead *now*?

Part of the problem is that the medical profession are told not to make absolute pronouncements. So it's not "your dad is dead", but "your dad is unlikely to recover". Then relatives pin their hopes on daddy being the 1% who make it, when the doctors know full well he's 200lbs of meat with no brain attached. And medical decisions based on religious conviction are not often much use. I have significant respect for Judaism in keeping fairly well abreast of modern technology, but it's still not an alternative to real thought from the kids about whether dad is ever going to come back. And most other religions (especially Jehovah's Witlesses, sorry, Witnesses) are much less sensible.

Yes, my whole family are mutually agreed that if anyone gets into that kind of situation, the plug gets pulled immediately. My mum actually brought this up after my gran died of cancer. My gran was in severe pain, but she chose not to end her life - however my mum and my aunt did (without explicitly saying so) give her this option by leaving a full bottle of painkillers by her bed so that she had this choice. Both are committed Christians, incidentally - religion doesn't necessarily have to take the place of personal responsibility.

Graham.

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: Rasener
Date: 03 Mar 08 - 05:00 AM

Its a very difficult one is this.
Firstly I personally do not think that a persons "GOD" whoever that may be, should influence somebody in to what they should make as a decision.
If you are a decent human being then you should do whats best for the person who is ill.
My mother 4 years ago at the age of 87 had non hodgkinsons and was given one month to live.
She was half blind, couldn't walk, but was still pretty switched on.
They offered a course of chemo, but couldn't offer more than a year if she had the treatment. However they offered a better quality of life.
I was against the treatment, but let my mother make the decision.
She chose Chemo. I talked with the consultant on his own and asked him to define better quality of life, but he was unable to say what that meant. After a very long debate with him, I managed to get him to agree that he wouldn't give the complete treatment if it made her more ill. He also agreed to not doing a lumber puncture as this was very painful and at my mothers age was not really fair on her.
He kept to his word and only did a quarter of the chemo, because he felt to do anymore would not have been good for her.
Result - she is still here at 91, totally clear of cancer.
However, her quality of life is nil. She sits in a chair all day, reliant on nursing staff, has to be winched into bed and chair. Reliant totally on the staff for toileting etc.
Up until a year and a half ago, my dad was with her which was a blessing in disguise, because he was able to keep an eye on her at all times.
She is now so confused, desperately unhappy. Oh how I wished I could use euthanasia to help her on her way.
She doesn't deserve to be treated like this. Animals get treated better.

My dad passed away one and a half years ago. He was never ill until about 6 months before he died at the age of 91. However he went down the hill very quickly. He went into hospital, because he fell over and cut his head. About 3 days before he died, the staff told me that he might just not make it. They asked me that if anything happened, did I want them to resuscitate. I said I didn't (basically he had had enough). They didn't resuscitate.
I do not feel guilty about my decision only happy that he doesn't have to suffer anymore.

So having said all that, my answer is that God has nowt to do with it, its about being compassionate about the person you love. If that person, has very little chance of enjoying/functioning again in life and the doctors tell you that. You have a straightforward decision and it should be based on the person not yourself.
As I said animals get treated better and what is strange about this, I don't hear many people criticising anybody when they put their beloved pet to sleep who in many cases means more to them, than a human being.

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: Richard Bridge
Date: 03 Mar 08 - 02:58 AM

So, Freightdawg, simply because there is a religious belief here, the state has to expend resources better applied to others, in order to keep a person (if he has any awareness) suffering. Why do we subsidise these irrational demands?

It does no-one any good to keep this poor man alive. It doesn't do him any good either. If he is aware of anything he will be suffering. There is only one right thing to do. Click.

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: freightdawg
Date: 03 Mar 08 - 01:00 AM

There seems to be a total disconnect here. Rabbi Sol is conversing from the point of view of a community of faith, a group of individuals that derives strength from something they belive is beyond themselves, something that they recognize gives them identity and, to a degree that many cannot accept, reality.

Guest, and a couple of others, are arguing either from the concept of a disaffected, isolated individual or, more tragically, from the bottom line of a hospital's profit/loss sheet. The gulf is so broad that GG is completely unable to fathom the content of Rabbi Sol's argument.

The point is that this is a family trying to follow their convictions based on Jewish Torah law. The doctors, beyond all logic in my mind (except the aforementioned bottom line) are advocating a mercy killing - manslaughter in some jurisdictions. As I understand it (and I am not Jewish, but have had experience in a hospice and worked with a Rabbi with her patients) you should not do anything to artificially keep a person alive, BUT ONCE THAT STEP HAS BEEN TAKEN you cannot reverse the process without violating Jewish beliefs.

People, this is so very simple. It is a case of greed vs. faith. The doctors realize their retirement account is being affected by keeping this gentleman alive. The family, regardless of their feelings about a future recovery, is bound by their faith in a higher being than the CEO or CFO of the hospital. They do not want their spiritual wishes to be quashed by the avarice of some cold hearted medical "professionals."

How can these doctors be defended?? As I mentioned before, in some jurisdictions in the US their proposed actions could be perceived as manslaughter. Since when is it the duty of a physician to kill a patient? And their justification is the cost it takes to keep him alive? I thought the Canadian health care system was to be the model for our new US single payer system. Thanks for giving me a preview of what we can expect!

Once again, for people of faith everywhere, I pray this family wins.

Freightdawg

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: GUEST,Guest
Date: 02 Mar 08 - 10:31 PM

I also wonder why moving him to a long term care facility, if the children want him kept on the respirator, isn't the solution?

It would be in the US. Hospitals only keep patients they can treat, and move patients who are considered to be at maximum medical improvement in the hospital setting out to long term or short term care pretty quickly.

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: Janie
Date: 02 Mar 08 - 10:23 PM

Based on what information is provided, it seems to me the issue is not "should or should not the plug be pulled."   Rather, the issue is about who, in the (assumed) absence of knowledge of the wishes of Mr. Golubchuk, ought to be that decider.

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: GUEST,Guest
Date: 02 Mar 08 - 10:07 PM

Sigh.

What is the point of this exercise, if all you want to do is cherry pick things you agree with, Sol? I mean, really. What is your point here?

I posted the Hippocratic oath as it was millenia ago, not as it is today. It is a myth that 'all doctors must take the Hippocratic oath'. A myth. Today's doctors don't "swear to it" as you seem to think they do.

Life is a bit more complicated now than it was then. Hell, the sons of doctors aren't even guaranteed admission to medical schools anymore!

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: TRUBRIT
Date: 02 Mar 08 - 10:04 PM

If the time ever comes or Tom or for me -- switch us off!!!

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: Rabbi-Sol
Date: 02 Mar 08 - 09:58 PM

"I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect."

That says it all!

                                                   SOL

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: GUEST,Guest
Date: 02 Mar 08 - 08:56 PM

The Hippocratic oath from Wikipedia:

A NOVA translation of the Oath runs as follows:

“ I swear by Apollo Physician and Asclepius and Hygeia and Panaceia and all the gods and goddesses, making them my witnesses, that I will fulfill according to my ability and judgment this oath and this covenant:

To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art - if they desire to learn it - without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but no one else.

I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.

I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art.

I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.

Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves.

What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself, holding such things shameful to be spoken about.

If I fulfill this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot.

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: jacqui.c
Date: 02 Mar 08 - 08:56 PM

Nearly two years ago my mother, at 86, suffered a debilitating stroke that left her unable to communicate and with minimal movement in her left arm only. She ended up with a feeding tube and was put into a nursing home in South London, totally helpless and with very little, if any quality of life.

Due to her difficult nature she had alienated mysel anf my eldest brother and my younger brother, with whom I had no contact, was unable to cope with the problem so she was left in the nursing home with no visitors and no personal belongings around her until my daughter found out and made sure, between her and my son, that their grandmother was was made more comfortable.

There was no real hope of recovery but, even so, when she suffered rectal bleeding she was sent to hospital where, since they were unable to do any tests to discover the cause, due to her incapacity, she was sent back to the nursing home. That was when we made the order for palliative care only.

It took her ten months to die and for all of that time she was totally dependent on others, unable, even, to make any decision as to whether she wanted the TV in her room left on all day. In fact, that was about the only company she had for most of the time.

If we could have had the feeding tube removed we would have. I did not like my mother and cannot truly say that I had any love left for her - she was not a good mother and didn't really even try to be. However, I would not want to see anyone in that situation and, if there had been more feeling there for her, might have taken the risk of helping her out of that life.

If we had been a venal family we might have tried to keep her alive by any means possible as, all the while she was in the nursing home, her pension was being paid, including various allowances, to the tune of about two hundred pounds a week. My daughter checked with the DHSS and was told that the amount was correct and that none of that would go to the nursing home for care. For us, though, it was a relief when she finally did die of pneumonia on my granddaughter's birthday in November 2006.

I now have a living will and have stated that I do not wish to be kept alive in such circumstances, If any of my loved ones were going down the same route I hope that I would have the strength to make that very difficult decision. Apart from the financial cost I feel that the emotional cost to those remaining has got to be heavier whilst a loved one lingers in such circumstances than the actual death of that person. On the religious question, I could not worship a god who would insist on keeping alive someone in that state, particularly at such an age. That, however, is my own personal opinion and I know that others are likely to disagree.

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: GUEST,Guest
Date: 02 Mar 08 - 08:40 PM

Rabbi Sol, you don't seem to have a clear understanding of what a doctor's ethical obligations are here, because you don't seem to appreciate that they can and do make the very decisions you are talking about here on a routine basis.

They have concluded the man cannot be cured by their medical treatments.

So their ethical obligation is to NOT provide medical care, because it isn't warranted in this case. I don't even know if they are the ones who initiated the treatment involving the respirator, or if the family insisted they do it as a medical intervention of last resort.

The real injustice, it seems to me, was to have put this poor man on the respirator to begin with, when he first presented with the symptoms described in the media, at the emergency room. This man has been unable to move since 2003. The hypertension and pneumonia are complications of that previous medical symptoms that, in a man his age, normally result in death.

It could and should have been that simple. This is heartbreaking, but I don't think you can simply fault the doctors, or claim they are breaking the Hippocratic oath, because of their medical decisions in this case. It is far more likely they balked when the family said they wanted to bring the rabbi in--which is often what happens when medical professionals have no cultural clue as to why the family is making the requests they are making.

To me, this sounds like a cultural communication breakdown, not a medical and ethical one.

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: Rabbi-Sol
Date: 02 Mar 08 - 08:15 PM

Guest,
       A doctor's legal, ethical and moral obligation is to save lives and try to cure people, not to terminate life (remember the hippocratic oath?). That is why they can not get doctors to participate in legal executions by lethal injection.

You seem to be implying that it is the doctors legal and ethical obligation to terminate this man's life.

                                                    SOL

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: GUEST,Guest
Date: 02 Mar 08 - 07:10 PM

Rabbi Sol, my understanding of the man's medical condition is this: he is 84 years old, and has been in hospital since Oct. 26. He had a pre-existing brain injury from a fall in 2003 that resulted in the removal of part of his brain. Prior to this hospitalization, he could still understand speech and communicate. Since the fall in 2003, he was being cared for in a nursing home, but was transferred to Grace Hospital emergency ward last October suffering from pulmonary hypertension and pneumonia. It was somewhere around that time (Oct 26), that he fell into a coma (apparently), and his condition remains unchanged.

I actually agree with the judge in this case, so far. The judge has ruled that the doctors/hospital do NOT have sole authority over the decision to withdraw life sustaining treatment in this case, because the family is protesting that decision.

To me, that is exactly how this process should work. The doctors AND family should be able to make this decision together, and come to a reasonable agreement. That is, in fact, what usually happens.

It does seem to me there is doctor arrogance involved here, but there is also religious arrogance on the family side. They, like the Schiavo's appear to have a religious agenda here.

For god sakes, the poor man is 84 years old, has been incapacitated since 2003, and his condition worsened to the point, due to medical conditions that usually kill far younger people than this man in a similar medical condition--ie hypertension and pneumonia. The pneumonia is, most certainly, what caused the doctors to put him on the respirator. Sometimes the respirator allows time for antibiotics to work, and the respirator can be removed.

It does seem that there is also a question of timing involved in this case. I have no medical expertise in this area of course, but perhaps the children feel there is a chance, however slim, that the treatment regiment for their father's pneumonia will miraculously 'kick in' and he will recover to his previous state of incapacitated but conscious.

Like I said, the guy is 84, was incapacitated prior to being admitted to hospital with pneumonia, and was temporarily (the key here) put on a respirator to see if he could fight off the pneumonia and regain his previous state of health. Such things can and do happen, but didn't in this particular case. Which does make me suspect there might be a religious agenda the children are trying to push.

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: GUEST,Guest
Date: 02 Mar 08 - 06:51 PM

In the case of our family, with five sibs, we did NOT all agree. Which is why we were so thankful our mom chose one of us to make the legal/medical decisions of when to provide/withhold care.

I find it hard to take on board what you are saying Rabbi Sol, that once a patient is MEDICALLY put on life support, that there is Jewish canon law that ONLY THEN kicks in.

In what century was that canon law established, considering that even in the best of circumstances, medically intervening in the death process by putting a patient on a respirator often doesn't keep them alive anyway?

No, this sounds to me like a case where the family, including the patient, may well have a strong desire to claim there are religious reasons to extend this care to this man. But that doesn't mean that doctors can ethically do what the family is demanding of them.

Doctors have ethical codes and legal codes they too must abide by, and they don't shift based upon the religion of the patient and the family, thank goodness. In a secular democratic society, medical decisions should never be predicated upon religious beliefs, unless the patient is in a facility governed by that religion. If this family feels so strongly about this, why didn't they move their father to a Jewish care center?

St. Paul MN isn't exactly the population epicenter for Jews in the US, yet my mother spent time in a Jewish long term care center--twice--as her health declined. She said (and we agreed, to a certain extent) she received good quality care there. Except they nearly killed her, for failing to treat her for a Clostridium difficile bacterial infection. They thought she was just being a drama queen (the horrific truth is how often the medical complaints of elderly women are dismissed by health care providers), or maybe was 'just depressed' as they told us as our mother lay near death when she had been the picture of health two days prior. And that one isn't even the worst horror story we can tell. She was still living independently in her own senior apt. when that happened, and was in the the long term care center receiving rehabilitation after surgery & a fall.

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: katlaughing
Date: 02 Mar 08 - 06:33 PM

Well said, GG, in this case.

In a speculative case, there are so many factors to consider...do all of the family agree, would the family be hanging on for themselves, rather than the person who is dying, do the doctors agree among themselves? It would be ideal if the medical people, family members, and the patient could all agree before it comes to that point. If that is not possible, it will come down to the courts, in some instances.

It is a tough decision, even if made beforehand as there are so many "whatifs."

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: GUEST,Guest
Date: 02 Mar 08 - 06:22 PM

McGrath, the case is being written about all across Canada right now. If you google it yourself and actually read what is going on, you will have a far better understanding of what we are going on about.

Peace, it isn't supposed to be about what the children of the person want. It is supposed to be about honoring the wishes, to the best of our ability, of the dying person, in a way that reflects the values and beliefs of the person in their life.

However, no one's god should be allowed to call the shots in these circumstances. As I understand it, that isn't what the courts will decide anyway. What the courts are deciding is far more narrow--ie, who has the ultimate authority to make these end of life decisions in cases where the patient cannot decide for themselves. The hospital contends it is the doctors/hospital alone. The family says it is their decision alone.

Ultimately, the courts will likely set guidelines in the middle there somewhere.

I presumed Rabbi Sol was actually a Canadian rabbi, so have been speaking as if he had a flock to tend to throughout all this.

Anyone in a leadership position with influence over the Orthodox community needs to counsel people to head off these disasters in advance through discussion, through educating themselves as to what is viable and realistic in terms of end of life care medically, and to demand culturally sensitive palliative care counselors be trained and employed, as well as medical students, in how to communicate with families from the Orthodox community on these issues.

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: Rabbi-Sol
Date: 02 Mar 08 - 06:14 PM

Skivee, I would have to research this question further but my intitial answer would be yes, the patient would have to be transferred to another ventilator. It would be both, the right and the responsible thing to do.
                                                      SOL

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: Rabbi-Sol
Date: 02 Mar 08 - 06:08 PM

In this case the patient and the family are in agreement that life support should be continued but it is the doctors that want to discontinue it CONTRARY TO THE WISHES and religious beliefs of the family.

I think that a distiction should be drawn between someone who is in the terminal stages of cancer and suffering much pain and somone who is in a comatose state and feeling no pain at all.

As I stated before, the Jewish law does not require someone with a terminal prognosis to be hooked up to life support but does not forbid it either. However, once hooked up it is forbidden to withdraw it.

Most of these cases now arise with stroke victims where the standard treatment now is to put the patient in to a drug induced coma for a few days so that body temperature can be lowered. This necessitates hookup to a ventilator and feeding tube. Many patients do recover with this treatment but those who do not may not be disconnected.
However, since they remain comatose and do not suffer any pain there is no urgency that would dictate hastening the patient's demise.

The Jewish law provides for a "Halachic Living Will" which names an Orthodox Rabbi or an organization such as Agudath Israel Of America as the final decision maker in such cases. They have experts on their staff such as physicians, Rabbis, and attorneys (all orthodox) who are competent to decide each case on its merits. They will work with the family to see that the wishes of the patient and family are carried out "within the framework of Torah law".

One thing that nobody wants is the fate of the patient to be determined by the bean counters at the HMO and this organization will go to court if necessary to prevent this from ever happening.

The accepted criteria for death according to Jewish law (for purposes of organ donation), is brain stem death. This is in accordance with the opinion of Rabbi Moses Tendler who is the leading recognized expert in this field. He is a Professor of Biology, Talmud, & Medical Ethics at Yeshiva University and is an MD as well as a Rabbi. And yes, there is such a thing as a Jewish Hospice which exists right here in Rockland County, NY where I live.

                                                          SOL

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: McGrath of Harlow
Date: 02 Mar 08 - 06:00 PM

"Euthanasia", to qualify for that name, has to be justified solely on the basis that it for the benefit (avoids suffering etc) of the person being killed, rather than other people.

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: Peace
Date: 02 Mar 08 - 05:48 PM

If he was my dad, I would want to pull the plug.

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: Skivee
Date: 02 Mar 08 - 05:39 PM

Rabbi Sol: Since men and machines all fail in time, what if a vital part of the ventilater was to break? Would the hospital be required to put the patient on a new ventilater? In doing so, would the hospital be doing the responsible thing?
This may seem like a frivilous question, but I am asking honestly.

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: McGrath of Harlow
Date: 02 Mar 08 - 05:29 PM

This case likely could have been averted had the family member discussed his wishes with his children,

The assumption here is that the children are not acting in accordance with the wishes of the old man. That may well not be true, on the information given in this thread.

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: GUEST,Guest
Date: 02 Mar 08 - 05:10 PM

Most would, but not all. And it isn't always possible, if family isn't very close to hand.

Also, I would say you need to make your wishes known for end of life care to your family, and appoint one (with their agreement, of course) to be the designated decision maker on your behalf in the event you can't or no longer wish to make the difficult health care decisions for yourself.

A lot of people end up 'leaving it to my family to decide' without ever discussing it with them. Not a cool thing to do to your family.

This case likely could have been averted had the family member discussed his wishes with his children, and had the family sought palliative care advise immediately.

Rabbi Sol, I do know there is a movement of sorts here in the US, to bring together hospice/palliative care providers with the Orthodox community, to create culturally sensitive guidelines for use in cases such as this. You might try googling palliative care + orthodox jews, to find information about it.

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: McGrath of Harlow
Date: 02 Mar 08 - 04:50 PM

I'd sooner trust my family than trust the doctors when it comes to my time.

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: GUEST,Guest
Date: 02 Mar 08 - 04:28 PM

And don't kid yourselves, when you finally see the end to suffering that comes only with death after a long, painful decline, you really don't understand those words like 'merciful death' and the end of life coming as a blessing--redemptive suffering in the Catholic way of looking at it--to describe death after much suffering.

I have no advice for you Rabbi, but Passover is upon us. Reflecting upon how redemption might come about in this case is the family's best answer. Will it be as a result of divine intervention alone? Or will you, the family, and the doctors--human beings and covenantal partners with God (I am assuming this is congruent with your worldview), have a role to play in the redemptive process?

Isn't it our duty to ease the passage, and work with the redemptive process rather than against it?

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: GUEST,Guest
Date: 02 Mar 08 - 04:06 PM

Actually, they likely aren't over-reaching. It can be very hard to let a loved one go, as we saw with the tragedy surrounding Terry Schiavo, where the family used their religion (Catholic in that case) as their rationalization and justification for not taking her off life support.

These are painful, difficult decisions. But when next of kin seem to be in complete denial of the reality that the person isn't a person anymore, then it is the doctor's and hospice staff's role to ease them into letting go.

It is quite difficult, especially if their loved one said they wanted to be kept alive with a respirator or other extraordinary means, as happens some times.

Towards the end of my mother's life, when she was revising her living will for the last time at the urging of her hospice coordinator (they eventually ask you to do this, or may not accept/keep you in their care program), she suddenly thought going on a respirator might be a good idea. Now, she was really just denying that if a respirator became necessary to sustain her, it simply meant it was her time to go. She came around within a day or two. It is hard and sad having to guide loved ones through this. I know I don't ever want to be faced with the choice for my own care my mother was forced to make about hers.

Finally, the decisions for her care were turned over to my sister, so our mom wouldn't have to keep making those hard decisions. When her pain got so bad they had to up the morphine to the lethal level, we never even discussed it with her. We simply asked if she wanted to increase the morphine, and she said yes. She was gone in just under 48 hours.

Mercifully, and compassionately as we could make it for her, and her for us.

Don't hesitate to ask the family what they think their loved one would have wanted regarding THEIR suffering along with them to the end. Almost without exception, elderly people will say they don't want to be a burden, or any trouble, or some such thing. But what they do want is for us to be there compassionately for them, and to do the loving thing--which is sometimes the hardest thing of all, as seems to be the case here.

Ending the suffering as quickly and painlessly as humanly possible is always the most merciful thing we can do, unless the person still is conscious and in control of their decisions, and chooses to hang on.

The patient's wishes should be followed as much as possible. But it isn't always possible, or even merciful and compassionate, to always give the patient their way on these issues. Which is what makes the judgment call so hard on others, family and medical staff left with the decision especially.

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: McGrath of Harlow
Date: 02 Mar 08 - 01:22 PM

What's it got to do with the doctors to make a decision like that anyway? Seems to me they are seeking to go beyond their professional role.

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: Greg F.
Date: 02 Mar 08 - 12:01 PM

If they were to remove life support would that not leave survival totally in the hands of God? What better act of faith for those who believe?
For G*d's sake, don't introduce logic into the discussion.

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: wysiwyg
Date: 02 Mar 08 - 11:27 AM

In our denomination, canon law generally trumps civil law if the parties can be shown to have agreed to abide by canon law. (Canon law is sort of like bylaws for a given governing body such as an individual diocese.) But canon law is different from religious law.

Rabbi, is there a body of currently-maintained writing in a hierarchy of Orthodox congregations that governs your equivalent to canon law? And to whom does the rule you quoted above apply-- family, docs, rabbis? Is it a rule designed to advise/govern the rabbi the family consults, or is it designed to apply to the doctors who would implement a family decision? Do only Orthodox doctors treat Orthodox patients?

In the case you describe, who is "governed" by whom?

~Susan

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: SINSULL
Date: 02 Mar 08 - 11:06 AM

I have a living will. My brother and others know my wishes. I recommend that to all.
Mary

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: john f weldon
Date: 02 Mar 08 - 09:59 AM

A nice principle: an individual's right to choose his own medical care.

However, impossible to achieve in practice, since there are limitations. If everyone decides to keep their bodies alive after their brains are dead, and medical science manages to keep them going indefinitely, the "living dead" will outnumber the living.

Whether private or public, cost will always be a factor.

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: Sorcha
Date: 02 Mar 08 - 09:32 AM

Thank you Jeri.

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: Jeri
Date: 02 Mar 08 - 09:30 AM

What it comes down to is not religious beliefs, although they're certainly a factor. What were the man's wishes? If he was an Orthodox Jew, he probably wouldn't want the plug pulled, but maybe he had a previous conversation with family and said he didn't want to exist on life support.

It doesn't matter what anyone else believes is right or wrong, should or shouldn't be done. What matters is that an individual's right to determine his own medical care, including how his life ends.

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: Richard Bridge
Date: 02 Mar 08 - 05:14 AM

Since this is in Canada, the pointless exercise is costing the state a huge amount of money.

I don't know who is paying for the pointless task of keeping Ariel Sharon's brain-dead body ventilated.

Religion is all very well (sometimes, and sometimes it isn't) but when it costs the state large amounts of money, is that sensible?

I'm all for the off-switch. My father wanted one for years but had I helped him find it I would have been susceptible of being charged with murder. My late wife was quite abrasive about my moral cowardice because I would not take that risk.

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: Bee
Date: 02 Mar 08 - 12:56 AM

Agree with Guest. Every case is different, and should be decided on its individual merits.

In the case mentioned, the family is aganst it, and there is a minimal hope of recovery (though I do see a little hint of 'having it both ways' - taking the patient off life support certainly leaves the results 'in God's hands').

But I think people should be thoroughly educated and informed on their relatives' condition when these situations arise. Many people, faced with a breathing body, don't understand that it may be just machines keeping heart and lungs at work, and that there may be no thinking person there anymore. In religious terms, the soul has fled.

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: GUEST,Guest
Date: 02 Mar 08 - 12:33 AM

Be merciful and compassionate first, to all involved.

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: Sandy Mc Lean
Date: 02 Mar 08 - 12:29 AM

Sorry, I should have added that " that it's His will"!

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: Sandy Mc Lean
Date: 02 Mar 08 - 12:25 AM

If they were to remove life support would that not leave survival totally in the hands of God? What better act of faith for those who believe?

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: john f weldon
Date: 02 Mar 08 - 12:07 AM

Forty years ago, a couple of nurses revealed to me what was then a secret... ...code 99. If a doctor wrote that on your chart... ...bye-bye! I was a bit shocked; not so much by the practice, but by the secrecy of it.

In the intervening years, I have seen many, many long, drawn-out painful demises. The dreadfulness of pain, to the patient, the family! The pointless months of agony! I have become much more inclined to the "Brompton Cocktail" method of dealing with dying (a jolly dose of alcohol & barbiturates guaranteed to end your troubles).

But I notice that many (most?) people prefer the old method, both for ourselves & our families. Yes, pull the plug... ...but don't tell me about it!

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: Rabbi-Sol
Date: 01 Mar 08 - 11:55 PM

The Jewish law states that if there is no hope for recovery you are not required to hook the person up to life support to begin with.

However, if the person is hooked up it is prohibited to pull the plug.

The perfect example is former Israeli Prime Minister Ariel Sharon who has been in a comatose state for the past 2 years.

                                                      SOL

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: Mrrzy
Date: 01 Mar 08 - 11:39 PM

"Minimal" isn't "no" chance - I'd keep him alive if that's what he wanted or that's what the family wants now. Since it's Canada at least it isn't up to whether they can afford it or not... but then again, MY kids have instructions never, ever to pull the plug - I want to stay around in case I miss something!

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: freightdawg
Date: 01 Mar 08 - 11:30 PM

The good Rabbi brings up an interesting point of discussion. I am surprised that many feel reticent to offer an opinion.

For many years now we have seen an erosion of the ability of individuals to express their religious beliefs. Although the case would be handled much differently here in the US (where one's family must request the removal of life support, and there usually needs to be a DNR in effect, or a living will, etc.) I envision a time in the not so distant future where a person's life will be measured against the ticking of the clock and the growing medical bill. The final decision will be made in some back room somewhere with some bean counter saying in effect..."look he owes 100,000 and he's only worth 95,000, let's pull the plug."

I certainly hope the family wins...if the case does go to court. A human being and his/her family should not have their religious beliefs quashed at the time of death (or any time, for that matter). I would hope this issue would be covered by the "separation of church and state" clause in the US, but I wonder how it will play out in Canada.

Freightdawg

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: bobad
Date: 01 Mar 08 - 11:05 PM

Apart from the religious aspect of this issue there is the far broader one of it's societal impact. It is not inconceivable that in the foreseeable future technology will have advanced to the point where it will be possible to keep organisms alive for a long time, if not virtually forever, and at a great cost. It's not hard to see the financial impact that institutions filled with people in this state    would have on a country's finances, especially in a taxpayer funded system such as Canada's. If the family or the person's religious institution is willing to bear the cost, that is one thing but asking the taxpayer to foot the bill is unfair, in my opinion, the assumption being, of course, that there is no hope of any meaningful recovery.

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: John on the Sunset Coast
Date: 01 Mar 08 - 11:02 PM

Rabbi Sol, you are the official Rabbi for Mudcat. What is your responsa in this case? ----
Yonah ben Avraham

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: katlaughing
Date: 01 Mar 08 - 10:59 PM

Maybe Bush and Company will touch it.

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: Rapparee
Date: 01 Mar 08 - 10:39 PM

Me neither!

1. I'm not a follower of Judaism.
2. I'm not Canadian.
3. I don't deliberately stick my hands into the fire.

Rabbi, I may not be learned or wise, but I'm not stupid enough to try to discern the ways of God or the courts.

Subject: RE: BS: To Pull Or Not To Pull The Plug
From: Bill D
Date: 01 Mar 08 - 10:24 PM

And *WE* should have an opinion on a personal/religious issue like that? Not me...

Subject: BS: To Pull Or Not To Pull The Plug
From: Rabbi-Sol
Date: 01 Mar 08 - 10:14 PM

This is the case of Samuel Golubchuk, an 84 year old Orthodox Jew who has been on life support (ventilator & feeding tube), at a Winnipeg, Canada hospital since November.

The doctors say that he has minimal brain function and that his chances for recovery are slim. They decided to remove him from life support against the wishes of his adult children.

The children went to court and claimed that taking their father off life support and hastening his death is a violation of Orthodox Jewish law.

Judge Schulman issued an injunction against the doctors and Grace Hospital ruling that under current Canadian law, doctors should not have the final say in such matters. He ordered the case to go to trial.
                                                      SOL