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...

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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...

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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...

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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...

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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...

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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...

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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...

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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...

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"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...

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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...

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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...

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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...

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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...

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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...

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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...

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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...

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Rasouli Daughter on CTV News

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

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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...

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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...

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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...

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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...

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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....

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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...

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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...

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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...

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Thanksgiving & Advance Care Planning

Thanksgiving is a classic time to do some advance care planning. When family and friends gather around a table and share a holiday meal, they also get a chance to share how much they care for one another. The holidays are also a great time to talk with your family and those you love about your healthcare decisions before a serious illness. When the discussion is framed in terms of family love, comfort and dignity, a difficult topic is much easier to talk about.Aging with Dignity suggests two things you can do during this week before Thanksgiving:1)...

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Death: A Self-portrait

Tomorrow, the Wellcome Collection opens a new exhibition titled "Death" A Self-portrait."  This exhibition showcases some 300 works from a unique collection devoted to the iconography of death and our complex and contradictory attitudes towards it. Here is a sample print and a description from the catalog:Assembled by Richard Harris, a former antique print dealer based in Chicago, the collection is spectacularly diverse, including art works,...

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The Medical Profession's Expectation of Deference

This phrase from Graeme Archer, a few days ago, in the Telegraph, resonated with me:  "What doesn’t help is the attitude of the medical profession, which retains an expectation of deference, as though we haven’t seen scandal after scandal about patient care . . ....

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Vegetative Patients Can Communicate

Scott Routley suffered a severebrain injury in a car accident 12 years ago.  He had been diagnosed with a persistent vegetative state.  But Professor Adrian Owenat the Brain and Mind Institute, University of Western Ontario (formerly at Cambridge) recentlyconcluded that Scott was clearlynot vegetative.  (BBC News)  Dr. Owenasked Scott questions while having his brain activity scanned in an fMRImachine.  "Scott...

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End of Life Care Planning In Minnesota: Issues and Complications

Tomorrow, at the University of Minnesota - Duluth, BarbaraElliot will present "End of Life Care Planningin Minnesota: Issues and Complications"Dr. Elliot will speakabout various complications regarding end-of-life planning in theNorthland.  In particular, she will focus upon, POLST (Physician Ordersfor Life-Sustaining Treatment), DNR (Do Not Resuscitate) orders, AdvanceDirectives and Proxy Consent. BarbaraElliott is Professor...

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The Honorable John "Jack" Louis Coffey

The judge for whom I clerked on the U.S. Court of Appeals for the Seventh Circuit during the 1999-2000 term, the Honorable John "Jack" Louis Coffey, died on Saturday.  Here is an excerpt from his obituary.Jack and his nine siblings earned degrees from Marquette University. He served for the U.S. Navy during World War II and then matriculated to Marquette University Law School, which led to his lifelong career in the legal profession. Jack's 58 years on the bench began with elected judicial positions on the Milwaukee Municipal Court, Circuit...

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University of Minnesota Futility Policy

Today marks the one-year anniversary of the University of Minnesota Medical Center's adoption of a non-beneficial treatment policy.  I understand that UMMC had four cases in the policy's first ye...

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Minnesota Mini Bioethics Academy 2012

This Monday, from  6:30 to 8:30 p.m., is the first of three sessions in the University of Minnesota's "Mini Bioethics Academy 2012."  The sessions will be in the St. Paul Student Center’s Cherrywood Room, 2017 Buford Avenue, St. Paul, MN 55108. November 12“Genes for a Better Life: Why Leave Your Happiness to Chance?”John Song, MD, MPH, MAT, Associate Professor, Center for Bioethics; and Department of Medicine, University of Minnesota Medical SchoolKnowledge of the human genome and one’s own genes brings great promise to...

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Joni and Friends

Inspiring and uplifting.  This made my weeke...

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Jacobs v. CORE - Settled for over $1 Million

In2009, I described a unique lawsuit: MichaelJacobs v. The Center for Organ Recovery & Education; Jonathan Coleman; TheHamot Medical Center Of The City Of Erie, Pennsylvania; William R. Phelps,M.D.; Peter Pahapill, M.D.; Jeffrey Bednarski, M.D.; Roberto Lopez, M.D.; RuyCruz, M.D.; Emergycare, Inc., NO. 1:09-CV-00048 (W.D. Pa. filed Mar. 4,2009).This is a case inwhich a high school student suffered a serious head injury while skiing. Hisparents allege all sorts of medical malpractice from many different providers.But most notably,...

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Death by Joy

DEATH BY JOY isan escorted journey to the next world. Your guide is Mary, a quirky, selfless,funny, and irrepressible fifty-five-year-old who is told she will be dead inweeks without aggressive medical intervention.ButMary chooses to forgo that route. The physical has a time and place; whatmatters more to Mary is that essence—call it awareness, spirit, soul, innerbeing—that she believes carries into the life beyond.  Andso Mary embarks...

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Elder Law Mediation (Dec. 18 in Minneapolis)

I plan to attend this two-hour CLE in Minneapolis on December 18:  Elder Law Mediation.  Here is the description:There is growing interest in the field of elder law mediation. When disputes arise involving elders’ living situation, medical care, assistance with activities of daily living, and/or finances, it is often in everyone’s interest to resolve these issues without resort to the courts. On the other hand, for the elders involved, their lives, rights, and well-being are at stake. How can elders’ interests be protected, family and...

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

I am pleased with the symposium that I organized today:  Legal, Medical, and Ethical Issues in Minnesota End-of-Life Care.  The 200 participants and I were lucky to have such expert, energetic, and delightful presenters on topics such as POLST, surrogate decisions, guardianship. the unbefriended, medical futility, and aid-in-dying.  Those presenters included:Bud Hammes, Ph.D., Director, Medical Humanities and Respecting Choices Gundersen Lutheran Health System; Chair, National POLST Paradigm Task Force; Vice President, International...

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Top 10 Legal Developments in Bioethics

I have posted an MP3 recording of the 2012 ASBH Annual Meeting 90-minute panel session, Top 10 Legal Developments in Bioethics.  It was a pleasure to work on this panel with co-panelists Art Derse, Amy Campbell, and Alicia Ouellette.  My 10 minute update on medical futility begins at about the one hour ma...

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Slow Codes, Show Codes, and No-codes in Neonatal Intensive Care

Children’s Mercy Bioethics will have its second in a series of live webinar debates about hot topics in pediatric bioethics, on Thursday, Nov. 29, from 12-1, Central Time:  Slow Codes, Show Codes, and No-codes in Neonatal Intensive Care.Every NICU or PICU doctor has faced the following situation:  A baby is dying, slowly, of multisystem organ failure.  The family insists that everything be done and will not agree to a DNR order.  The doctors, nurses, chaplains and social workers have tried explaining the situation.  The...

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Consent to Treatment: A Practical Guide, Fourth Edition

I just noticed that the Fourth Edition of Consent to Treatment: A Practical Guide is out.Described as "the Bible" on consent by health lawyers and risk managers, the 1500-page Consent to Treatment has been cited in over 90 law review articles and 20 court decisions, including a landmark ruling by the U.S. Supreme Court regarding end-of-life choice-maki...

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End-of-Life Care Decisions: Importance of Reviewing Systems and Limitations After 2 Recent North American Cases

In the November 2012 Mayo Clinic Proceedings, anesthesiologists Christopher Burkle and Jeffre Benson provide a nice overview of present systems existing in the United States and Canada for resolving end-of-life decisions, including the difficulty in defining medical futility, the role of medical ethics committees, and controversies involving surrogate decision making.  They use the recent Barnes and Maraachli cases to highlight the difficulties surrounding medical futility conflicts. Best of all, the authors cite me about 50 times in their...

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The Darkening Veil of "Do Everything"

On the theme of vague and bad language (see my immediate prior post on DNACPR), I truly enjoyed Feudtner and Morrison's piece, The Darkening Veil of "Do Everything" in the Archives of Pediatric & Adolescent Medicine.  They colorfully illustrate why "saying that we are going to 'do everything' is dangerous nonsens...

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DNACPR

In its End-of-Life Guidance, the British General Medical Council uses the term "DNACPR."  The term is used widely across the United Kingdom.  But one does not see this term much in the United States. But healthcare providers might consider its adoption.  First, the "A" correctly indicates that a patient with this order will not necessarily be deprived of cardiopulmonary resuscitation.  For many hospital inpatients, it is unlikely that CPR would be effective even if it were attempted.  Instead, a patient with this order...

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Tracey v. Cambridge University Hospitals NHS Foundation Trust

Over the next 10 days, London High Court Judge Dame Nicola Davies will hear evidence from witnesses regarding the circumstances surrounding a hospital's resuscitation policy.  David Tracey alleges that two Do Not Resuscitate (DNR) orders were included in the notes of his late wife, Janet, without her knowledge or consent.  But Cambridge University Hospitals NHS Foundation Trust says that a doctor did seek her informed consent.  (BBC News)After the factual dispute is resolved, a full judicial hearing is listed for February, which...

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Proposals to strengthen the NHS Constitution

The UK NHS has published Proposals to strengthen the NHS Constitution.  Comments and public consultation on the 60-page document are open is 28 January 2013.  One of the key proposed changes makes it clearer that patients, their families and carers should be fully involved in all discussions and decisions about their end-of-life care and treatment.  Responses to the consultation will feed into a revised version of the NHS Constitution, which will be published by April 20...

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Health Law Moot Court Competition

I have spent the weekend at Southern Illinois University for the 21st National Health Law Moot Court Competition.  Using both written and oral appellate advocacy, law school teams from San Diego to Boston competed on a problem concerning a municipal clinic system's constitutional duty to protect the privacy of patient medical records.  My team from Hamline University School of Law was awarded Second Place Brief and advanced to the semi-finals...

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England to Require Clinicians to Write Unilateral DNAR Orders with More Transparency

As I have been reporting these past months, there have been quite a few recent British cases (many now in the courts) involving patients placed on the Liverpool Care Pathway without relatives' knowledge.On Monday, UK Health Secretary Jeremy Hunt will announce the new obligation on doctors as part of a raft of changes to the NHS constitution.  Under the reforms, being put out for consultation on Monday, health trusts that fail to involve...

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Nickolas Coke Lived Three Years without a Brain

Nickolas Coke, a Colorado boy who survived three years despite being born without a brain, has di...

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Conference on Medicine and Religion: What Does It Mean to Care? Religious Traditions and Health Professions Today

On May 28-30, 2013 in Chicago - the second annual Conference on Medicine and Religion:  What Does It Mean to Care? Religious Traditions and Health Professions TodayAt the heart of medicine is care. Medical care, surgical care, nursing care, wound care, palliative care, even spiritual care—almost everything health professionals do is advanced as a form of care. Yet patients, health professionals, and critics of medicine often question how much care there is in health care. Moreover, it is often unclear how health care fits into a faithful life,...

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