Thứ Năm, 27 tháng 12, 2012

Tracey v. Cambridge University Hospital - No Guidance on Duty to Consult Patient before Entering DNR

Lastweek,  Mrs. Justice Nicola Davies ruled in Tracey v. CambridgeUniversity Hospital.  I have posted a copy of the decisionhere.Janet Tracey was not consulted before a "do notresuscitate" notice was placed on her medical records.  But JusticeDavies held that the failure to inform or involve Janet had"minimal causative effect," as the notice was cancelled five dayslater when her family objected, and not acted upon.  The judge also foundthat a second notice, which followed three days afterwards and two days beforeMrs...

Thứ Ba, 25 tháng 12, 2012

Legality of VSED - VRFF

I wish I had used this scene from Hamlet Act V, scene I in my argument for why VSED does not constitute assisted suicide.GRAVEDIGGERIs she to be buried in Christian burial when she willfully seeks herown salvation?             OTHERI tell thee she is. Therefore make her grave straight. The crowner hathsat on her and finds it Christian burial.GRAVEDIGGERHow can that be, unless she drowned herself in her own defense?OTHERWhy, ’tis found so.GRAVEDIGGERIt must be se offendendo. It cannot be...

Chủ Nhật, 23 tháng 12, 2012

Career Guide for the Future Healthcare Attorney

I just posted my new seven-page article "Career Guide for the Future Healthcare Attorney."  I have been expanding this for a more exhaustive piece to be submitted in March.  So, I would greatly appreciate any criticism, comments, suggestions.  Here is the abstract:I have two objectives in this Article. First, I will outline the wide range of career paths available to you as a health lawyer. Second, I will describe the experience and credentials that you should acquire to make yourself a competitive candidate for these jobs.The plethora...

Thứ Sáu, 21 tháng 12, 2012

Obama Pushing Grandma off Cliff

I don't know how I missed this earlier this year.  Mean, unfair, and inaccurate.  But clev...

Health Law & Bioethics before the Minnesota Supreme Court

There are a number of interesting health law and bioethics cases now pending before the Minnesota Supreme Court and the Minnesota Court of Appeals.  I will review these at a lunchtime workshop on Tuesday, January 29, 2013.1.  State v. Melchert-Dinkel.  William Melchert-Dinkel is a former Minnesota nurse convicted of going online and encouraging two people to kill themselves.  This week, Melcher-Dinkel filed his opening brief the Minnesota Supreme Court, arguing that he did not directly participate in the suicides, was...

Minnesota v. Final Exit Network (Part II)

I wanted to follow-up from my brief post, earlier this week, about Tuesday's motions hearing in Minnesota v. Final Exit Network (Dakota Cty., Minn.).  The hearing has since also been covered in the local and national media.  Here are some highlights from the hearing:Rivas:  Explained how the prohibition on advising and encouraging suicide is not only content-based but also viewpoint based.  For example, a law banning billboards over 20 feet would be content neutral.  A law banning advertising on billboards would be...

Thứ Tư, 19 tháng 12, 2012

CMS Signals Renewed Focus on Advance Directives

This North Carolina law firm caught my eye with this headline: "CMS Signals Renewed Focus on Advance Directives" in one of its newsletters.  Here is the key language from the newsletter summarizing the impact of this CMS Memo:On September 27, 2012, CMS issued revised surveyor guidance in Appendix PP to the state operations manual, further interpreting F Tag 155, which is based on 42 Code of Federal Regulations section 483.10(b)(4). The revised guidelines became effective on November 30, 2012.  The regulation itself has not changed, nor...

Nursing Home Inspect Tool for Researching Deficiency Reports

ProPublica has launched a great new tool that you can use to compare nursing homes in a state based on the deficiencies cited by regulators and the penalties imposed in the past three years.  You can search more than 58,000 nursing home inspection reports to look for trends or patterns. ProPublica has also prepared a guide for making the most of this to...

Thứ Ba, 18 tháng 12, 2012

Minnesota v. Final Exit Network - Omnibus Motions Hearing

This morning, I attended the omnibus motions hearing in the Dakota County, Minnesota criminal case against the Final Exit Network and five individual FEN defendants.  The primary defense motion attacks the constitutionality of the statute under which the defendants are charged, Minn. Stat. 609.215.That statute provides:  "Whoever intentionally advises, encourages, or assists another in taking the other's own life may be sentenced to imprisonment...

Thứ Hai, 17 tháng 12, 2012

National Healthcare Decisions Day - 4 Months to Go

Today marks four months to NHDD 2013 - April 16, 2013.  Continue to spread the word about NHDD, and please encourage others to join by clicking here.  In the spirit of holiday gift-giving, consider a gift to NHDD he...

Thứ Sáu, 14 tháng 12, 2012

Slow Code & No Codes / Medical Futility - Free Webinars

Children's Mercy Bioethics Center in Kansas City has posted a copy of its recent webinar "Slow Codes, Show Codes, and No-Codes: A Debate Between Annie Janvier and William Meadow."Click here to register for their February, 5, 2013 Debate: "Does the Concept of ‘Medical Futility’ Help Clinician...

Thứ Năm, 13 tháng 12, 2012

Australian Health Minister Calls for Better Informed Consent at End of Life

Australian Federal Health Minister Tanya Plibersek has challenged doctors to better explain to terminally ill patients when treatments become futile.  Several Australian physicians have recently highlighted the fact that terminally ill patients are undergoing aggressive and uncomfortable treatments even though they are fruitless.  For example, intensive care specialist Peter Saul says some doctors reflect a death-denying Australian culture...

End-of-Life Law & Policy - Video from NYLS Conference

New York Law School has posted a video of all sessions from its November 16, 2012 conference of end-of-life care law and policy.  My talk on medical futility begins at 2:52:...

Thứ Tư, 12 tháng 12, 2012

Definition of "Life-Sustaining Treatment" in New Jersey

Last year, New Jersey defined “life-sustaining treatment” as "the use of any medical device or procedure, artificially provided fluids and nutrition, drugs, surgery, or therapy that uses mechanical or other artificial means to sustain, restore, or supplant a vital bodily function, and thereby increase the expected life span of a patient."  N.J. Stat. Ann. 26:2H-131.This means that physiologically futile interventions do not even qualify as life-sustaining treatment.  CPR for a patient in whom it will not restore circulation...

Cuthbertson v. Rasouli - Oral Argument Video

The video of the oral argument before the Supreme Court of Canada in Cuthbertson v. Rasouli, is available here.  I plan to post detailed comments next we...

Thứ Ba, 11 tháng 12, 2012

Advance Care Planning Lessons from Gunderson Lutheran (NBC Rock Center)

Visit NBCNews.com for breaking news, world news, and news about the econ...

David James - Court Denies Hospital Permission to Stop Life-SustainingTreatment

In May, 68-year-old formermusician David James was admitted to aBritish hospital with constipation.  But he went on to develop pneumoniaand became critically unwell.  He has hada stroke, resulting in damage to the brain and loss of function on his rightside, and he has also had a number of cardiac arrests and suffered kidneydamage.  Clinicians have diagnosed him as in a minimally conscious state.More recently, the hospital...

Thứ Hai, 10 tháng 12, 2012

Video Decision Support Tool for CPR Decision Making

In a new study published in the Journal of Clinical Oncology, researchers found that showing patients with advanced cancer a video of simulated cardiopulmonary resuscitation (CPR) improved their understanding of the intervention and caused more patients to opt against CPR.The innovative Advance Care Planning Decisions video used in the study was created by a nonprofit foundation led by physicians who aim to empower terminally ill and elderly patients and their families to make informed choices about end-of-life care. These videos are created based...

New Position: Health Law & Policy Fellow and Instructor of Health Law

Saint Louis University Law Center for Health Law Studies Announces a New Position: Health Law & Policy Fellow and Instructor of Health LawSaint Louis University School of Law is seeking applicants for a full-time Health Law & Policy Fellow and Instructor in Health Law in the Center for Health Law Studies.  This new position is funded through a contract with the Missouri Foundation for Health.  The Fellow will work under the general direction of Professor Sidney Watson.Health Law and Policy Fellow, Instructor of Health Law,Center...

Chủ Nhật, 9 tháng 12, 2012

VSED - VRFF

I was just informed about two new materials regarding VSED-VRFF as a means to hasten death:  (1) a short manual called Cheat the Nursing Home, and (2) a memoir called Life, Death and Iguanas.The manual covers some of the basics of VSED.  The memoir, Life, Death and Iguanas, is the story of the life and death of a strong woman who chose to fast until her end rather than endure a living death of Alzheimer’s in a nursing home.  It’s...

Thứ Sáu, 7 tháng 12, 2012

Rasouli Case to be Heard by Supreme Court of Canada on Monday

On Monday, the Supreme Court of Canada will hear oral arguments in Cutherbertson v. Rasouli.  Interestingly, until 1949, Court’s non-criminal decisions could still be appealed to the Judicial Committee of the Privy Council in England.  The Court is now Canada’s ultimate court of appeal.  This is the first time a nation's ultimate judicial tribunal has grappled with a medical futility case.  Even better, the issues are framed very crisply.  In typical futility cases, the core "Who Has the Right" question...

Thứ Tư, 5 tháng 12, 2012

In re Kenny Ng - B.C. Court Asked to Order fMRI for PVS Patient

57-year-old Kenny Ng has been in a vegetative state since an automobile accident seven years ago.  His wife Lora wants medical staff at George Pearson Centre to remove his feeding tubes.  (Vancouver Sun)But Kenny's parents, siblings and relatives have asked B.C. Supreme Court Justice Miriam Gropper to intervene and keep Ng alive in the hope he can benefit from recent neuroscience medical discoveries.  They argue that Kenny may qualify for pioneering treatments by brain researcher Adrian Owen.Provincial precedent in...

Besse Cooper, World's Oldest Person, Dies

Besse Cooper, the woman who was listed as the oldest person in the world, has died at the age of 116 in a Georgia nursing home.  The title of world’s oldest person now belongs to 115-year-old Dina Manfredini of Johnston, Iowa, according to the Guinness World Records.  (ABC Ne...

Thứ Ba, 4 tháng 12, 2012

Michigan to Mandate Disclosure of Medical Futility Policies

In October, I observed that a bill was introduced in the Michigan House that would mandate the disclosure of futility policies when they might be applied to minor patients.  A few days ago, HB 6070 was introduced by a different Representative to achieve the same thing.  Here is the key provision:A HEALTH FACILITY OR AGENCY THAT ADOPTS OR  IMPLEMENTS A FUTILITY POLICY THAT APPLIES TO THE TREATMENT OF A  CHILD FROM BIRTH TO 18 YEARS OF AGE MUST DISCLOSE THAT FUTILITY  POLICY TO THE CHILD'S PARENT OR GUARDIAN WHEN THE...

Open Position - Executive Director, New York State Task Force on Life and the Law

The New York State Task Force on Life and the Law is looking for a new Executive Director.  Requirements:Superior academic credentials (M.D., J.D., or Ph.D. preferred), demonstrated expertise in bioethics/health policy, and an ability to forge consensus on controversial issues.Responsibilities: The Task Force is a nationally recognized multidisciplinary body whose members are gubernatorially appointed and leaders in law, medicine, nursing, philosophy, and bioethics, as well as patient advocates and representatives of religious...

Seven Harms from Over-treatment in the ICU

There are at least seven discrete harms from over-treatment in the ICU:Patient - The patient's autonomy is violated, because she is not getting treatment consistent with her preferences and values.Patient - The patient will likely physically suffer from this over-treatment. Nurses - The nursing staff will likely experience moral distress.Other Patients - The anxiety of the nursing staff can adversely impact their care of other patients.Other Patients - Over-treating patients in the ICU means that other patients in need of that level of...

Thứ Hai, 3 tháng 12, 2012

Critical Legal Issues in Alzheimer’s - Free Webinar

Join the American Bar Association (ABA) Commission on Law and Aging and the Administration on Aging (AoA) to talk through what is important for your clients with Alzheimer’s and related dementia.  A free December 12 webinar covers legal issue spotting and finding dementia capable legal assistance and resources.   Participants will learn about:• Common legal issues • When to seek legal assistance• Legal issue resources• Finding dementia capable legal assistance Presenters: David Godfrey, Esq., Senior Attorney,...

Overtreatment: Making Money from Unnecessary Treatment

The hospital chain, Health Management Associates (70 hospitals in 15 states) is accused of pressuring doctors at some of its hospitals to admit patients regardless of medical need just to increase revenues, the CBS program 60 Minutes reported Sunday. Doctors at several HMA hospitals told 60 Minutes that administrators had set quotas for admissions through their emergency rooms.  HMA disclosed in previous SEC filings that federal authorities have been investigating certain aspects of the company, including "the medical necessity of emergency...

Slow Code - Short Code - Show Code

The slow code has been getting a lot of attention over the past week.  First, there was an excellent webinar at Children's Mercy Bioethics Center.  And Robert Cribb covered the topic in the latest in his end-of-life medicine series in the Toronto Star.I especially liked this part of Cribb's article:  Lantos acknowledges that many in the medical community have called his defence of slow codes a paternalistic endorsement of cloak-and-dagger secrecy.  “It’s a nice argument,” he says. “But why is honesty so obviously the only moral...

Thứ Sáu, 30 tháng 11, 2012

End-of-Life Matters: Cultural Representations through the Entertainment Arts

The 2012 National Academies of Sciences Rosenthal Lecture will be on December 12.  It will focus on how the language of the entertainment arts informs our cultural understanding of end-of-life care. Through the screening of clips from the film Beginners and television medical dramas, and a live theatrical performance reading from Sophocles’ Philoctetes, the Rosenthal Lecture panelists will explore the various ways the entertainment arts can provide a platform for an engaging and compelling conversation about end-of-life. The panel will...

Thứ Tư, 28 tháng 11, 2012

Minnesota v. Smith: Does Advance Directive Break Chain of Causation?

The Minnesota Supreme Court has agreed to hear a drunken driver's claim that he was not responsible for the death of a 93-year-old woman killed in a 2010 crash because her "do-not-resuscitate" order kept her from potentially life-saving medical care.Eddie Cortez Smith, 34, was convicted by a Ramsey County District Court jury in June 2011 of criminal vehicular homicide in the death of Edith Schouveller of St. Paul on March 28, 2010. He was sentenced to 10 years in prison, the maximum term allowed by state law.  His conviction was affirmed by...

Role of Minnesota Guardians in End of Life Decision-Making

Join us for breakfast and CLE on Friday, December 21 for "The Role of Guardians in End of Life Decision-Making: Reflections on the Tschumy Decision and its Implications for Guardians and Health Care Providers."  The expert panel will beThe Honorable Jay Quam, Hennepin County District CourtRebecca Egge Moos, Bassford RemeleRobert McLeod, Lindquist & Vennum PLLPCharles W. Singer, Attorney at Law  Guardians play extremely important roles within our legal system, and are granted wide ranging authority under Minnesota law, including...

Physician Sanctioned for Not Completing End-of-Life Care CME

West Virginia, like New Jersey and many other states, requires that physicians complete a certain number of CME credits in end-of-life care.  The West Virginia Board of Medicine recently sanctioned Michael W. Brown for falsely representing, in 2002, that he had completed this CME requirement.  Late last month, the Kanawha County Circuit Court reversed and vacated the Board's order.  The Court found that Dr. Brown believed in good faith that his coursework satisfied the then-existing requirements.  Still, it is nice to see this...

Thứ Ba, 27 tháng 11, 2012

POLST - DNAR without Consent

I strongly support POLST.  I have been actively engaged with its implementation in both Delaware and Minnesota.  And I am presently preparing a lengthy report to aid the continuing nationwide roll-out.  But I was surprised to see that some POLST programs and forms explicitly permit unilateral clinician orders.  This form from Vermont, for example, permits the clinician to complete a DNAR order on a patient's POLST without either...

KCET Show on End-of-Life Medicine

Los Angeles KCET will post a video, today, from last night's broadcast of SoCal Connected.  Three segments are of interest:UpFront: One woman makes an end-of-life decision many people dread.Your Turn to Care: L.A. Times columnist Steve Lopez reflects with his readers on the hardships of having a parent in decline.In the Studio: Dr. Ken Murray, a retired family physician, talks to Val about how doctors choose to approach the end of life differently than most people.video platformvideo managementvideo solutionsvideo player...

Another New Review of Liverpool Care Pathway

The Liverpool Care Pathway has come under intense scrutiny.  Several lawsuits have already been filed overpatients put on the pathway without a proper explanation or their families being involved.  (BBC News)Care and Support Minister Norman Lamb said he would appoint an independent chair to report back in the new year.  The new review will pool together data gathered from existing reviews which are being undertaken by the Association Palliative Medicine, Dying Matters and the national End of Life Care Strate...

Thứ Hai, 26 tháng 11, 2012

Carina Melchior: The Girl Who Refused to Die

A teenage girl in a coma after a catastrophic car crash came round just as doctors were about to declare her brain dead.  Carina Melchior had had life support withdrawn on the advice of medics and was being prepared for organ donation.  But to the astonishment of staff at the Aarhus Hospital, in Denmark, the 19-year-old suddenly opened her eyes and started moving her legs. (Daily Telegraph; Copenhagen Post)She is now making a good recovery...

Chủ Nhật, 25 tháng 11, 2012

"Way to Go" - New BBC Assisted Suicide Comedy

US comedy writer Bob Kushell has created a black comedy for BBC3 about a group of men forced into launching an assisted suicide business.  (Broadcast Now; Radio Times)Way To Go will center on twenty-something Scott, who is moved by his neighbor’s request to die, but is also grappling with a predatory female boss, a split from his girlfriend, and a need for cash to pay off his brother Joey’s gambling debts.  Together with Joey and friend Cozzo, Scott stumbles across the solution of illegally purchasing an assisted-suicide machine. It’s...

Thứ Bảy, 24 tháng 11, 2012

Edwarda O'Bara, World's Longest Coma Patient, Dies

Edwarda O'Bara, the world's longest coma patient, who had been calledthe "Sleeping Snow White" during the 42 years she remained comatose, has diedat the age of 59. In 1970, when Edwarda was 16, she suddenly fell ill and slipped into adiabetic coma.  As she lay in her bed, she turned to her mother, and pleaded with her tostay near.  “Promise me you won't leave me,” the teen begged her mother.  The mother promised, "I would neverleave...

Thứ Sáu, 23 tháng 11, 2012

Delaware Repeals MOLST

Most state are moving progressively toward clearer and stronger authority for their POLST programs.  Oddly, a few days ago, the Director of the Delaware DHSS Division of Public Health formally asked "all healthcare providers to please discontinue use of the STATE OF DELAWARE MOLST for...

Thứ Tư, 21 tháng 11, 2012

Not Dead Yet and the NYLS End-of-Life Symposium

NotDead Yet reports that last Friday, threedisability activists in New York City went to the Justice Action Center at theNY Law School to distribute flyers protesting the way in which a symposium on “Freedom of Choice at the End of Life” handled“issues of concern” that people with disabilities have with proponents ofassisted suicide (and other “end of life” issues).As Iwrote privately to one of the activists, Nadina Laspina, I was pleasedthat these activists were able to come up to the conference area deep insideNew York Law...

Tonight on PBS: "Honoring Choices: Giving Thanks"

For those in Minnesota, tune in tonight at 8:00 p.m., to watch Honoring Choices: Giving Thanks.In this final documentary of the series, Jearlyn and Jevetta Steele share why Thanksgiving is their preferred time to give the gift of a conversation with family and loved ones about end-of-life choices; why those close to you are your best advocates when you can't speak for yourself; and why it's important to participate in our healthcare decisions.This documentary will be rebroadcast on Friday at 7:00 on TPT 2.1.  You can also visit...

Compassion & Choices 2012 Annual Report

Compassion & Choices has published the Fall 2012 edition of its magazine.  This issue contains C&C's 2012 annual report.  Few organizations do (or have done) as much to protect and promote safety and autonomy in end-of-life ca...

Emergency Medicine on Futile Treatment

The Australasian College for Emergency Medicine is having a good discussion about futile interventions at its annual scientific meeting.  The focus appears to be more on physician-caused, rather than on surrogate-caused, overtreatment at the end of life.Calls to End Futile Care by tvnpor...

Thứ Ba, 20 tháng 11, 2012

Man Claims "Doctors Murdered My Wife"

Alan Booth says that doctors forced his wife, Sue, to die, by withdrawing food and water for two days, without the family's consent.  Although Sue had battled breast cancer for 7 years, she'd been told her cancer was under control.  (Jersey News; Jersey Evening Post)  Booth says, "The doctors murdered my wife. She didn't die naturally, she didn't die of cancer. She was put on a Pathway which is designed to kill. That was professed to be 'care'."  The Health Minister says she cannot comment on individual cases - but she...

Thứ Hai, 19 tháng 11, 2012

Rasouli Daughter on CTV News

Hassan Rasouli's daughter discussed her father's case on CTV News (video clip) this morning. &nb...

The Most Difficult Ethical Dilemma Facing Science Today

The Guardian newspaper recently interviewed Britain's most celebrated scientist, David Attenborough.  Here is the final question and answer: What is the most difficult ethical dilemma facing science today?DA:  How far do you go to preserve individual human life?HT:  Ken Hillman, who just wrote in the American Journal of Respiratory & Critical Care Medicine:  "At the end of the day, it is our profession, through our societies and as individual critical care physicians, that needs to initiate and be involved in this...

Chủ Nhật, 18 tháng 11, 2012

Rasouli Case Coverage in Toronto Life Magazine

Just in time for upcoming oralarguments in the SupremeCourt of Canada on December 10:  Nicholas Hune-Brown has amajor piece in the December 2012 issue of Toronto Life magazine.  The article providesextensive background on the Hassan Rasouli ca...

Advance Directives Should Address fMRI Results

At least for the foreseeable future, there will be uncertainty over whether some PVS patients are in a cognitive state more like locked-in syndrome.  (National Post)Consequently, it might be prudent for individuals to address this situation in their advance directives.  For example: "I do/do not want to be sustained with life support if I am diagnosed in a PVS, even if fMRI shows I have some responsiveness."  Of course, if the fMRI data shows that the patient has decision making capacity, then the patient could revoke the advance...

Thứ Bảy, 17 tháng 11, 2012

Physicians, Not Surrogates, to Blame for Non-Beneficial Overtreatment

Another interesting result from the new Medscape survey of top ethical dilemmas.  Too many patients are just not getting the truth about how bad things really are.I was pleased to hear, this weekend in NYC, more about New York's Palliative Care Information Act (in effect since Feb. 2011) and about similar legislation now in the NY pipeline.  While there are some intractable futility disputes, most inappropriate, non-beneficial end-of-life...

National Healthcare Decisions Day 2013

Yesterday, marks five months to the sixth annual National Healthcare Decisions Day.Many of you will have family gathered next week for Thanksgiving, and I encourage you to take the opportunity to have a discussion about your advance care planning.  Then, reflect on the discussion and use your experience to guide the way you bring up the topic with others. NHDD has a great video to get the conversation started.  The Canadian “Speak Up” Campaign (with their own National Advance Care Planning Day on April 16) also has a great video....

2013 Canadian Bioethics Society Annual Conference

The 2013 Canadian Bioethics Society Annual Conference will be in Banff from May 29 to June 1, 2013.  Abstracts are due at the end of this mon...

Thứ Năm, 15 tháng 11, 2012

Physicians' Top Ethical Dilemmas

Medscape has just published its 2012 Ethics Report: Physicians' Top Ethical Dilemmas, based on survey responses from 24,000 US physicians across 25 specialties.  Here is the first questi...

Symposium: Freedom of Choice at the End of Life

I am looking forward to participating, tomorrow, in New York Law School's symposium, Freedom of Choice at the End of Life.  I have posted my slides he...