Chaplain's Corner

On November 7, 2007, Samuel Golubchuk was admitted to the ICU at the Grace Hospital in Winnipeg; where his life is being sustained by a ventilator and tube feeding. Most of us would have probably never heard the name of this man, nor given a thought to his situation, except for the fact that a legal battle developed around the doctors desire to remove the life sustaining treatments and the family’s insistence that they be maintained.

Since then, Samuel’s plight has been the source of much discussion, his medial state has been examined by a variety of specialists, health care ethicists have weighed in on his situation and courts have made rulings about what the hospital may and may not do in relation to Mr. Golubchuk. Mercifully that battle ended naturally on June 25th when Mr. Golubchuk died in that ICU of natural causes despite the life sustaining treatments that he was receiving.

Although the situation involving this man’s care raises many issues worthy of consideration, perhaps one that every one of us should consider is the matter of Health Care Directives. These are called by a variety of names, sometimes Living Wills, sometimes Advance Directives, but in Manitoba the Government calls them Health Care Directives and they are defined in law in “C.C.S.M. c. H27 – The Health Care Directives Act (assented to June 24, 1992 and updated June 20, 2008).

This Act provides citizens of Manitoba who are 16 years of age or older who possess the capacity to make health care decisions certain rights related to advanced decision making related to one’s own health care should the situation arise in which you are not capable to express your own desires and make your own decisions. In the Act two categories of decisions can be made. The first concerns decisions directly related to receiving treatment, withholding treatment or withdrawing treatment should certain health care conditions arise. The second allows for the appointment of a proxy who is recognized then under law as having the right and responsibility to make health care decisions on our behalf should we be incapable of making those decisions ourselves.

In the first case, these instructions can be as detailed as one wishes. However, in discussions I have had with physicians, a very important question has been raised, “How can any person possibly anticipate every possible health care situation and make decisions about what they would want in each before hand?” Good question. So although we have the right under law to do this, most doctors may counsel their patients against it, simply because of the complexity of determining before hand how you might want each possible health care issue dealt with should you lose capacity to make those decisions at the time. The second case, the naming of a proxy, is much simpler, but requires quite a deep level of trust. If a proxy is named, then all health care decisions necessary would be made by your proxy once capacity has been lost.

Let’s suppose Mr. Jones makes a Health Care Directive and instead of attempting to identify all the possible medical issues that may arise and how he would have them dealt with he makes one simple statement on the Directive. “Under no circumstance do I want any form of resuscitation to be attempted, no matter what causes my heart to stop and my lungs to cease breathing.” Beyond this statement he simply names a proxy.

As he considered naming his proxy he logically considered his wife and four children. His wife, although he loves her dearly, tends to fall apart when trouble hits. He is not sure he wants to place his wife in a position to make decisions about his health care in the event of his incapacity, knowing from their past history just how difficult that would be on her. His two sons both live out of Province and he does not name either one of them simply because of the distance. His two daughters live within 30 minutes of his home, in the same city. They are both attentive and Mr. Jones has a good relationship with both. His oldest daughter is a nurse and has demonstrated over the years that she is level headed in a crisis, even when it comes to her own parents, husband and children. She can handle the stress of a situation and knows how to be decisive. The youngest daughter is the sweetest gal a father would ever want as a daughter. The affection he shares with her is wonderful but her constitution is a bit like her mom’s and she doesn’t do well under pressure. Mr. Jones decides to name his oldest daughter as his health care proxy.

It is important to share this information within the family so Mr. Jones takes an opportunity that presents itself at their Christmas gathering to sit the family down and have the discussion. He explains the decision he has made, he expresses his reasoning and asks the members of the family to support his decision. Each understands Dad’s reasoning, each accepts his decision and promises to support Mabel, the oldest daughter in the event that something happens and Dad is no longer able to make his own health care decisions. Mr. Jones also has had several long discussions with Mabel about what he wants and doesn’t want should certain things happen to him. He makes it clear in the discussions with Mabel that he doesn’t want to be resuscitated – under any circumstances – no matter what the circumstances surrounding the situation. Other than that, he trusts her to make the best decisions under the circumstances.

One mistake that most people make with Health Care Directives is that they tuck them away somewhere and because they are not available they get ignored. Without the piece of paper, emergency medical personnel have no choice but to simply follow normal procedures in dealing with the crisis. The Act enables them to do so with no fear of penalty even if what they do contravenes a Health Care Directive that was not presented at the time of care being provided. Therefore, it is a good idea to keep a copy handy, to make sure your proxy, if one is appointed, has a copy; that your spouse has a copy, that every member of the family has one, so that it is more likely, in the event of a medical emergency, that it can easily be accessed and presented to those providing care so that they can respect your decisions.

A person may have a lawyer make out a Health Care Directive, but this is not necessary, the forms can be downloaded from the Government of Manitoba website and are fairly easy to fill in. It would be best, if you chose not to use a lawyer that you get a copy of the “The Health Care Directive Act” as well as the “APPENDIX – Health Care Directive Act (A11)” since these contain the legislation, instructions and forms to use in making your Directive. These can be down loaded from the Government of Manitoba website and are not difficult to understand. If you want to do more than appoint a proxy, a conversation with your physician is in order and when you make the appointment, you should tell the receptionist that you are needing to consult with your doctor about your Health Care Directive so that your doctor will be prepared to spend the time necessary to answer your questions and provide the guidance you may need.

I don’t know if Mr. Golubchuk had a Health Care Directive. I know the vast majority of people don’t have one. I know it is hard to think about these things, for we don’t like to think about such possibilities. But we all know that the potential exists for each of us to find ourselves in a situation where a Health Care Directive would be useful. If you are the kind of person who has clear and strong feelings, personal or religious, about your wishes being honored then don’t put it off any longer, you certainly don’t want to end up the object of a court’s ruling like Mr. Golubchuk nor do you want your family to experience the additional trauma of having to enter the adversarial environment of the courts to insure that what they believe you would want is honored.