March 4, 2008
By Connie Marshner
There are moral costs in socialized medicine
Anyone who considers Canada's health system a role model for the
U.S. should consider the case of Samuel Golubchuk. His case shows
the inevitable collision course between government-controlled
health care and the rights of private conscience.
Golubchuk is an 84-year old patient at Grace General Hospital in
Winnipeg, Manitoba. He is believed to be cognitively disabled. I
say "believed" because two months after his admission to the
hospital -- when his children had to rush his case into court to
prevent what they saw as government-assisted homicide -- he still
hadn't been examined by a neurologist or had diagnostic tests,
which in the United States would be standard procedure almost
Golubchuk is on a respirator and is fed by a tube. The doctor
wants to remove the tube and unplug the respirator.
The family objects, citing their Orthodox Jewish beliefs. "It is
our belief that life is paramount and one should do everything
possible to maintain life and sustain it, as it is a sin to do
anything to hasten death," wrote son Percy Golubchuk in a court
Here is the ethical conflict. The doctor believes that he cannot
"ethically participate in the administration of this treatment any
longer." He thinks the machines only prolong Golubchuk's suffering.
So he wants to unplug them. British common law, the foundation of
Canadian law, requires a physician to provide care only as long as
he thinks it benefits the patient. The Golubchuks believe it would
be intrinsically evil to unplug the machines.
The Canadian government controls what happens in the health care
system, not individuals and families. If your values place you in
opposition to the government's values . . . well, tough.
Because of the government's overriding control over health care,
this is potentially every Canadian family's story. And if the U.S.
adopts a government-controlled health care system, it is
potentially every American family's story as well.
In Canada's "single payer" system, each province is responsible
for funding all of its own health care. Which procedures are
covered varies by province. But, with few exceptions, a Canadian
cannot go outside the system to purchase medical services the
government already provides -- unless they go to the United States
and foot the bill themselves.
In the case of Golubchuk, we have a microcosm of what's wrong
with a government-controlled health care system, including
substandard care and an unconscionably long wait to use proper
diagnostic tools. But the bigger problem is the lack of practical
alternatives for patients and their families. Suppose Golubchuk's
family could find a hospital with a standard of care satisfactory
to the family (say, a hospital that followed orthodox Jewish or
Catholic principles), and the space to take him for whatever they
could pay, even pro bono? Wouldn't it solve the problem for the
family to transfer Golubchuk to that hospital?
That was precisely the solution Dr. Peter A. Singer, a prominent
Toronto ethicist, proposed in Canada's National Post: "The family
of Mr. Golubchuk should be given a period of time to find a health
care team and hospital who share their belief that the treatment
being provided is worthwhile."
Yes, that would solve the problem. Golubchuk's children could be
satisfied that they were not being forced to violate their
religious convictions. At another hospital, they could arrange for
the tube feedings to be kosher, and the family could be at
But in Canada this solution is fraught with difficulties. The
government determines what care you get and don't get, and it
finances that care under a government budget and under government
The lesson here is simple. Any national health system is
inevitably on a collision course with private conscience. The only
way conscience can ever be given primacy is in an environment of
personal freedom. That means personal choice -- if a family can
choose a doctor, hospital or health plan with similar moral values.
This is most urgently the case in matters concerning the quality of
care, and the standard of care, before birth or before death.
In the United States, we will face similar problems. Insurance
companies and government officials often make decisions about the
kind of care we get, what we pay for, and what the fine print is in
medical treatments and procedures. Individuals and patients often
have little or no direct control, for example, over the kind of
health care plan they have, or what's in that health care plan.
They get what the employers, managed care executives or government
officials give them.
There is a better idea. Individuals and families should be able
to get the kind of health care they want, not just what big
third-party players says they can and cannot have. Americans need
the freedom to choose the health care they trust. Where are the
companies that offer health coverage that is morally acceptable to
practicing Catholics or Orthodox Jews, or Evangelical
Many faith-based fraternities sell life insurance, but they
don't offer health insurance. It's time that they did. And Congress
and state officials should change federal and state laws to enable
that to happen.
The need for more freedom in the American health care system has
never been greater. And the reform should begin with allowing
people to own their own health insurance without either the
outdated tax or the onerous regulatory penalties that plague the
As for Samuel Golubchuk: Fortunately, Canada still has an
independent judiciary, and his case went before a judge who issued
a temporary injunction forbidding the hospital from killing him, at
least as of this writing.
May his case be a lesson to those of us south of the 49th
Connie Marshner, founding editor of the Family Protection Report
newsletter, is a consultant in the Center for Health Policy Studies
at The Heritage Foundation.
Distributed nationally on the McClatchy Tribune wire
There are moral costs in socialized medicine. Anyone who considers Canada's health system a role model for the U.S. should consider the case of Samuel Golubchuk. His case shows the inevitable collision course between government-controlled health care and the rights of private conscience.
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