Top 10 Legal Issues in Bioethics - ASBH Annual Meeting

The 14th annual meeting of the American Society of Bioethics and Humanities is coming up in a few weeks in Washington, DC.  I hope that you will join Art Derse, Alicia Ouellette, Amy Campbell and me for the fourth annual Legal Update 2012:  Top 10 Legal Issues in Bioethics.  This is session 105 on Thursday, October 18 from 1:00 to 2:30 p.m.  I have posted materials from prior "Legal Update" panel sessions here.  If you are interested in legal bioethics, please also join us at the Law affinity group meeting on Friday, October 19 from 11:30 to 12:30 p.m.

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Legal, Medical, & Ethical Issues in Minnesota End-of-Life Care

Join us on November 8-9, in Saint Paul for this Symposium to discuss Legal, Medical, and Ethical Issues in Minnesota End-of-Life Care.

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Video - Two Physician-Patient Conversations about End-of-Life Decisions

Here are two five minute video clips from PBS:



At Intermountain Medical Center Dr. Sam Brown, the supervisor at the medical ICU, meets with Paul Keith, who has terminal cancer. The cancer, which has spread to Mr. Keith’s throat, prevents him from speaking, but he communicates with his wife and doctors by writing his wishes. He is extremely articulate and clear about his prognosis as well as his desire for palliative interventions only as he bravely faces his imminent death. This poignant conversation about his medical decision-making process with Dr. Brown is both powerful and deeply moving. 

At UCLA Medical Center Dr. Bruce Ferrell, a devoted geriatrician and palliative care expert, has a monthly appointment with one of his longstanding patients, 92-year-old Mary Feldman. Ms. Feldman is in the very advanced stages of Alzheimer’s disease. She is disoriented and can’t speak, walk, or control any of her bodily functions. Her two devoted sons, Ned and Lynn, take loving care of their mother at home, but they need the help of Dr. Ferrell and a home health professional to manage their mother’s ongoing care. PBS films a moving discussion with Dr. Ferrell about how to handle Ms Feldman’s worsening condition and her desire to avoid spending her final days in a hospital hooked up to tubes and machines.

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Baby Carner - A Baby "M" in Houston

On the heels of the Baby "M" case in Alberta is this sadly similar case from Houston.  Jessica Marie Carner and Jarroin Louis Carner were both arrested and charged with felony injury to a child with serious bodily injury after their infant son suffered head trauma so severe, he remains in a vegetative state.

Doctors discovered the baby boy suffered subdural hematomas, an extra axial hemorrhage and an anoxic brain injury which resulted in cardiac and respiratory failure, renal failure and shock. The baby also suffered retinal hemorrhaging. Doctors said the baby suffered abusive head trauma possibly as a result of being violently shaken.. Doctors said it is in the best interest that the child to be a DNR—Do Not Resuscitate – both inside and outside of the hospital.  The parents are likely to refuse consent for that.

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Share Your Story of Unwanted or Unnecessary Medical Treatment.

Compassion & Choices invites you to submit your story about situations involving unwanted or unnecessary medical treatment.  

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Residents' Rights Month

Residents' Rights Month is an annual event designated by the Consumer Voice and is celebrated in October to honor residents living in all long-term care facilities, including nursing homes, sub-acute units, assisted living, board and care and retirement communities.



Residents’ Rights Month is a time for celebration and recognition offering an opportunity for every facility to focus on and celebrate awareness of dignity, respect and the value of each individual resident. The theme for Residents' Rights Month 2012 is, "My Voice, My Vote, My Right" with the goal of encouraging residents' right to vote and participation in the political process.



This year marks the 25th anniversary of the landmark Nursing Home Reform Law, which was enacted as part of the Omnibus Reconciliation Act (OBRA) of 1987. The Nursing Home Reform Law was the first comprehensive federal effort to promote and protect the rights of residents. Its passage guaranteed residents their individual rights in order to promote and maintain their dignity and autonomy in long-term care facilities.  



OBRA’s 25th anniversary is a great opportunity to bring much-needed attention to ongoing issues threatening residents’ quality of life and care. Despite the federal protections included in the Nursing Home Reform Law, it is still regrettably far too common for residents’ rights to be abused and disregarded in long-term care facilities.

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Legal Standards Become Medical Standards of Care

In Osborn v. Irwin Memorial Blood Bank, the California Court of Appeal confirmed that "professional prudence is defined by actual or accepted practice within a profession, rather than theories about what 'should' have been done."



In the medical futility context, this is a problem.  While clinicians judge that continued life-sustaining interventions are inappropriate, they continue them.  Since, legally speaking, actions speak louder than words, clinicians are creating the very standard of care that they do not want to comply with.



In this brief clip, Richard Anderson, the CEO of the Doctor's Company, the nation's largest medical malpractice insurance provider, explains how defensive medicine produces this result.

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Baby M - Treatment Case Ends, Criminal Case Begins

Litigation over Baby "M's" treatment is over.  The criminal case against her parents will continue.



Medical Background.  Baby “M” suffered cardiac arrest and as a result was hospitalized in a “persistent vegetative state,” completely dependent on a mechanical ventilator and feeding tube for her survival.



Procedural History.  On Wednesday, the Alberta Court of Appeal ruled that an earlier court decision permitting clinicians to take Baby "M" off life support could not be appealed.  The parents had argued the decision should be left to them and they could not agree to withdrawing life-support due to religious convictions and love for their daughter.  



Nevertheless, the Court of Appeal states that “the child’s condition is irreversible and no further medical intervention is warranted.”  On Thursday, a motion to the Supreme Court of Canada to stay the decision was denied.  Baby “M” was then taken off the ventilator. 



Funeral.  On Saturday, Baby "M"'s funeral was held at the Al-Rashid Mosque in Edmonton.  During the service, both parents — who are facing assault and negligence charges in the case — were escorted into and out of the building separately by sheriffs through the back door of the mosque. Both were in handcuffs and shackles.  (Edmonton Sun)



Criminal Charges.  The parents are charged with aggravated assault, criminal negligence causing bodily harm and failing to provide the necessities of life.  A pediatrician is quoted in court documents saying bruises on the girls were “clearly due to multiple impacts” and “cannot be explained by only one event.”  Police have said that M’s death could mean the charges will be upgraded to criminal negligence causing death or the more serious charge of manslaughter.  

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Suggested Members for IOM Committee on Transforming End-of-Life Care

The Institute of Medicine is searching for experts in the scientific, technical, and medical professions to be considered for a study committee titled “Committee on Transforming End-of-Life Care.”  Nominations are due Monday, September 24, 2012.  (Hint:  I would love to be nominated to participate with this.)  



The overall objective of the project is to advance policies to improve the care that individuals and families receive at the end of life through alignment with individual values and preferences and to stimulate a national conversation with individuals, families, and communities on improving the way we approach death. Specifically, the IOM committee will: review progress since the landmark 1997 IOM report Approaching Death: Improving Care at the End of Life, assess challenges and opportunities, and examine ways to integrate end-of-life care into a patient- and family-centered, team-based framework of health and community care; make recommendations about changes in public policy, health care financing, and clinical care to better align care with individual values and preferences and promote compassionate, high-quality, and cost-effective care at the end of life; and develop a communication strategy for promoting public information and engagement.

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Baby M - Appeals Court Affirms Ruling Allowing Removal of Life Support over Parents' Objections

On Friday, the Alberta Court of Queen's Bench agreed with doctors that it is in 2 1/2 year-old Baby M's best interest to be removed from machines keeping her alive and to be provided with palliative care.  That conclusion, based on a best interest analysis, was unaffected by the wishes of Baby M's parents or their Muslim beliefs.  The conclusion was only reinforced by the fact that the parents are charged with inflicting the very injuries that caused Baby M's vegetative state, indicating that their decisions on Baby M's behalf are probably not in her best interest.



Yesterday, the Alberta Court of Appeal upheld the Court of Queen's Bench order.  The Appeal Court also ruled that each parent will be allowed a separate final 20-minute visit with the girl, if Edmonton police have the resources to accompany them.  Today, the Supreme Court of Canada dismissed an appeal to that court. So, the Court of Queen's Bench order is now final.

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NEW Mary J. Labyak Institute for Innovation

The National Hospice and Palliative Care Organization (NHPCO) has created the Mary J. Labyak Institute for Innovation.  The Institute, which is named after the late hospice pioneer, Mary J. Labyak, is designed to continue her legacy of listening, learning and innovating.  The Institute is a part of the National Center for Care at the End of Life which also houses NHPCO and three affiliate organizations.

The Institute will develop and promote new strategies to ensure the best possible care of patients and families. The initial work of the Institute includes:

• Convening experts within the hospice and palliative care field and beyond to create new care models and practices


• Publishing articles, Continuum Briefings and other communications aimed at promoting and cultivating innovation


• Identifying, packaging and disseminating promising practices and innovative programs


• Infusing hospice values into the ongoing work of The National Center for Care at the End of Life and stakeholders

The Institute is comprised of 10 Centers that will work collaboratively to advance the care continuum through education, leadership, and resource dissemination. Each Center will determine gaps in practice, identify resources, and develop and disseminate tools to deliver the best possible care to patients and families. The 10 Centers are:

1. Children's Hospice and Palliative Care


2. Clinical Excellence


3. Consumer and Caregiver Engagement


4. Ethical Practice


5. Expanding the Continuum


6. Grief and Bereavement


7. Leadership Development


8. Organizational Excellence


9. Spiritual Care


10. Veterans' Care

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Talking about death brings end-of-life benefits (NBC News)

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

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End-of-Life Care after Terri Schiavo - Conference

This
Friday, September 21, 2012, Stetson Law School is hosting a conference, at
its downtown Tampa building, titled "End-of-Life Care after Terri
Schiavo."

The
conference includes perspectives from four, nationally-known speakers: (1) an
attorney involved in the Terri Schiavo case, (2) an award-winning novelist, (3) a
palliative care director at a leading hospital, and (4) a physician whose system for
predicting the survivability of near-drowning children has been cited as the
gold stand for such critical care.

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Seven Months to National Healthcare Decisions Day 2013

Today marks seven months to National Healthcare Decisions Day, April 16, 2013.  Resources remain available at www.nhdd.org

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Surrogate Decision Making in the Internet Age

The just-released October 2012 issue (12[10]) of the American Journal of Bioethics includes a target article and peer commentaries on surrogate decision making in the internet age.  I participated in this debate.  Here is the table of contents for this part of the issue:  



Surrogate Decision Making in the Internet Age

Jessica Berg

pages 28-33



Surrogate Decision Making 2.0: Digital Evidence as Clinical Testimony

Lance Wahlert

pages 34-36



A Disability Response to Surrogate Decision Making in the Internet Age

Teresa Blankmeyer Burke

pages 36-37



The Self, Social Media, and Social Construction

Meredith Stark & Joseph J. Fins

pages 38-39



Authenticating an Online Identity

Steve Matthews

pages 39-41



Claims About Surrogate Decision-Making Accuracy Require Empirical Evidence

Adam Feltz & Taylor Abt

pages 41-43



Facebook Can Improve Surrogate Decision Making

Thaddeus Mason Pope

pages 43-45



Social Media as a Contributor to Substituted Judgment: The Hazards Outweigh the Value

Nicholas Sadovnikoff & Martha Jurchak

pages 45-47



Are We Prepared for Surrogate Decision Making in the Internet Age?

Jessica A. Moore & Colleen M. Gallagher

pages 47-49



Status Update: The Complexities of the Internet Age Bring Urgency for Deliberately Making Advance Health Care Decision Wishes Known

Samantha Siess & Anne Moyer

pages 49-50



Considerations in Surrogate Decision Making in the Internet Age

Nancey Trevanian Tsai

page 51



Response to Open Peer Commentaries on “Surrogate Decision Making in the Internet Age”

Jessica Berg

pages W1-W2

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Alberta Court Orders Baby M's Life-Sustaining Treatment Stopped over Her Muslim Parents' Objections

Madam Justice J.M. Ross of Queens Bench Alberta has issued a 15-page decision in the Baby M case.  I have posted a copy here.  Summarizing the dispute, Justice Ross observed that the parents' position is that "as devout Muslims and loving parents, they find it 'unthinkable to agree to limit or withdraw medical treatment' and they ask that the court honour [their] beliefs."



But the court refused to honor the parents' beliefs, explaining that it could not do so "where their beliefs come into a fundamental conflict with [the child's] best interests."  Justice Ross concluded that "a life without awareness and totally supported by machines is not in accord with the best interests of any patient."  Therefore, "it is in [the child's] best interests that life-sustaining treatment be stopped."  

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Karen Okada - POA Contradicts Advance Directive

Karen Okada has been a patient at Hawaii's Queen's Medical Center since August 8, 2012.  Clinicians diagnosed her as being in a persistent vegetative state.  She has a 1998 advance directive stating that she does not want her dying "artificially prolonged."  But she also has a separate POA appointing her brother, and the brother does not want Karen's feeding tube removed.  The hospital petitioned Circuit Judge Patrick Border to order Karen's feeding tube removed in accordance with Karen's advance directive.  (Star Advertiser)



The judge said that he will probably not rule until late October.  The Hospital's attorney rightly noted that such a delay will give the surrogate exactly what he wants, since Karen may die before the court ruling.  The Hospital's attorney told the judge, "it's a fait accompli.  They've gotten whatever they need, whatever they wanted from the beginning."  This is often the result in futility disputes.  Judges typically order treatment to continue pending the outcome of the proceedings.  Since the proceedings take longer than the rest of the patient's life, the surrogates win de facto even though there is never an adjudication on the merits.



On August 15, the Queen's Ethics Committee found that "continuing to provide antibiotic treatment and nutritional supplementation is in violation of Ms. Okada's instructions . . . and such treatment should be discontinued."  I would like to look at the court papers, because I do not understand why the Hospital asked for permission from the court.  They should have just acted on the Ethics Committee determination.  Here are just four reasons:  





First, Hawaii Revised Statute § 663-1.7(b) provides: "There shall be no civil liability for "any acts done in the furtherance of the purpose for which the . . . ethics committee . . . was established."  The resolution of a surrogate-advance directive conflict is a core ethics committee function.  The Legislature determined that the HEC determination is sufficient.  The issue need not go to court.



Second,  Hawaii Revised Statute § 327E-9 provides immunity for "declining to comply with a health-care decision of a person based on a belief that the person then lacked authority."  Since the surrogate is contradicting express written instructions, the hospital has at least a "belief" that he is acting outside the scope of his authority.  They can and should just (politely) ignore him.    



Third, Hawaii Revised Statute § 327E-7(f) provides that "a health-care provider or institution may decline to comply with an individual instruction or health-care decision that requires medically ineffective health care or health care contrary to generally accepted health-care standards."  The hospital could ignore BOTH the advance directive AND the surrogate and just follow the recommended treatment plan, because any other plan would be inappropriate.



Fourth, Hawaii Revised Statute § 327E-9 provides immunity for complying with 327E-7(f).

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Baby M - Futility, Surrogate Religion, and COI

In many current and recent conflicts over the appropriateness of continuing life-sustaining medical treatment, the family's demand for continued treatment, contrary to clinician recommendations,t is grounded in Muslim religious beliefs.  



That is also true in the "Baby M" case at Stollery Children's Hospital in Edmonton.  But it sure seems like the Baby M case should be easier to resolve.  Since the parents are charged with inflicting the injuries that caused Baby M to be in a vegetative state, they are probably not (as I have argued in analogous cases) the best decision makers.  They likely do not have Baby M's "best interest" in mind, but may instead be concerned with their own exposure to increased criminal sanctions should Baby M die.  Court of Queen's Bench Justice June Ross is expected to issue her ruling later today.

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Childless and Aging: Designate an Agent or Risk Being Unbefriended

The New York Times highlights a growing concern, the childless and aging.  More people in the United States remain childless. In 2010, according to census data, nearly 19 percent of women age 40 to 44 had not given birth, compared with around 10 percent in 1980.  That is why it is important for people without children to set up a health care proxy that will enable someone to handle medical decisions and a power of attorney for someone to handle finances.  

Those without available family risk becoming "unbefriended" when they later lose decision making capacity due to illness or dementia.  As I explain in a recent series of articles, few states or healthcare systems have developed adequate mechanisms for taking care of unbefriended patients and residents. 

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Another Lawsuit over Unilateral DNAR Orders

I have blogged about several lawsuits (for example the David Tracey Case) by British patients against NHS hospitals in which clinicians placed a DNAR order in a patient's chart without consent.  Today's Guardian reports yet another one.



The unnamed family of patient "AWA" is bringing a legal challenge against a hospital in Kent where a doctor apparently decided staff should make no attempt to resuscitate the patient if he suffered cardiac or respiratory arrest, on the basis of his disability.  Lawyers for the family said a form added to the man's medical notes last September gave the reasons for no resuscitation as "Down's syndrome", "unable to swallow" (the man has a feeding tube in his stomach), "bedbound" and "learning difficulties".

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End-of-Life Care Is Improving (7min Video)

Here is a 7-minute video summarizing current challenges regarding end-of-life medical care.

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New IOM Committee on Transforming End-of-Life Care

During the last century and more, death has evolved from a common family event centered in the home to a medical event occurring in a distant medical facility overseen by trained experts and administrators. Coordinated, expert, compassionate care for people dying from chronic diseases continues to challenge the American health care system. The development of hospice was an early innovative response to these challenges, and a broader focus on palliative care to reduce pain and suffering during serious illness has emerged as another important response.



The IOM will conduct a consensus study that will produce a technical report on the current state of end-of-life care with respect to delivery of medical care and social support; patient-family-provider communication of values and preferences; advance care planning; health care financing and reimbursement; and education of health professionals, patients and their loved ones. The study will also explore approaches to advance the field. Specifically, the committee will:

• Review progress since the landmark 1997 IOM report Approaching Death: Improving Care at the End of Life, assess challenges and opportunities, and evaluate strategies to integrate end-of-life care into a person-centered, team-based framework. Demographic and cultural changes will be considered as will advances in technology that affect the provision of care in different settings, most notably in the home. Families are increasingly recognized as a vital component of the healthcare team, and the financial and other ramifications for families and society will be considered;


• Develop recommendations for changes in policy, financing and clinical care that will align care with individual values and preferences and promote high-quality, cost-effective care at the end of life; and


• Develop a dissemination and communication strategy to promote public engagement and understanding. This strategy will need to consider the fears and anxieties surrounding aging and death and cultural diversity in values and preferences. 

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American Health Lawyers Association Offers New ADR Training Opportunities

The American Health Lawyers Association is coming to Minnesota to offer a new and innovative training program. And AHLA is offering this program in partnership with Hamline University School of Law, a national leader in dispute resolution and health law. 



The arbitration and mediation training courses begin on October 19, 2012 at the Hamline University Executive Training Center. Both courses are multi-day and highly interactive. Learn how to acquire the knowledge and skills to arbitrate or mediate a health law dispute effectively and ethically from start to finish from a faculty of top flight neutrals. 

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Lawyer Kills Father with Forged Advance Directive

Yesterday, a grand jury indictment in Kansas City was unsealed.  It alleges that Susan Elizabeth “Liz” Van Note, a Kansas estate planning attorney, forged her father’s name to an advance directive.



In 2010, William Van Note was shot and stabbed in his home.  Liz soon showed up at the hospital in Boonville, Missouri with an advance directive stating that her father did not want prolonged treatment to keep him alive.  Accordingly, doctors and nurses stopped their life-saving efforts, and William died Oct. 6, 2010.  (Kansas City Star)



This criminal case has some interesting parallels to Minneapolis' Albert Barnes guardianship case.  That 2011 case also involving a forged advance directive, received significant media coverage.  But the Van Note case is far more serious.  First, the Barnes advance directive was altered to indicate a patient preference to continue treatment.  Here, the advance directive was forged to indicate a patient preference to stop treatment.  Second, the Van Note daughter is also alleged to have committed the underlying shooting and stabbing.

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The Least Bad Death: Who Decides?

Boston University's ninth annual Pike lecture will feature keynote speaker Marcia Angell, MD, senior lecturer in global health and social medicine at Harvard Medical School, and editor-in-chief, emerita, New England Journal of Medicine. Dr. Angell will discuss the initiative petition on the November 2012 ballot (question two), which would legalize physician-prescribed end-of-life drugs for terminally ill patients with a prognosis of six months or less. 

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Cultural Perspectives on the End of Life (Exhibit)

The Salem Multicultural Institute just opened an End of Life exhibit in its World Beat Gallery.  It focuses on the process of dying from a cultural perspective. The three cultures highlighted are Hispanic, Russian Old Believer and Micronesian.

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I will be speaking at this symposium in New York City, in November.

Symposium: Freedom of Choice at the End of Life
Patient’s Rights in a Shifting Legal Landscape

A Justice Action Center Symposium
Friday, November 16, 2012
New York Law School

Cosponsored with the New York Law School Law Review and the Diane Abbey Law Center for Children and Families

Additional support provided by the American Bar Association Commission on Law and Aging; the National Academy of Elder Law Attorneys; the Elder Law Section of the New York State Bar Association; Compassion and Choices of New York; and Collaborative for Palliative Care, Westchester/NYS Southern Region

More than 13% of all Americans are over 65 years of age; 2% are 85 or older. By 2050 20% of the population will be over 65 and 5% will be over 85. 50% of the over-85 cohort is unable to perform activities of daily living. Of total Medicare expenditures, 25% are for costs in the last 6 months of life.

The concept that individuals have the right to choose the manner and time of their death and the right to decline unwanted treatment has been a relatively recent development, as is the law that a person does not lose these rights upon incapacity. Individual rights are not uniformly recognized in practice, however, and there are many limits on when and how they can be enforced. This conference will address a broad range of issues including impediments to honoring those rights, advance planning tools for persons to ensure compliance with their choices and how to enforce them, legislative and decisional developments, surrogate decision-making for patients whose wishes are not known, pain management and palliative care, hospice, aid in dying, ethical dilemmas in decision making, medical ineffectiveness of treatment (“futility”), concerns of persons with disabilities, the effect of religion on law and policy, and how the media treats these issues.

CONTINUING LEGAL EDUCATION

This program has been approved for a maximum of [] credits of continuing legal education in professional practice for both transitional and non-transitional attorneys. There is no charge for CLE.

REGISTRATION

Conference registration is $50.

CONFERENCE SCHEDULE

[Unless otherwise noted, all events will take place in the Auditorium, Room WA14]

8:15am–9:00am
Registration and Continental Breakfast

9:00am–9:45am
Welcome Remarks and Keynote

Kathryn Tucker, Esq., General Counsel of Compassion & Choices, Inc., will discuss the movement to protect and expand the rights of the terminally ill over the past twenty years, provide an overview of the issues and current state of law and policy, discuss progress and setbacks, and offer thoughts about how these issues will be dealt with in the future.


9:45am–11:00am

Panel Discussion: Taking Control and Preserving Autonomy

Moderator: Peter J. Strauss

• Nadia N. Sawicki, Assistant Professor, Loyola Chicago School of Law; 2003-2009, George Sharswood Fellow in Law and Bioethics, University of Pennsylvania Law School


• Lisa Comeau, Esq., appellate counsel for the patient’s family in Cronin v. Jamaica hospital Medical Center, 60 AD3d 803 (App. Div. 3d Dep’t 2009) a New York lawsuit where the court described the plaintiff as seeking damages for “wrongfully prolonging the decedent’s life by resuscitating him against the express instructions of decedent and his family.”


• David C. Leven, Esq., Executive Director, Compassion & Choices of New York Mary Beth Morrissey, Esq., Ph.D, M.P.H.; President, Collaborative for Palliative Care, Westchester/NYS Southern Region

11:15am–1:00pm
Panel I: Real-Time Critical Issues

• David Muller, M.D., Professor of Medicine and Dean for Medical Education, Mt. Sinai School of Medicine, New York, New York; Director, Visiting Doctors Program


• Gabrielle Goldberg, M.D., Assistant Professor, Geriatrics and Palliative Medicine, Mt. Sinai School of Medicine, New York, New York; Education Director, Hertzberg Palliative Care Institute


• Thaddeus Mason Pope, J.D., Ph.D., Director, Health Law Institute and Associate Professor of Law, Hamline University School of Law


• Bonnie Steinbock, Ph.D., Professor of Philosophy, State University at Albany; founding faculty member, Union Graduate College-Mt. Sinai Bioethics program


• Paul T. Menzel, Professor Emeritus of Philosophy, Pacific Lutheran University

1:00pm–2:15pm
Lunch Keynote

Hon Sol Wachtler, former Chief Judge, New York State Court of Appeals, author of the opinions in Matter of Eichner and Matter of Storar (1981) and Matter of O’Connor (1988), decisions which established New York law with respect to end-of-life decisions for persons who lacked capacity. Judge Wachtler will address the thinking of the court in those early years and his thoughts on the state of the law today.

2:15pm–4:15pm
Panel II: Special People, Special Issues

• Alicia Ouellette, Associate Dean for Student Affairs and Professor of Law, Albany Law school; Professor of Bioethics at Union Graduate College/Mt. Sinai School of Medicine Program in Bioethics


• Rev. Dr. Martha R. Jacobs, B.C.C., Sabatical Pastor – Briarcliff Congregational Church, Briarcliff Manor, N.Y., Author, A Clergy Guide to End of Life Issues, Blogger, The Huffington Post, Coordinator and Adjunct Professor, Doctor of Ministry in Pastoral Care, New York Teological Seminary


• Ann Neumann, Editor, The Revealer,New York University’s Center for Religion and Media; Otherspoon, a blog about religion and end of life care


• Hon. Brian Fischer, Commissioner, New York State Department of Corrections


• Carl J. Koenigsman, M.D., Deputy Commissioner and Chief Medical Officer, New York State Department of Corrections

4:15pm–4:45pm
Plenary Session: How the Media Affects Policy and Individual Rights, from Schiavo to Death Squads

Sherrie Dulworth, R.N., executive healthcare management consultant, Master’s candidate at the Columbia University Graduate School of Journalism

4:45pm–5:00pm
Closing Remarks

5:00pm–5:45pm
Reception

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Medical Futility Blog - 300,000 Pageviews

I see that the blog odometer is rolling past 300,000 pageviews today.  And that probably under-represents the reach and readership.  Among other things, the full content of this blog has been republished on both Medpedia and WellSphere.

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New York State Bar Promoting Advance Directives

A series of New York State Bar Association radio announcements on on the importance of designating a health care agent hit airwaves across upstate New York this week.  



State Bar Association President Seymour W. James, Jr. (The Legal Aid Society in New York City) narrates the spots that inform the public about the free, valuable information available on the Association's website.  Each topic is recorded in 30-second (MP3) and 60-second versions (MP3). The radio spots will air from September 3 through 30.



Here is the script for one the radio announcements:

I'm Seymour James, President of the New York State Bar Association.  We can't reverse the aging process or predict unexpected injuries or illness. But we can prepare for these possibilities by planning for the future. In New York State, you can name a person you trust to make medical decisions for you if you become ill or injured and are unab le to communicate your wishes, by appointing a health care agent. It's unpleasant to think ab out the possibility of a serious illness or injury, and can be hard to have these conversations. But designating a health care proxy can give you peace of mind. It can assure that your wishes will be respected, and that your loved ones will not face the stress of determining who should make medical decisions on your behalf.  The health care proxy form is easy to complete and you can find it, free of charge, on our web site, www.nysba.org.  That's www.nysba.org.  Brought to you b y the New York State Bar Association, in cooperation with the New York State Broadcasters Association.

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Medical Miracles and End-of-Life Treatment Conflict

Kate Scannell has another great Bay-Area op-ed titled "Grappling with the Miracles of Modern Medicine."  She describes a patient of hers who woke up after all had considered him dead.  She then juxtaposes this case with the new study in the Journal of Medical Ethics in which British researchers asked whether doctors -- against their professional judgment -- should be obligated to provide intensive medical care to terminally ill children when parents demanded it, based on their religious beliefs in divine intervention or miraculous recovery.



Scannell observes:  "Doctors care about this issue because it deeply matters how their judgments and actions affect the lives of vulnerable patients and families. When they feel coerced into delivering useless or harmful care, it can feel professionally corrupting and morally disturbing."



And echoing some of the points that Doug White and I made in our JAMA piece earlier this year, Scannell writes: "Talk about using the courts to settle disagreements about medical care seems to be gaining steam. In the U.S., we're witnessing resurgent interest in devising hospital "futility" or "nonbeneficial treatment" policies that delineate a mechanism by which final decision-making authority is granted to doctors or hospital designees -- usually without patient or public involvement. . . . courts can offer patients and doctors a mechanism that allows the facts of an intractable dispute to be aired in broad daylight, under insightful legal consideration. The adjudicated cases could propose rules for everyone to follow and help to minimize future conflicts."

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