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

Last
week,  Mrs. Justice Nicola Davies ruled in Tracey v. Cambridge
University Hospital.  I have posted a copy of the decision
here.

Janet Tracey was not consulted before a "do not
resuscitate" notice was placed on her medical records.  But Justice
Davies held that the failure to inform or involve Janet had
"minimal causative effect," as the notice was cancelled five days
later when her family objected, and not acted upon.  The judge also found
that a second notice, which followed three days afterwards and two days before
Mrs Tracey's death, was put in place with the agreement of her family.

Justice Davies ruled that it would be neither "appropriate nor
proportionate", in the light of those limited findings of fact, to have a
judicial review hearing on the legal issues.  She refused permission to appeal but lawyers for Mrs Tracey can
pursue the application directly with the Court of Appeal.  Plaintiffs want a
judicial review to clarify whether there is a legal duty to inform patients
with capacity whether a DNR has been placed on their notes and whether they
have any right to be consulted about it.

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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.

GRAVEDIGGER

Is she to be buried in Christian burial when she willfully seeks her
own salvation?            

OTHER

I tell thee she is. Therefore make her grave straight. The crowner hath
sat on her and finds it Christian burial.

GRAVEDIGGER

How can that be, unless she drowned herself in her own defense?

OTHER

Why, ’tis found so.

GRAVEDIGGER

It must be se offendendo. It cannot be else. For here lies the point:
if I drown myself wittingly, it argues an act. And an act hath three
branches—it is to act, to do, to perform. Argal, she drowned herself wittingly.

OTHER

Nay, but hear you, Goodman Delver—

GRAVEDIGGER

Give me leave. Here lies the water. Good. Here stands the man. Good. If
the man go to this water and drown himself, it is, will he nill he, he goes.
Mark you that. But if the water come to him and drown him, he drowns not himself.
Argal, he that is not guilty of his own death shortens not his own life.

OTHER

But is this law?

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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 of health law career opportunities can be roughly grouped into twelve categories. As an entry-level lawyer, you could (1) clerk for a judge or (2) complete a health policy fellowship. As an attorney, you could do either (3) litigation or (4) transactional work for healthcare clients. Or you could practice in the particularly fast-growing areas of (5) public health law or (6) elder law. 



But I hasten to add that not all health law jobs involve working as an attorney or lawyer. Law school is excellent training for legal non-attorney careers in: (7) compliance, (8) regulatory affairs, (9) risk management, (10) clinical ethics consultation, (11) legal nurse consulting, and (12) dispute resolution.

Most of the strategies for success for aspiring health lawyers are the same are those for any other law student. I have taken the liberty to customize these strategies for the future healthcare attorney. I have grouped my law school strategies for success into five categories: (1) work experience, (2) moot courts, (3) writing, (4) networking, and (5) coursework.

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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 clever.

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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 merely supporting his alleged victims, and had no influence on their actions.  



2.  State v. Smith.  Eddie Cortez Smith was convicted of criminal vehicular homicide and sentenced to 10 years in prison.  Smith is arguing to the Minnesota Supreme Court that he was not responsible for the death because his victim's "do-not-resuscitate" order kept her from potentially life-saving medical care.



3. Dickhoff v. Green.  A physician failed to diagnose Jocelyn Dickhoff's cancer.  But even if it had been timely diagnosed, Jocelyn probably would still have had the same result.  The doctor's negligence made it more likely that she would be injured.  It deprived Jocelyn of an opportunity of a better outcome.  The Minnesota Supreme Court may join a growing number of states that permit plaintiffs to recover where they can establish  only "lost chance" even if not "but for" (more probable than not) causation.  



4.  In re Tschumy.  The Hennepin County Probate Court decided that court-appointed guardians do not have the authority to consent to withhold or withdraw life-sustaining treatment.  The court must specifically authorize such decisions.  The Minnesota Court of Appeals is concerned that the appeal is untimely and moot (Tschumy has died).  But if they reach the merits, they will hopefully clarify the scope of guardian authority for health care decisions.

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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 content based.  A law banning gun advertising would be both content based and viewpoint based.  Here, Minn. Stat. 609.215 focuses on assisted suicide specifically and in only one direction.  There is no prohibition on talking someone out of suicide.  



It appears the state conceded this much.  That means the statute is presumptively unconstitutional.  The state has the burden of establishing that the statute passes "strict scrutiny" analysis, that the state has a compelling state interest that is narrowly tailored.  That seems like a tall order.  While preventing suicide is a compelling state interest, including speech is not necessary to that objective.  



Lundquist:  Explained how the state concedes the book Final Exit is not illegal.  But then how is the line drawn?   Is it okay to sell the book to 100 people but not to just 1 person?  Is it okay to read the book to 100 people but not to just 1 person?  



Judge Asphaug:  Asked about a Kushner play at the Guthrie Theatre where a character thought he had a terminal illness.  Another character gave explicit instructions on stage, with props.  She asked: "Could the playright and actors be prosecuted for this?"  The state responded that such speech lacks the intent to affect an individual person.

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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 has the Federal Patient Self- Determination Act on which the regulation and the surveyor guidance are based. However, in this revised guidance in Appendix PP, CMS reaffirms its commitment to resident choice in end-of-life care and its direction to surveyors to assess providers’ compliance with that right in annual recertification and complaint surveys.



CMS describes four key expectations of SNFs in the revised guidance:

1. To establish and maintain policies and procedures governing the right of choice in end-of-life health care decision-making;


2. To inform and educate residents, or their legal surrogate, about end-of-life choices and the facility’s policies regarding how residents exercise these rights;


3. To help residents exercise these rights by creating advance directives (living wills, health care powers of attorney or other advance directives recognized by state law); and


4. To incorporate residents’ choices into treatment, care and services, specifically including initial, ongoing and revised care planning as a resident’s health care status changes over time.

CMS also (a) spells out the elements that must be addressed in each SNF’s policies and procedures on end-of-life care, (b) defines the normal survey sample for end-of-life issues, and (c) contains examples of deficiency categories applicable to violations of these expectations.  

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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 tool.

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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 for not more than 15 years or to payment of a fine of not more than $30,000, or both."  



While most states criminalize assisted suicide, they limit the scope of that prohibition to material assistance.  Minnesota is one of just five states that extends the prohibition to mere "advising."  FEN, through its regular counsel Robert Rivas, made a powerful case that this violates the First Amendment.  The prosecutors' opposition was neither cogent nor compelling.  



Judge Asphaug indicated that she would issue a decision in around two or three weeks.  However she rules on the motion (dismissing the indictment or allowing an interlocutory appeal if she denied it), the ruling will probably be immediately appealed, even though the core First Amendment question may soon be addressed by the Minnesota Supreme Court in State v. Melchert-Dinkel.

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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 here.

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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 Clinicians?"

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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 and offer futile treatment because it is easier than having difficult conversations.



Plibersek said that doctors need to make sure they are acting in their patients' best interests.  "Doctors have to be very sure that what they're doing is what the patient wants and in their best interests. . . .  I would be very disappointed to think that doctors are offering ... treatment, because it's quicker to have the conversation or easier to have the conversation."

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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 2:52:00.

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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 is not life-sustaining treatment for that patient, even though the same procedure might be life-sustaining treatment for another patient.



But such a definition also implies that the end of "increasing the expected life span of a patient" is in and of itself a worthy end of medicine.  

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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 week.

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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 economy

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

In May, 68-year-old former
musician David James was admitted to a
British hospital with constipation.  But he went on to develop pneumonia
and became critically unwell.  He has had
a stroke, resulting in damage to the brain and loss of function on his right
side, and he has also had a number of cardiac arrests and suffered kidney
damage.  Clinicians have diagnosed him as in a minimally conscious state.

More recently, the hospital applied to the Court of Protection for
a declaration that, if James’ condition deteriorated, it need
not offer him “futile and burdensome” treatment
(cardiopulmonary resuscitation, renal replacement treatment, or invasive
support for chronic low blood pressure). 

Mr. Justice Peter Jackson refused the hospital's declaration, stating:
 “Although Mr. James’s condition is in many

respects grim, I am not persuaded that treatment would be
futile or overly burdensome or that there is no prospect of recovery.”
 “Although the burdens of treatment are very great indeed, they have
to be weighed against the benefits of a continued existence.”  He added that recovery did not mean a return
to full health but the resumption of a quality of life that James himself would consider worthwhile.

Justice Jackson further observed that doctors had undervalued
the limited quality of life that the patient could still enjoy. He also
noted that James’s medical condition was “fluctuating,” adding that it
would not be right to validate in advance the withholding of the
treatments in all circumstances.  (Liverpool
Daily Trust) (BMJ 2012; 345: e8404)

This case is not surprising.  Many cases (famously Wendland and Martin in the USA, for example) have drawn a sharp distinction between PVS and MCS patients.  Clinicians can usually establish zero quality of life, and thus best interest, to stop LSMT for a PVS patient.  But it is far tougher to do that for an MCS patient.  Even British cases have denied clinician requests to stop LSMT in which severely brain damaged children would still interact with her environment, for example, by smiling at their parents.

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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 on rigorous
research and review from leading medical experts, and are in use at 35 health
systems across the U.S. They improve decisions by overcoming the inability of
patients to envision what CPR and subsequent care on a ventilator entails, as
well as overcoming variability in the quality of physician counseling.

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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 Law



Saint 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 for Health Law Studies, School of Law



The School of Law at Saint Louis University, a Catholic, Jesuit institution dedicated to student learning, research, health care and service, is seeking applicants for a full-time Health Law and Policy Fellow and Instructor in the Center for Health Law Studies. The position is a non-tenure-track faculty appointment at the rank of Instructor. It is funded for two years through a contract with the Missouri Foundation for Health. The Fellow will work under the general direction of Professor Sidney Watson.



The Fellow will prepare and present a variety of legal and policy analyses on priority health access issues identified in collaboration with Missouri Health Care for All, Missouri Jobs with Justice, Missouri Rural Crisis Center and other members of the Missouri health advocates coalition. One emphasis is the creation of “plain language” analysis of legal and policy initiatives related to the Affordable Care Act, Medicaid, federal and state budget discussions, and private insurance reforms including fact sheets, longer briefs and white papers, email alerts, and training materials, including some developed specifically for rural communities and rural stakeholders.



The Fellow will serve as a liaison with national organizations monitoring emerging issues and long-term strategy, providing analysis and translation of information for advocacy coalition members’ use. The Fellow will also provide written and oral testimony at legislative and administrative hearings and assist coalition members in preparing their testimony for such hearings.



The Fellow will also help educate the public about the Affordable Care Act, Medicaid, and other health access and health reform legal and policy issues. He or she will help design and conduct law school courses and community trainings to develop a cadre of law students and community members to present educational programs and create story banks through which people can share their health care experiences. The Fellow will have the opportunity to design and present intergenerational learning opportunities for both law students and volunteer community advocates.



A Juris Doctorate degree is required. Study or experience in health law and policy is also required as is an understanding and appreciation of grassroots health advocacy.



Applications will be considered as they are received until the position is filled. Applications should include a resume and cover letter indicating particular qualifications. Apply online at http://www.slu.edu/jobs/

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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 also the story of her three sons, struggling to help her, warring against each other, and finally uniting.  Lastly, it’s the author’s story of depression and loss, with a bittersweet regeneration and growth at the end.  Balancing life with grief, laughter with tears, this book suggests a better way to die—and to live.

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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 gets substantially obfuscated by legal framing into causation, procedural, and other issues.

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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 B.C. endorses the view that life support should be terminated where medical specialists unanimously believe the patient is without awareness or hope of recovery and invasive treatment provided no potential benefit.  Normally, that would be the situation here.  An easy case.  



But the family insists that letting Ng die would be wrong given the startling work in neuro-imaging by Dr. Owen.  That research proves some patients  who have lain in vegetative states for years may be more conscious than we realize.



Most U.S. and Canadian jurisdictions authorize surrogates to withdraw life-sustaining treatment when the patient is PVS.  If the B.C. court overrides Kenny's wife on the grounds that there is still hope for PVS patients, such a decision will be in stark contrast to a huge body of jurisprudence. 

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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 News)

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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 HEALTH FACILITY  OR AGENCY IDENTIFIES THE NEED FOR A FORMAL PROCESS TO ADDRESS  CONCERNS OVER THE PROPOSED TREATMENT OF A CHILD. THE HEALTH  FACILITY OR AGENCY MUST, UPON REQUEST OF THE PARENT OR GUARDIAN OF A PATIENT OR PROSPECTIVE PATIENT, PROVIDE A COPY OF THE FUTILITY  POLICY IN PLACE AT THE HEALTH FACILITY OR AGENCY AT THE TIME THE  REQUEST IS MADE. 

The bill also defines the key terms:

"FUTILITY POLICY" MEANS ANY WRITTEN POLICY THAT ENCOURAGES OR ALLOWS A HEALTH FACILITY OR AGENCY EMPLOYEE, OR OTHER MEDICAL PROFESSIONAL WHO PROVIDES CARE TO PATIENTS AT A HEALTH FACILITY OR AGENCY, TO WITHHOLD OR DISCONTINUE TREATMENT FOR A PATIENT ON THE  GROUNDS OF MEDICAL FUTILITY. 

"MEDICAL FUTILITY" MEANS A JUDGMENT THAT FURTHER MEDICAL TREATMENT OF A PATIENT WOULD HAVE NO USEFUL RESULT

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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 communities. The Task Force’s mandate is to develop state policy recommendations on issues related to bioethics. Past reports have addressed policy questions related to end-of-life care, physician assisted suicide, organ transplantation, assisted reproductive technologies, and genetic testing. The Task Force is working on projects related to research with human subjects, ethical issues in public health disasters, and surrogate decision making. The Executive Director’s role is to: strategically facilitate meetings and build consensus on challenging issues and provide guidance to the New York State Department of Health; supervise staff who, together with the Executive Director, conduct legal research and analysis and draft related guidance; provide project oversight for Task Force activities; formulate and revise reports; develop grant proposals, and represent the Task Force to the public. Other related duties as assigned.



I have had the good fortune to know four attorneys who have worked at the NYSTFLL over the past few years.  They are quite impressive and indicate the high caliber of this professional experience.

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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:

1. Patient - The patient's autonomy is violated, because she is not getting treatment consistent with her preferences and values.


2. Patient - The patient will likely physically suffer from this over-treatment. 


3. Nurses - The nursing staff will likely experience moral distress.


4. Other Patients - The anxiety of the nursing staff can adversely impact their care of other patients.


5. Other Patients - Over-treating patients in the ICU means that other patients in need of that level of treatment will be boarded in the ED or elsewhere, increasing their risks.


6. Other Patients - over-treating can 'incubate' multi-drug resistant infections.


7. Society - Much over-treatment is billed to public payers like Medicare that we pay for but really cannot afford.

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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, ABA Commission on Law and Aging 


• Troy Johnson, MSW, Director of Programs and Services, Nursing Home Ombudsman Agency of the Bluegrass 


• Jane Tilly, DrPH, Office of Supportive and Caregiver Services, Administration on Aging/Administration for Community Living 

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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 room tests and patient admissions."



While I do not regularly track these sorts of developments on this blog, new federal and state investigations into financially-motivated medical over-treatment are announced daily.

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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 consideration? There’s an argument against the brutal-honesty approach. Families might be better off if you do a little CPR and say, ‘I’m very sorry but your loved one died.’”

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