1. Ethical Analysis:Ethics and the Right to Life Ruqayya Salam
2. The Right to Life• Each person has an essential right to live and not be killed by another human being.• Pro-life concepts are central to debate on the issues of: • Euthanasia • Abortion • Capital Punishment • Self defense
3. The Case of Samuel Golubchuck and the Right to Live• 84-year old patient• Orthodox Jew from Manitoba, Canada• His neurological function was open to debate.• Neither brain dead or in a vegetative state.• Artificially ventilated and fed by a gastronomy tube.
4. The Case of Samuel Golubchuck and the Right to Live• The physician requested to remove Mr. Golubchuck from life support.• The family opposed that the removal of life support because: – Mr. Golubchuck himself would oppose the removal of life support. – It goes against the Orthodox Jewish law of withdrawing ventilation and tube feeding with the intent of hastening death.
5. The Case of Samuel Golubchuck and the Right to Live• In 2008, the College of Physicians and Surgeons of Manitoba released a new guideline: – The physician has the final decision to draw life support regardless of family wishes. – If the family disagrees, the physician must consult with another physician. – If the consulted physician agrees, life- sustaining therapy may be withdrawn.• Mr. Golubchuck died on June 24, 2008.
6. Patient/Family Perspective• Mr. Golubchuck’s son and daughter opposed the removal of life support. – Mr. Golubchuck lived during the Holocaust.• They also stated Mr. Golubchuck would oppose the idea as well.• The family obtained a legal injuction against the discontinuation of life support twice.
7. Provider Perspective• Physicians are given the decision making power even if it goes against the patient or family’s wishes.• In their opinion, they can give Mr. Golubchuck’s ICU bed to another patient with higher priority.
8. Social Perspective• There is a potential negative impact on giving physicians decision-making power. – Decrease of trust in the healthcare system – Patients also wondered if they would be denied care under the new guidelines
9. Legal Perspective• The Manitoba ruling granted physicians the authority to make the ultimate ethical decision. – The ability for physicians to predict life expectancy in terminally ill patients is limited.
10. Financial Perspective• Canada has socialized medicine and is limited to the resources they can offer.• They set societal priorities on what resources can be provided.• In response to financial pressures, they limit health care expenditures.
11. Principle of Autonomy• Person’s right to make choices based on their values and belief system. – Exercised through informed consent. – Patients should play a role of primary decision maker.• In this case, the guidelines: – Were not sensitive to the patient’s culture. – The physician did not obtained informed consent.
12. Principle of Beneficence• Action that is done to benefit others. – These actions can be taken to prevent or remove harm .• The removal of life support goes against this principle because: – Physicians have an obligation to help and promote the welfare of their patients. – They should also defend the rights of others, including the Right to Life.
13. Principle of Nonmaleficence• “Do no harm.”• Harm can be defined as death (removal of life support) and deprivation of freedom.• The life-sustaining therapies did not show any potential risks or as being ineffective treatments.
14. Principle of Justice• Fair distribution of resources and benefits offered by a society and respect for a person’s rights.• The removal of life support should be decided by the patient, family or guardian, not solely by the physician. – Mr. Golubchuck’s physician was given all decision making power. – The physician did not need obtained informed consent.
15. Conclusion• Life has its purpose regardless if it’s physically challenged or normal. – The Right to Life should be respected and preserved.• The physician’s main role is to treat patients fairly and respect their autonomy as well as the choices they make. – It is not their role to play God, legislator or judge.• A patient’s values and health care beliefs should be respected so they can live accordingly.
16. References1. Jotkowitz A, Glick S, Zivotofsky A. The Case of Samuel Golubchuck and the Right to Live. The American Journal of Bioethics. 2010; 10; 50-53.2. The Right to Life. Ascension Health Web site. 2013. Available at: http://www.ascensionhealth.org/index.php ?option=com_content&view=article&id=205&Itemid=172. Accessed on January 13, 2013.3. Key Ethical Principles. Ascension Health Web site. 2013. Available at: http://www.ascensionhealth.org/index.php ?option=com_content&view=article&id=47&Itemid=171. Accessed on January 13, 2013.