Today is a milestone of sorts for the Medical Futility Blog. Google Analytics tells me that this blog has just reached 250,000 pageviews. &nb...
Thứ Hai, 30 tháng 4, 2012
Hawkins v. DeKalb Medical Center (Update)
I first blogged about Hawkins v. DeKalb Medical Center over four years ago. The Georgia defendants maintained the pregnant teen patient on life support until she delivered a baby. Providers then confirmed that she was brain dead and stopped ICU interventions. The patient's grandmother sued the Georgia hospital for "tortuous termination of life support." But she failed to factually dispute the defendants' contention that the teen was dead before the termination of life support. Therefore, the Georgia Court of...
Chủ Nhật, 29 tháng 4, 2012
Thứ Bảy, 28 tháng 4, 2012
Medical Futility in Japan vs. North America
A new comparative survey of Japanese physicians and laypeople concerning judgments of futility is roughly consistent with similar Canadian and American studies. Laypeople were nearly twice as likely to think continued treatment was appropriate. For example, take a hypothetical case in which physicians determined that "there were no longer any agents anticipated effective" for a patient with advanced lung cancer and a life expectancy of several weeks. If the patient requests another round of chemotherapy, 65% of laypeople say it...
Thứ Tư, 25 tháng 4, 2012
Rasouli - No Longer in PVS
The Globe & Mail reports that Hassan Rasouli is no longer in a persistent vegetative state. This could have a material impact on the pending Supreme Court of Canada case concerning whether physicians at Sunnybrook can stop his life support over his family's objections.Until recently, Rasouli was diagnosed as being in a persistent vegetative state. But an affidavit filed with the Supreme Court says he’s now "minimally conscious." Doctors’ reports say Rasouli can “voluntarily control” certain behaviors – suggesting he may be...
Chủ Nhật, 22 tháng 4, 2012
Dead Woman Delivers Twin Boys
Several weeks after being declared dead as the result of a burst brain aneurysm, Michigan resident Christine Bolden delivered (at 25-weeks) twin boys Alexander and Nicholas by Cesarean. Mother's death brings new life: woodtv....
Thứ Bảy, 21 tháng 4, 2012
Vermont - Lack of Default Surrogates
Like Minnesota and a few other states, Vermont has no law authorizing "default" surrogate decision makers. On the one hand, this leaves providers with the flexibility to identify and choose the best surrogate. On the other hand, it leaves providers somewhat uncertain about their validity and safety of their choices. New York's lack (until June 2010) of authorized default surrogate created even worse problems. The long-standing problem in Vermont has bubbled to the surface as Vermont now aims to enact legislation authorizing...
Thứ Năm, 19 tháng 4, 2012
Thứ Tư, 18 tháng 4, 2012
Futility & Conscientious Objection - Free Video Conference
The theme of the University of Wisconsin School of Medicine and Public Health's Fourth Annual Bioethics Symposium, last Thursday, was "Doctors, Politics and Conscience." Videos of the presentations are available he...
Thứ Hai, 16 tháng 4, 2012
Coming to Grips with End-of-Life Care
At the prestigious 2012 TEDMED conference, organizers identified fifty great challenges of health and medicine. These are complex and persistent problems that affect great numbers of people. Delegates voted on these challenges, narrowing them down to just twenty. One of the twenty (along with other challenges like "The Obesity Crisis," the "Impact of Poverty on Health," and "Addressing Healthcare Costs") is "Coming to Grips with End-of-Life Care." Here is the description of this challenge: Modern medicine has extended...
Chủ Nhật, 15 tháng 4, 2012
National Healthcare Decisions Day
In honor of National Healthcare Decisions Day (NHDD), April 16, I’m taking a break from blogging this week and spending my writing time with my loved ones. I hope that this guest post, by Nathan Kottkamp, Founder and Chair of NHDD, will inspire you to think about the conversations we should all be having with our own loved ones about an uncomfortable but important topic – planning for when we die.Are you one of the 80% of Americans who haven’t completed an Advanced Directive yet? We’ve all struggled with how to get started on this topic –...
Safe Haven Network of Vitalist Hospitals
The Terri Schiavo Life & Hope Network is developing a comprehensive directory of “Safe Haven” facilities which consists of hospitals, long term care facilities and other medical facilities where individuals can receive care and not be faced with the threat of having medical care, nutrition and hydration withheld. Schneiderman and Jecker recommended such a resource in Wrong Medicine. And such a directory is mandated in section 166.053 of the Texas Advance Directives Act. That registry is available he...
Over-treatment: Defensive vs. Offensive Medicine
Nancy Morden has a new article in Health Affairs that examines the association between hospital characteristics and eleven end-of-life care measures, such as hospice use and hospitalization. Her study reveals a relatively high intensity of care in the last weeks of life. At the same time, there was more than a twofold variation within hospital groups with common features, such as cancer center designation and for-profit...
Thứ Sáu, 13 tháng 4, 2012
Helping Clients Produce Advance Directives That Work
If you will be near San Diego on May 4, be sure to attend this workshop. Most people know they should make an Advance Care Directive, yet manydo not. Why? Here are two possible reasons.They do not really understandthe medical conditions and treatment choices. They are not convinced thatcompleting these forms will be effective or even be available to clinicianswhen “that time comes”- if they no longer can speak for themselves. Dr....
Thứ Ba, 10 tháng 4, 2012
Extraordinary Measures to Save Gravely Ill Pets
With the availability of treatments like bone-marrow transplants and heart stents, it is now easy to spend $10,000 to $25,000 on medical procedures for a pet. Knowing that many humans die of preventable illnesses, or even considering that many dogs and cats are euthanized in overcrowded animal shelters, can a person justify spending that much money to prolong one animal’s life? If so, is it ethical to have a pet if you cannot afford such...
Thứ Hai, 9 tháng 4, 2012
Can a Physician Write a DNR Order without Consent?
James Bernat, who has written one of the best books on medical ethics, has also just written a brief article in this week's Neurology Today. He answers the question, "Can a neurologist write a DNR order on a terminally ill patient without consen...
Chủ Nhật, 8 tháng 4, 2012
Idaho Anti-Futility Bill Signed into Law
Just a few years ago, Idaho was close to enacting Texas-style legislation permitting healthcare providers to refuse life-sustaining interventions that they deemed inappropriate. This week, Idaho reversed course 180 degrees. It has enacted legislation (here too) that directly prohibits providers from refusing requested life-sustaining treatment. The following amendments are effective on July 1, 2012.S.B.1348 adds a new section (3) to Idaho Code 39-4514: "Assisted feeding or artificial nutrition and hydration may...
Thứ Sáu, 6 tháng 4, 2012
Medical Futility Legislation in Minnesota
Yesterday afternoon, on the floor of the Minnesota Senate (around 3:30:00), Senator Nienow proposed amendment A33 to HF2294 (the Omnibus Health and Human Services Finance bill). The proposed amendment would require hospitals to disclose a futility policy. The amendment otherwise would not restrict either the existence or content of such policies. The amendment was adopted, but must now go to conference, since it was not in the original house bi...
Thứ Năm, 5 tháng 4, 2012
Oklahoma Anti-Futility Legislation
Oklahoma has pending legislation titled the "Nondiscrimination in Treatment Act" (SB 1695). This is very similar to pending Idaho legislation about which I have blogged several times. The Idaho bill has passed both houses and is sitting on the governor's desk. The Oklahoma bill has passed the Senate and has been passed out of the house public health committee. The purpose of the Oklahoma bill is to prohibit the denial of life-preserving health care services from a requesting patient on the basis of a view that extending...
Choosing Wisely - EBM Recommendations to Avoid Waste
The ABIM Foundation's "Choosing Wisely" initiative has some implications for end-of-life interventions. Basically, 9 U.S. specialty societies representing 374,000 physicians developed lists of "Five Things Physicians and Patients Should Question" in recognition of the importance of physician and patient conversations to improve care and eliminate unnecessary tests and procedures. These lists represent specific, evidence-based recommendations physicians and patients should discuss to help make wise decisions about the most appropriate...
Thứ Ba, 3 tháng 4, 2012
Legal Help for Families in a Medical Futility Conflict
I often get asked what legal support there is for an individual whose family member is or was the subject of medical futility dispute. While these conflicts are almost always resolved informally through consensus-building resources within the facility (e.g. chaplains, ethics consultants, social workers, ethics committees), sometimes the conflict is intractable. Sometimes, the providers proceed to take unilateral action, and the family feels powerless. Fortunately, hospitals and providers are regulated by a large and overlapping...
End-of-Life Liberty - Compassion & Choices National Conference
Compassion & Choices is holding its National Conference in Chicago from Thursday, June 28, 2012 to Saturday, June 30, 20...
Legal Fundamentals of Surrogate Decision Making
My article, "Legal Fundamentals of Surrogate Decision Making" has just been published in Chest. Here is the abstract:The four previous articles in this series have traced the history of patient autonomy and have identified its ethical and legal foundations. Patient autonomy is highly valued in the United States to the extent that the patient does not lose the right of self-determination when he or she loses the capacity to make health-care...
Chủ Nhật, 1 tháng 4, 2012
Expiration Date - Theater on Facing Death
If you are in Minneapolis during the next week, head over to Uptown to see Expiration Date. This was an impressive and moving theater piece about facing death. It was under 90-minutes long. After a nice ride along the Mississippi and a bluff-side picnic, this was a fantastic capstone to my afternoon.&nb...
New Book - "It's OK to Die"
Dr. Monica Williams-Murphy vividly recalls performing emergency chest compressions on a 100-year-old nursing home patient with advanced dementia. Lacking a 'Do Not Resuscitate' order, Williams-Murphy was obligated to do all she could to try to save a woman that she knew was beyond saving. "I wasn't going to bring her back to something better." That experience got the Huntsville, Alabama Hospital emergency department physician thinking...
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