New Case: Zody Cervantes v. Rady Children's Hospital

San Diego has long been a center for innovation in the resolutionof medical futility disputes.  While not all hospitals in the area have signedonto proposed community-wide guidelines, several did.  One manifestationof the enforcement of that policy is now playing out at Rady Children's Hospital.Zody Cervantes has serious widespread brain damage probably due to meningitis.  Physicians told Zody's mom:  "We're 99 percent sure he's never going to have anyquality of life."  Physicians told her that they do not...

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The Hospice Nurse

PalliMed has an interesting discussion overthe appropriateness of this portrayal of the hospice nur...

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Withdrawal of Treatment against the Consent of Substitute Decision-Makers

The Supreme Court of British Columbia's opinion in Carter v. Canada is a masterful and thorough review of the medicine, law, and ethics of hastened death.  Justice Smith even devotes five paragraphs to the law of medical futility.VII.  Medical Ethics and Medical End-of-Life Practices . . .C.  Current State of the Law and Practice in Canada . . .3.  The Law . . .d.  Withdrawal of Treatment against the Consent of Substitute Decision Makers[227] The law makes clear that consent is a sufficient condition for the withdrawalor...

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New Film: "A Good Death"

The film “A Good Death” is for patients with COPD or other serious lung conditions, their families, and the doctors and nurses who provide care for them. It is not an easy film to watch, because it describes the struggles of a real patient, Mr. Martin Cavanagh, and his family during the last months of his life. If you are living alone, it may be best to invite a family member or friend to watch it with you.The film is designed to introduce the concept of ADVANCE CARE PLANNING. It is meant to prompt meaningful discussion and helpful planning for...

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Health Care Reform and Health Care Stakeholder Disputes: Can We Identify Common Ground?

I will be speaking at Health Care Reform and Health Care Stakeholder Disputes: Can We Identify Common Ground? on Friday, October 12, 2012 at Marquette University.  Here is the tentative agenda:8:30 - 9:20 a.m.       PLENARYModerator - Professor Howard Bellman, J.D., LL.M., Marquette University Graduate Program in Dispute Resolution, Distinguished Adjunct ProfessorPanelists:Dr. Arthur Derse, MD, J.D., Institute for Health...

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Clinicians Hasten Death of even Non-Terminal Patients

The Liverpool Care Pathway is an integrated care pathway that is used at the bedside to improve the quality of the dying in the last hours and days of life.  It is a means to transfer the best quality for care of the dying from the hospice movement into other clinical areas, so that wherever the person is dying there can be an equitable model of care.But Professor Patrick Pullicino charges that the clinicians use the pathway even when...

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Legal Briefing: The Unbefriended: Making Healthcare Decisions for Patients Without Surrogates

The second part of my article "Legal Briefing: The Unbefriended: Making Healthcare Decisions for Patients Without Surrogates" was just published in The Journal of Clinical Ethics 23(2): 177-12.  Here is the abstract:This issue’s “Legal Briefing” column continues coverage of recent legal developments involving medical decision making for unbefriended patients. These patients have neither decision-making capacity nor a reasonably available surrogate to make healthcare decisions on their behalf. This topic has been the subject of recent articles...

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Raz: Death in Our Life

The eminent legal philosopher Joseph Raz has posted the text of the Annual Lecture of the Society for Applied Philosophy, delivered in Oxford in May 2012.  Here is his abstract:  I kept the talk style of the paper. It examines a central aspect of the relations between duration and quality of life by considering the moral right to voluntary euthanasia, and some aspects of the moral case for a legal right to euthanasia. Would widespread acceptance of a right to voluntary euthanasia lead to widespread changes in attitude to life and death?...

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Krela v. Kryla: Case of the Forged POLST

Here is the Complaint in a recently-filed federal case in Oregon: Krela v. Kryla.  One of the allegations is that a POLST was completed without the patient's consent and over his objections.  I wrote just a few days ago about a Minnesota case in which DNR orders were accidentally switched.  There may be some real merit to the arguments of those concerned with increasing the security safeguards in POLST.&nb...

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Pay Up or We Turn Off the Ventilator

A Mexican hospital allegedly threatened a Scottish family that it would turn off the ventilator of Olivia Downie who is suffering from stage four neuroblasto...

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8 Questions Patients Forget to Ask Their Doctor

Medical futility conflicts are often due to patients and surrogates demanding more aggressive interventions than clinicians deem appropriate.  But far greater volumes of overly-aggressive end-of-life treatment is provided not because patients and surrogates want (or need) it, but because clinicians want to provide (and bill for) it.Both in the end-of-life context and elsewhere in medicine, patients need to be empowered to protect themselves against growing cultural and economic influences that may undermine patient rights.  To this end,...

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DNAR Orders: Resetting the Defaults

The latest issue of JAMA includes some correspondence on Blinderman at al.'s proposal to revise the approach to DNAR status.  In one letter, Dr. Georgiou paints an overly pessimistic picture of the legal obstacles to not performing desired CPR.  In fact, EMTALA is almost always inapplicable to hospital inpatients and it is completely inapplicable to long-term care residents.  More generally, as I have argued here and here, there is hardly as strong or clear a legal prohibition of unilateral DNAR as Dr. Georgiou suggests....

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Refusal to Resuscitate: Paramedic Disciplined

A British Health Professions Council panel has found paramedic Alan Clark guilty of misconduct for refusing to resuscitate a 93-year-old woman with COPD.  (HPC Committee Finding; Daily Mail)  Clark allegedly determined that the woman was "life extinct" even though he had not determined how long she had stopped breathing and even though there was no “do not resuscitate” or living will formally in place.Interestingly, the Panel also considered related charges that Clark engaged in a show code ("mimicked resuscitation") to...

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Another Algorithm to Handle Requests for Non-beneficial Interventions

Last month, I described an algorithm published in the Journal of Medical Ethics that the authors argued should be used to appropriately handle medical futility disputes.  This week, the same journal (Journal of Medical Ethics) has posted another article defending a different algorithm by a different group of German medical/ethical researchers:  "Evaluating a patient's request for life-prolonging treatment: an ethical framework."  The...

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Defending Presumed DNR

In early May, I blogged about this JAMA article that defends a three-tiered approach to DNR orders.  On the same subject, I was just moved by this powerful story posted to KevinMD this week.  It presents a case illustrating why CPR should not be offered as an option when it is physiologically or imminently futile. &nb...

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POLST - Include Patient Photo?

A Dungarvin LLC assisted living facility in my neighborhood was just reprimanded by the Minnesota Department of Health for failing to resuscitate a patient.  The patient had been choking, and staff summoned EMS.  But when EMS arrived, staff presented them with a DNR order.  So, EMS did not resuscitate.  Unfortunately, the DNR order was not the patient's but was another patient's.  It seems that matching the order to the patient is an area presenting some risk of error, especially in the emergency context.  Perhaps...

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Legal Mechanisms to Resolve Futility Disputes (Video)

I have posted, here, an MP4 video of my May 2012 presentation at the ATS 2012 Conference in San Francisco:  "What Are the Boundaries of Acceptable Medical Practice Near the End of Life In ICUs?  Legal Mechanisms to Resolve Futility Disputes."  This is not a video of me but of my slides with me speaking. &nb...

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Video Advance Directives

Angelo Volandes has spearheaded a body of research (e.g. here and more to come in 2012-2013) persuasively demonstrating that compared with participants who only heard a verbal description, participants who viewed a goals-of-care video were more likely to prefer comfort care and avoid CPR, and were more certain of their end-of-life decision making. I was delighted to hear, this morning, that version 2.0 of Volandes' research will move from using videos to inform patient decision making to using videos to document that decision making....

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Lantos on Medical Futility, Huck Finn & ET

While I missed his presentation at the 2012 Healthcare Law and Ethics Institute at Samford University, I thoroughly enjoyed John Lantos’ slides on medical futility and moral distress.  Lantos powerfully uses literature and film-- from Huckleberry Finn to ET -- to illustrate relevant themes and issues. &nb...

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35th Annual Health Law Professors Conference

I am heading, this morning, to hot, hot Tempe, Arizona to attend and speak at the 35th Annual Health Law Professors Conference.  This is probably the largest U.S. gathering of academic lawyers teaching and researching health law and bioethics.  Last year, I also attended the Australasian Association of Bioethics and Health Law (AABHL) conference.  AABHL is Australia and New Zealand’s leading organisation concerned with issues...

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Hospice as the Default Option

For all those patients who have left no evidence of their treatment preferences at the end-of-life, hospice should be the default argues this physician (in the clip below).  I agree.  It is time to revisit, as Justice Rehnquist put in in Cruzan, the "societal judgment about how the risk of error should be distributed."  Empirical evidence over the past twenty years about patient preferences and the reversibility of certain medical states supports Justice Brennan's observation that "an erroneous decision in either direction is irrevocable."...

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"How to Die" - TIME Mag. cover story

Take a look at the cover of this week's Time Magazine.  "How to Die" appears in large white letters on a red background.  This is great sign that our society is having much needed discussion and dialogue about these issues.  The author explains how the high-quality end-of-life care that his parents received from the Geisinger Health System was due largely to its salaried physician structure that avoids problematic fee-for-service incentives....

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New Report on DNR: Time to Intervene?

The UK National Confidential Enquiry into Patient Outcome and Death (NCEPOD) has released a new report that highlights the process of care for adult patients who received cardiopulmonary resuscitation in an in-hospital setting.  The report takes a critical look at areas where the care of patients might have been improved, and factors which may have affected the decision to initiate a resuscitation attempt. Notably, the report found that even when a DNACPR decision had been made it was not always followed, and 52 patients underwent...

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