Tracey v. Cambridge University Hospital - No Guidance on Duty to Consult Patient before Entering DNR

Lastweek,  Mrs. Justice Nicola Davies ruled in Tracey v. CambridgeUniversity Hospital.  I have posted a copy of the decisionhere.Janet Tracey was not consulted before a "do notresuscitate" notice was placed on her medical records.  But JusticeDavies held that the failure to inform or involve Janet had"minimal causative effect," as the notice was cancelled five dayslater when her family objected, and not acted upon.  The judge also foundthat a second notice, which followed three days afterwards and two days beforeMrs...

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Legality of VSED - VRFF

I wish I had used this scene from Hamlet Act V, scene I in my argument for why VSED does not constitute assisted suicide.GRAVEDIGGERIs she to be buried in Christian burial when she willfully seeks herown salvation?             OTHERI tell thee she is. Therefore make her grave straight. The crowner hathsat on her and finds it Christian burial.GRAVEDIGGERHow can that be, unless she drowned herself in her own defense?OTHERWhy, ’tis found so.GRAVEDIGGERIt must be se offendendo. It cannot be...

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Career Guide for the Future Healthcare Attorney

I just posted my new seven-page article "Career Guide for the Future Healthcare Attorney."  I have been expanding this for a more exhaustive piece to be submitted in March.  So, I would greatly appreciate any criticism, comments, suggestions.  Here is the abstract:I have two objectives in this Article. First, I will outline the wide range of career paths available to you as a health lawyer. Second, I will describe the experience and credentials that you should acquire to make yourself a competitive candidate for these jobs.The plethora...

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Obama Pushing Grandma off Cliff

I don't know how I missed this earlier this year.  Mean, unfair, and inaccurate.  But clev...

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Health Law & Bioethics before the Minnesota Supreme Court

There are a number of interesting health law and bioethics cases now pending before the Minnesota Supreme Court and the Minnesota Court of Appeals.  I will review these at a lunchtime workshop on Tuesday, January 29, 2013.1.  State v. Melchert-Dinkel.  William Melchert-Dinkel is a former Minnesota nurse convicted of going online and encouraging two people to kill themselves.  This week, Melcher-Dinkel filed his opening brief the Minnesota Supreme Court, arguing that he did not directly participate in the suicides, was...

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Minnesota v. Final Exit Network (Part II)

I wanted to follow-up from my brief post, earlier this week, about Tuesday's motions hearing in Minnesota v. Final Exit Network (Dakota Cty., Minn.).  The hearing has since also been covered in the local and national media.  Here are some highlights from the hearing:Rivas:  Explained how the prohibition on advising and encouraging suicide is not only content-based but also viewpoint based.  For example, a law banning billboards over 20 feet would be content neutral.  A law banning advertising on billboards would be...

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CMS Signals Renewed Focus on Advance Directives

This North Carolina law firm caught my eye with this headline: "CMS Signals Renewed Focus on Advance Directives" in one of its newsletters.  Here is the key language from the newsletter summarizing the impact of this CMS Memo:On September 27, 2012, CMS issued revised surveyor guidance in Appendix PP to the state operations manual, further interpreting F Tag 155, which is based on 42 Code of Federal Regulations section 483.10(b)(4). The revised guidelines became effective on November 30, 2012.  The regulation itself has not changed, nor...

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Nursing Home Inspect Tool for Researching Deficiency Reports

ProPublica has launched a great new tool that you can use to compare nursing homes in a state based on the deficiencies cited by regulators and the penalties imposed in the past three years.  You can search more than 58,000 nursing home inspection reports to look for trends or patterns. ProPublica has also prepared a guide for making the most of this to...

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Minnesota v. Final Exit Network - Omnibus Motions Hearing

This morning, I attended the omnibus motions hearing in the Dakota County, Minnesota criminal case against the Final Exit Network and five individual FEN defendants.  The primary defense motion attacks the constitutionality of the statute under which the defendants are charged, Minn. Stat. 609.215.That statute provides:  "Whoever intentionally advises, encourages, or assists another in taking the other's own life may be sentenced to imprisonment...

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National Healthcare Decisions Day - 4 Months to Go

Today marks four months to NHDD 2013 - April 16, 2013.  Continue to spread the word about NHDD, and please encourage others to join by clicking here.  In the spirit of holiday gift-giving, consider a gift to NHDD he...

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Slow Code & No Codes / Medical Futility - Free Webinars

Children's Mercy Bioethics Center in Kansas City has posted a copy of its recent webinar "Slow Codes, Show Codes, and No-Codes: A Debate Between Annie Janvier and William Meadow."Click here to register for their February, 5, 2013 Debate: "Does the Concept of ‘Medical Futility’ Help Clinician...

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Australian Health Minister Calls for Better Informed Consent at End of Life

Australian Federal Health Minister Tanya Plibersek has challenged doctors to better explain to terminally ill patients when treatments become futile.  Several Australian physicians have recently highlighted the fact that terminally ill patients are undergoing aggressive and uncomfortable treatments even though they are fruitless.  For example, intensive care specialist Peter Saul says some doctors reflect a death-denying Australian culture...

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End-of-Life Law & Policy - Video from NYLS Conference

New York Law School has posted a video of all sessions from its November 16, 2012 conference of end-of-life care law and policy.  My talk on medical futility begins at 2:52:...

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Definition of "Life-Sustaining Treatment" in New Jersey

Last year, New Jersey defined “life-sustaining treatment” as "the use of any medical device or procedure, artificially provided fluids and nutrition, drugs, surgery, or therapy that uses mechanical or other artificial means to sustain, restore, or supplant a vital bodily function, and thereby increase the expected life span of a patient."  N.J. Stat. Ann. 26:2H-131.This means that physiologically futile interventions do not even qualify as life-sustaining treatment.  CPR for a patient in whom it will not restore circulation...

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Cuthbertson v. Rasouli - Oral Argument Video

The video of the oral argument before the Supreme Court of Canada in Cuthbertson v. Rasouli, is available here.  I plan to post detailed comments next we...

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Advance Care Planning Lessons from Gunderson Lutheran (NBC Rock Center)

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

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David James - Court Denies Hospital Permission to Stop Life-SustainingTreatment

In May, 68-year-old formermusician David James was admitted to aBritish hospital with constipation.  But he went on to develop pneumoniaand became critically unwell.  He has hada stroke, resulting in damage to the brain and loss of function on his rightside, and he has also had a number of cardiac arrests and suffered kidneydamage.  Clinicians have diagnosed him as in a minimally conscious state.More recently, the hospital...

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Video Decision Support Tool for CPR Decision Making

In a new study published in the Journal of Clinical Oncology, researchers found that showing patients with advanced cancer a video of simulated cardiopulmonary resuscitation (CPR) improved their understanding of the intervention and caused more patients to opt against CPR.The innovative Advance Care Planning Decisions video used in the study was created by a nonprofit foundation led by physicians who aim to empower terminally ill and elderly patients and their families to make informed choices about end-of-life care. These videos are created based...

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New Position: Health Law & Policy Fellow and Instructor of Health Law

Saint Louis University Law Center for Health Law Studies Announces a New Position: Health Law & Policy Fellow and Instructor of Health LawSaint Louis University School of Law is seeking applicants for a full-time Health Law & Policy Fellow and Instructor in Health Law in the Center for Health Law Studies.  This new position is funded through a contract with the Missouri Foundation for Health.  The Fellow will work under the general direction of Professor Sidney Watson.Health Law and Policy Fellow, Instructor of Health Law,Center...

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VSED - VRFF

I was just informed about two new materials regarding VSED-VRFF as a means to hasten death:  (1) a short manual called Cheat the Nursing Home, and (2) a memoir called Life, Death and Iguanas.The manual covers some of the basics of VSED.  The memoir, Life, Death and Iguanas, is the story of the life and death of a strong woman who chose to fast until her end rather than endure a living death of Alzheimer’s in a nursing home.  It’s...

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Rasouli Case to be Heard by Supreme Court of Canada on Monday

On Monday, the Supreme Court of Canada will hear oral arguments in Cutherbertson v. Rasouli.  Interestingly, until 1949, Court’s non-criminal decisions could still be appealed to the Judicial Committee of the Privy Council in England.  The Court is now Canada’s ultimate court of appeal.  This is the first time a nation's ultimate judicial tribunal has grappled with a medical futility case.  Even better, the issues are framed very crisply.  In typical futility cases, the core "Who Has the Right" question...

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In re Kenny Ng - B.C. Court Asked to Order fMRI for PVS Patient

57-year-old Kenny Ng has been in a vegetative state since an automobile accident seven years ago.  His wife Lora wants medical staff at George Pearson Centre to remove his feeding tubes.  (Vancouver Sun)But Kenny's parents, siblings and relatives have asked B.C. Supreme Court Justice Miriam Gropper to intervene and keep Ng alive in the hope he can benefit from recent neuroscience medical discoveries.  They argue that Kenny may qualify for pioneering treatments by brain researcher Adrian Owen.Provincial precedent in...

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Besse Cooper, World's Oldest Person, Dies

Besse Cooper, the woman who was listed as the oldest person in the world, has died at the age of 116 in a Georgia nursing home.  The title of world’s oldest person now belongs to 115-year-old Dina Manfredini of Johnston, Iowa, according to the Guinness World Records.  (ABC Ne...

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Michigan to Mandate Disclosure of Medical Futility Policies

In October, I observed that a bill was introduced in the Michigan House that would mandate the disclosure of futility policies when they might be applied to minor patients.  A few days ago, HB 6070 was introduced by a different Representative to achieve the same thing.  Here is the key provision:A HEALTH FACILITY OR AGENCY THAT ADOPTS OR  IMPLEMENTS A FUTILITY POLICY THAT APPLIES TO THE TREATMENT OF A  CHILD FROM BIRTH TO 18 YEARS OF AGE MUST DISCLOSE THAT FUTILITY  POLICY TO THE CHILD'S PARENT OR GUARDIAN WHEN THE...

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Open Position - Executive Director, New York State Task Force on Life and the Law

The New York State Task Force on Life and the Law is looking for a new Executive Director.  Requirements:Superior academic credentials (M.D., J.D., or Ph.D. preferred), demonstrated expertise in bioethics/health policy, and an ability to forge consensus on controversial issues.Responsibilities: The Task Force is a nationally recognized multidisciplinary body whose members are gubernatorially appointed and leaders in law, medicine, nursing, philosophy, and bioethics, as well as patient advocates and representatives of religious...

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Seven Harms from Over-treatment in the ICU

There are at least seven discrete harms from over-treatment in the ICU:Patient - The patient's autonomy is violated, because she is not getting treatment consistent with her preferences and values.Patient - The patient will likely physically suffer from this over-treatment. Nurses - The nursing staff will likely experience moral distress.Other Patients - The anxiety of the nursing staff can adversely impact their care of other patients.Other Patients - Over-treating patients in the ICU means that other patients in need of that level of...

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Critical Legal Issues in Alzheimer’s - Free Webinar

Join the American Bar Association (ABA) Commission on Law and Aging and the Administration on Aging (AoA) to talk through what is important for your clients with Alzheimer’s and related dementia.  A free December 12 webinar covers legal issue spotting and finding dementia capable legal assistance and resources.   Participants will learn about:• Common legal issues • When to seek legal assistance• Legal issue resources• Finding dementia capable legal assistance Presenters: David Godfrey, Esq., Senior Attorney,...

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Overtreatment: Making Money from Unnecessary Treatment

The hospital chain, Health Management Associates (70 hospitals in 15 states) is accused of pressuring doctors at some of its hospitals to admit patients regardless of medical need just to increase revenues, the CBS program 60 Minutes reported Sunday. Doctors at several HMA hospitals told 60 Minutes that administrators had set quotas for admissions through their emergency rooms.  HMA disclosed in previous SEC filings that federal authorities have been investigating certain aspects of the company, including "the medical necessity of emergency...

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Slow Code - Short Code - Show Code

The slow code has been getting a lot of attention over the past week.  First, there was an excellent webinar at Children's Mercy Bioethics Center.  And Robert Cribb covered the topic in the latest in his end-of-life medicine series in the Toronto Star.I especially liked this part of Cribb's article:  Lantos acknowledges that many in the medical community have called his defence of slow codes a paternalistic endorsement of cloak-and-dagger secrecy.  “It’s a nice argument,” he says. “But why is honesty so obviously the only moral...

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