Art Caplan: "Little Hope of Medical Futility"

In the November 2012 issue of the Mayo Clinic Proceedings, Art Caplan finds that "the future of futility assessment, as well as downstream actions based on those assessments, looks bleak."  "Battling to get recognition for futility policies does not hold much promise of resolving the hardest battles at the bedside.  Improving how we communicate about course of care does."  Caplan rightly urges that our energies are better...

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California Health Care Decisions Week

This week, October 28 to November 3, is California Health Care Decisions Week, during which Californians should think about and plan for the types of treatment they would want if they become seriously ill. A poll released earlier this year from the California Health Care Foundation found that more than half of Californians said they have not talked with a loved one about the kind of care they want at the end of life. Additionally, nearly 8 in 10 Californians said that if they were seriously ill, they would want to speak with their doctor about...

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Fostering Improvement in End-of-Life Decision Science (FIELDS) Program

The Fostering Improvement in End-of-Life Decision Science (FIELDS) Program was launched in 2012 by Dr. Scott Halpern of the Perelman School of Medicine at the University of Pennsylvania with support from the Otto Haas Charitable Trust. The FIELDS Program's core goals are to understand and improve upon the ways in which end-of-life decisions are made.  We believe that end-of-life decisions often are influenced by "choice architecture" - that is, the ways in which choices are presented and the environments in which decisions are made. Rather...

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

In 1988, the Richard and Hinda Rosenthal Foundation established a lecture series at the Institute of Medicine to bring to greater attention some of the critical health policy issues facing our country today.  The 2012 Rosenthal Lecture will focus on how the language of the entertainment arts informs our cultural understanding of end-of-life care. It will be at 5:00 p.m., on December 12, 2012, at the National Academy of Sciences Building Auditorium, 2101 Constitution Avenue, NW, Washington, DC 20418.Through the screening of clips from...

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Another Call for Physician Transparency about Incurable Cancer

Many patients who receive chemotherapy for incurable cancers still believe they can beat the disease, a new study in this week's New England Journal of Medicine suggests. The researchers behind the study question if patients are simply in denial or doctors are skirting the truth with their patients' prognos...

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Guidance for Healthcare Ethics Committees

Last Saturday at the ASBH Annual Meeting, I enjoyed the "meet the author" session for Cambridge University Press' new Guidance for Healthcare Ethics Committees.  This is great little primer on core procedural and substantive issues that ethics committees face.  Thousands of hospitals, long-term care facilities, and others should get copies for their committee members.  But I want to echo one of Jessica Berg's critical (though...

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Palliative Paternalism

Palliative paternalism.  I really like this term and wish I had coined it.  But a group of UC-San Diego palliative care clinicians beat me to it.  At the March 2013 meeting of the American Academy of Hospice and Palliative Medicine, they will introduce and define "palliative paternalism," and discuss its role in patient care. The presenters explain that "autonomy is the current 'gold standard' approach to patient communication and has grown to the point that patient choice dictates care even when the choices are not...

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Not Only The Doctor's Dilemma: The Complexity of Conscience in Medicine

Faulkner University Law School is hosting an interesting law review symposium tomorrow:  "Not Only The Doctor's Dilemma: The Complexity of Conscience in Medicine."  It will be webcast. &nb...

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Freedom of Choice at the End of Life Patients' Rights in a Shifting Legal and Political Landscape

I am excited about this upcoming conference at New York Law School:  "Symposium: Freedom of Choice at the End of Life Patients' Rights in a Shifting Legal and Political Landscape."  Not Dead Yet just posted a very strong post attacking the biased composition of the presenters.  But I really like the diverse composition, including: legal academics, philosophy academics, judges, palliative care professionals, clergy, state government officia...

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Dorsey v. Chicago Mercy Hospital - NIED for Erroneous Declaration of Death

Last Thursday, Chicago parents Sheena Lane and Pink Dorsey filed a lawsuit against Mercy Hospital Thursday alleging that clinicians declared  their 8-year-old son, Jaylen dead when he was actually still alive. The lawsuit is for negligent infliction of emotional distress.  While not apparently a DCD case, the spontaneous return of heart function does throw some shorter protocols into question. View more videos at: http://nbcchicago.c...

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2013 Revisions to the Texas Futility Law?

The 2013 biannual Texas legislative session is just over two months away.  So, the Texas Hospital Association has released a two-page summary of talking points for the session.  Included, along with with issues like Medicaid and insurance reform, are three paragraphs on the Texas Advance Directives Act:Texas has addressed end-of-life care issues very comprehensively, and state law includes protections for patients as well as physicians...

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Physician Criminally Convicted for Unilateral DNR Order

Yesterday, a Dubai court convicted Dr. EugenAdelsmayr of premeditated murder and sentenced him to life in prison after hegave orders to switch off a patient's life support.  Prosecutors had originally sought a death sentence for the physician.  (News24)  (The National)Adelsmayr, chief medic at the Rashid governmenthospital intensive care unit, "allowed a quadriplegic patient, GhulamMohammed, to die after (he) shut down his life support...

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Michigan Legislation to Require Disclosure of Medical Futility Policies

In April, I described proposed legislation in Minnesota that would have required hospitals to disclose the existence and content of institutional futility policies.  Along very similar lines, a few days ago, Michigan introduced SB 1343, the Medical Good-Faith Provisions Act.Basically, the bill would amend the Michigan Public Health code to require: "a health facility or agency that maintains a medical futility policythat applies to the treatment of a patient from birth to 18 years of age shall,upon request, provide a copy of that medical futility...

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Desmond Watson v. Oakville-Trafalgar Memorial Hospital

A year and one-half ago, I blogged about the CCB decision in the Desmond Watson case.  On Friday, the Robert Cribb published yet another lengthy discussion of end-of-life treatment conflicts in the Toronto Star.  he used Desmond's case -- he is still a patient at Oakville-Trafalgar Memorial Hospital --  as a central vehicle to illustrate the issu...

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Minnesota Supreme Court Takes Assisted Suicide Case

The Minnesota Supreme Court has agreed to hear the appeal of a former nurse convicted of searching out suicidal people in online chat rooms and encouraging them to commit suicide.William Melchert-Dinkel was convicted in 2011 on two counts of aiding suicide. The Minnesota Court of Appeals in July rejected his argument that he was merely practicing free speech.&nb...

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Minnesota Guardians Cannot Consent to Withdrawal of Life Support

Minnesota Guardians cannot order their wards removed from life support.  (Star Tribune)  In an 18-page order, Hennepin County District Judge Jay Quam wrote that although guardians have a strong case to make end-of-life decisions under a state law that grants them power to allow or withhold medical care, it does not specifically allow them to terminate life support. Until the state Legislature decides to revisit the issue, only a judge or legally authorized representatives can order life support removed.  In the underlying case,...

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Nuffield Trust: "Understanding patterns of health and social care at the end of life"

The Nuffield Trust has just published a new Report: "Understanding Patterns of Health and Social Care at the End of Life."  The Report draws on information from seven different local authority areas across England, comprising a total population of more than three million people. Using this data, the authors were able to describe the uptake and costs of key health and social care services for people in the last 12 months of life.The researchers found that the use of social care at the end of life varied between conditions (for example...

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American Nurses Association Requests Comments on "Active Euthanasia and Assisted Suicide"

The American Nurses Association Department of Nursing Practiceand Policy is requesting public comment on the document "Active Euthanasiaand Assisted Suicide.” The purpose of this draft position statement is toaddress both topics to more clearly define what differentiates assisted suicidefrom active euthanasia and the nurse’s ethical obligations to the patient andthe profession as outlined in the ANACode of Ethics for Nurses with Interpretive Statements.ANA is seeking comments of nurses, nursing students, andstakeholders on this draft position...

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The Real Truth About Death Panels: Comparative Effectiveness Research and the Health Reform Legislation

Distinguished health law professor Eleanor Kinney has published a speech that she delivered, last year, at Oklahoma City University Law School, titled "The Real Truth About Death Panels: Comparative Effectiveness Research and the Health Reform Legislation."  Here is her abstract:The current debate over health reform has been intense and highly polarizing. In 2009, it was dominated by a brouhaha over death panels and talk of government rationing and domination of health care. I will begin my remarks by addressing the provisions of the...

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How Much Are You Willing to Pay to Live Longer?

A new Singapore survey shows that people are willing to pay $24,000 a year to relieve severe pain, but only $9,100 to prolong life for another 12 months. In presenting the findings at a Lien Centre for Palliative Care conference on Wednesday, Dr Chetna Malhotra said what people value has implications on where government subsidies should go.  She asked: "Does it make sense for the Government to pay for expensive therapies to extend...

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Futility at ASBH Meeting this Weekend

I am heading to Washington, DC, this morning, for the ASBH Annual Meeting.  Here are six sessions that I will be sure to attend.Thursday, 1:00p-2:30pTop 10 Legal Developments in Bioethics (105)Friday, 11:30a-12:30pLaw Affinity GroupFriday, 2:45p-3:45pFutility in the ICU: ACCCM & ATS Guidelines (225) Saturday 8:00a-9:00aICU and EOL (304)Saturday, 1:45p-2:45pHEC Guidance (304)Sunday, 8:30a-9:30aPrescribing Hope when Treatments are 'Hopeless' (4...

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Olive Goom - British Clinicians Again Fail to Consult Family over End-of-Life Care

Olive Goom died at Chelsea and Westminster Hospital in March 2011.  Olive's niece, Marion Hebbourne, said that she was only told of the death when she went to visit her aunt and that she was "shocked" nobody in the family was consulted about Miss Goom being put on a palliative care plan.  The hospital said it was "very sorry for the distress caused."  (BBC News)  A statement from the hospital said: "Chelsea and Westminster...

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NHS Rationing – A Neutral Guide

British barrister David Lock, QC has launched a new blog called "NHS Rationing."  The aim of his website is to give independent information and general advice on the issue of rationing of drugs and other treatments within the N...

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Health Law Institute Annual Report

When I am not speaking or writing about end-of-life issues, I am teaching classes and organizing programming at Hamline University's Health Law Institute.  For a summary of our various activities and accomplishments in 2011-2012, please take a look at our new annual report. &nb...

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Flockhart v. Basildon Hospital: Yet Another Unilateral DNR Order in England

John Flockhart was admitted to Basildon Hospital on November 26, 2008, with severe pneumonia.  Dr. Riz Mohamed soon issued a “do not resuscitate order” for Mr Flockhart, on the basis that should he go into cardiac arrest, attempts to resuscitate him would be “futile.”  Despite guidance suggesting it is appropriate to inform the patient, or his family, neither was done. Later that night Mr Flockhart’s condition deteriorated.  When Mr. Flockhart's was then informed about the order, she begged” the hospital to overturn...

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India to Allow Passive Euthanasia?

The Law Commission of India has delivered its Report No. 241 to the Government.  In this Report, the Law Commission defends passive euthanasia and proposes authorizing legislation.The report notes that passive euthanasia "is allowed in many countries [and] shall have legal recognition in our country too subject to certain safeguards."  "A competent adult patient has the right to insist that there should be no invasive medical treatment...

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Missed Opportunity to Avoid a Futility Conflict

Check out minute 12:00 in this PBS film. UCLA ICU physician Ravi Aysola has a critically ill patient. If this patient arrests, the chance that CPR will restore the patient to a functioning level is less than 1%. But the family does not consent to the DNR order. I realize that the PBS film captures only a piece of the physician-family interaction. But, unfortunately, it looks like the family does not really understand what they are being asked.  Watch Money & Medicine on PBS. See more from Need To Kn...

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UCLA Health President Feinberg on Futility

UCLA Health System President David Feinberg was part of PBS' recent Money and Medicine film.  At one point, he seems to accurately describe the law on medical futility in California (and most states):The family wants everything done.  The way the system is set up currently, that spouse, that child, that parent can really demand a full court press, regardless of what the odds are.Yet, as the PBS program proceeds, we learn that UCLA, through...

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RATION END-OF-LIFE CARE: A DEBATE AT CHICAGO IDEAS WEEK

Debate: Should the United States Ration End-of-Life Care? from Intelligence Squared U.S. Debates on FORA...

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Conversations with Linda Emanuel

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Minnesota Advance Directives

Today, on WCCO, on the John Hines show.For more on Minnesota advance care planning, come to listen to national and regional experts in law, medicine, social work, and other fields.  Hamline University in Saint Paul on November 9, 2012.  More information is available he...

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Voicing My Choices - Advance Care Planning for Adolescents

Aging with Dignity, the creator and distributor of the nationally-known "Five Wishes" advance directive, today introduced "Voicing My Choices," the nation's first advance care planning guide specifically designed for adolescents and young adults.The new document was created based on findings from researchers at the National Institutes of Health (NIH).  The multi-year study was directed by Lori Wiener, Head of the Pediatric Psychosocial Support...

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VSED–VRFF: The Barbara Grainger Case

75-year-old Barbara Grainger was diagnosed with motor neurone diseasein 2008.  She decided that, life with the disease would, for her, be intolerable.  Barbara had hoped for a quick and pain-freedeath with lethal drugs in Switzerland.  Butthe disease progressed so rapidly that she lost her ability to swallow beforeher family could finalize arrangements.  (Belfast Telegraph)So, Barbara instead opted for voluntarily stopping eating and drinking (VSED)also known as voluntary refusal of food and fluids (VRFF).  Unfortunately,...

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Mr. L - Clinicians Can Write DNR order over Muslim Family Objections

Several weeks ago, I referred to Mr. L. as a "British Mr. Rasouli."  Similar to the Canadian case, doctors argued it would be unfair to resuscitate Mr L, if his condition worsened.  And Mr. L.'s family said that was against their Muslim faith, which requires that everything to be done to prolong life "until God takes it away."  (BBC)Today, at the Court of Protection, Mr Justice Moylan said it would be lawful to withhold treatment as it would not prolong life "in any meaningful way."  "It would result in death being characterized...

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ICU Resource Allocation in the New Millennium - Will We Say "No"?

Here is a new anthology worth checking out:  ICUResource Allocation in the New Millennium - Will We Say "No"? (Springer 2013).Intensive care medicine is one of the fastest growing services providedby hospitals and perhaps one of the most expensive.  Yet in response tothe global financial crisis of the last few years, healthcare funding isslowing or decreasing throughout the world. How we manage health care resources in the...

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Grace Lee - Appellate Court Denies Stay

I was pleased to see that,contrary to my earlier prediction, the Appellate Division of the New YorkSupreme Court ruled today [Decision and Order inPDF] that it would not stay the Nassau County trial court's denial of the parent's guardianship petition in the Grace Lee case.In other words, while the appeal has not yet been briefed, heard, or decided;the court will not order that the patient be kept alive pending the outcome of that appeal.  North Shore Hospital can nowremove the ventilator that has been keeping 28-year-old woman aliveagainst...

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Sungeun Grace Lee - Parents Refuse To Take Daughter Off Life Support, Despite Her Pleas

It sounds like the parents are pursuing futile court options, not because they really believe that they have any chance of success.  Rather, they are pursuing guardianship to delay the hospital's ability to comply with the patient's (competent) instructions.  Just as in futility cases, the temporary injunction itself, pending an outcome on the merits, can get the family exactly what they want.  The parents do not need to win their case.  The mere cumbersomeness and slowness of litigation may mean continued treatment for as long...

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Parents Ask NY Court to Override Competent Daughter's Decision to Refuse Treatment

She is paralyzed from the neck down, tethered to breathing and feeding tubes.  But Manhattan bank manager Grace Sung Eun Lee still managed to mouth four words Wednesday:  “I want to die.”  Doctors at Long Island's North Shore University Hospital are trying to honor Lee’s wish, but her devout parents believe that removing the tubes is suicide, a sin that would condemn the 28-year-old to hell.  (NY Daily News; Daily Mail)In...

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Susan Van Note - Murder via Forged Advance Directive

The criminal case against Liz Van Note about which I wrote three weeks ago, has now been getting worldwide covera...

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Rasouli - Medical Futility and Physician Power

Robert Cribb has a superb and detailedarticle on the Rasouli case in Friday's Toronto Star.  Among otherinteresting observations, Sunnybrook is apparently far more willing to stand upto surrogates than are other Toronto hospitals.While Cribb doesnot note it, this is borne out by the several recent cases in which Sunnybrook (allegedly) acted unilaterally and did not seek consent through the CCB process.  Three cases other than Rasouli areMan Kee LiDeGuerre / Wawrzyniak (lawsuit for damages)DeGuerre / Wawrzyniak (licensure/registration...

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NY Lawsuit Charges Deaths Hastened to Procure Organs

Three years ago, Dr. Hootan Roozrokh was acquitted of hastening a patient's death in order to procure his organs.  I have written about other cases in Pennsylvania, Florida and elsewhere.  Now, there is a new case in New York City.  Patrick McMahon, a former transplant coordinator,for the New York Organ Donor Network alleges that NYODN pressured hospital staffers to declare patients brain dead so their body parts could be harvested....

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Karen Okada: Resolving Conflict between Surrogate and Advance Directive

Afew weeks ago, I wrotea post about the ongoingKaren Okada case in Hawaii.  This 95-year-old woman expressed in her 1998written advance directive not to have her dying “artificially prolonged.” Last month, Mrs. Okada suffered the latest in a series of medicalcrises.  Her doctors at The Queen’sMedical Center determined she was beyond recovery and recommended removingher feeding tube.  But at the same time she documented her wishes,Mrs. Okada also appointed her brother as her health care proxy.  He...

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Pediatric Bioethics Debate Series

Check out this fantastic Pediatric Bioethics Debate Series at Children’s Mercy Bioethics Center.  I am delighted to be a part of it.Tuesday, October 2, 2012 Is Neonatal Euthanasia ever Morally Defensible?Eduard Verhagen, JD, MDNeonatologist and Clinical Director of Pediatrics, Department of Pediatrics, University Medical Center Groningen, NetherlandsBrian Carter, MDProfessor of Pediatrics, University of Missouri-Kansas City; Bioethics Center and Section of Neonatology, Children’s Mercy Hospitals and ClinicsTuesday, November 27, 2012 Is...

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