George Bernard Shaw hated doctors, and by avoiding them managed to live a vibrant and productive life until his death at age 95.

He summed up one of his major complaints against doctors in the brilliant prelude to his play The Doctor's Dilemma: "It may be necessary to hang a man or pull down a house. But we take good care not to make the hangman and the housebreaker the judges of that. If we did, then no neck would be safe and no house stable."

What Shaw is saying is that, in medicine, there are areas in which conflict of interest is a major factor in decision-making.

In Manitoba recently, this came to the fore in the case of 84-year-old Samuel Golubchuk, who had been diagnosed by his physicians as having no chance for recovery. His doctors ordered the Orthodox Jew to be removed from a ventilator and feeding tube but Golubchuk's children objected, in part because their father's religious beliefs would be violated if doctors pulled the plug. They took it to the Manitoba courts and a judge ruled he would remain on life support until a trial's determination.

The doctors' now-stalled decision was supported by a recent directive from the College of Physicians and Surgeons of Manitoba. The family must be informed and given four days' notice, but the life-or-death decision rests solely with the doctors.

I would like to view this case in the context of conflict of interest. Not in the sense that Shaw meant. Clearly, the doctors would earn more money keeping Golubchuk alive than allowing him to die.

No, here the conflict is more subtle ' but also more relevant for all of us who use health care. Put bluntly: the cost of care is being borne by those who will not receive any benefit from it. Mr. Golubchuk and/or his children are receiving what has been deemed to be unnecessary health care, solely because they demanded it.

In Canada, there is a finite amount of health-care money available. And 40 to 50 per cent of all the money spent on health care for someone will be spent in the last few months of their life ' and of that, more than half in the last week or so.

Clearly, this is not money well spent in terms of years of life ' or health ' per dollar. Obviously we should spend to care for all who are sick. But toward the end of a life, the amount spent rises sharply and some argue that we are really just extending the dying process.

In this case it can be argued that for every day Golubchuk continues on extremely expensive life support, there is less money available for other medical needs.

One of the biggest issues in health care in Canada is how to decide where to spend our health-care dollars. These priorities will become more and more important.

We should not leave these decisions to the courts, since we run the risk of excluding those who should be making the decisions ' you and I, the people who use, fund and, yes, work in the system.

Dr. Murray Waldman has been a family doctor, coroner and administrator.

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