Thứ Tư, 30 tháng 1, 2013

Minnesota 's Four Pending End-of-Life Cases


There are now four end-of-life cases pending in the Minnesota Courts.





1.  Can a guardian consent to withholding or withdrawing life-sustaining treatment?  In re Tschumy, No. 27-GC-PR-07-496 (Hennepin Cty. Dist. Ct. Oct. 18, 2012) (ruling guardian lacks authority to consent), on appeal No. A12-2179 (Minn. filed Oct. 2012) (now briefing threshold jurisdiction question).  





2.  Is the prohibition of "encouraging" suicide unconstitutional under the 1st Amendment?  State v. Melchert-Dinkel, No. No. 66-CR-10-1193 (Rice Cty. Dist. Ct. May 2011) (conviction), aff’d, No. A11-0987, 816 N.W.2d 703 (Minn. App. July 17, 2012), on appeal No. A11-0987 (PFR granted Oct. 16, 2012) (App. brief filed Dec. 20, 2012; Resp. brief due Feb. 25, 2013).





3.  Is the prohibition of "advising" suicide unconstitutional under the 1st Amendment?  State v. Final Exit Network (Dakota Cty. Dec. 18, 2012) (omnibus motion hearing) (forthcoming order will probably be appealed).





4.  Does the implementation of a patient's advance directive break proximate causation between a criminal injurer and the patient's death?  State v. Eddie Cortez Smith, No. 62-CR-10-4146 (Ramsey Cty. Dist. Ct. June 2011) (conviction), aff’d No. A11–1687 (Minn. App. Sept. 4, 2012), on appeal No A11-1687 (Minn. PFR granted Nov. 20, 2012) (App. brief filed Dec.20, 2012; Resp. brief filed Jan. 23, 2012).







Commission on Law and Aging Publications Moving Sale





Thứ Ba, 29 tháng 1, 2013

World Federation Right to Die Conference


The
World Federation Right to Die conference is tentatively
scheduled
 for September 16-22
in Chicago, Illinois (USA).  The theme is 
“Dignity, Control,
Choice – Around the World.” 




Do No Harm Project


Clinicians at the University of Colorado have
pioneered a new initiative called the "Do No Harm Project."  
Their goal is to emphasize trainee scholarship that
highlights the wisdom of Bernard Lown’s credo: "do as much as possible for the patient and as little as possible to the patient."




The project website explains:




Harms from over-testing,
over-diagnosis, and over-treatment are a serious threat to the health of our
patients and the long-term solvency of our health care system. Harms of overuse
have not traditionally been taught to medical trainees and there are few
incentives to pay attention to overuse: performance measures and payment
incentives reward doing more, the legal system punishes under-diagnosis, and
there is a dominant cultural belief that more care is better.

Basically, the project entails residents submitting vignettes where they have witnessed
unnecessary harms from over-testing, over-diagnosis, or preference
misdiagnosis. Once per quarter the best vignette is selected for an award.  (HT: 
GeriPal)





Ariel Sharon - Significant Brain Activity Detected after 7 Years in Vegetative State

Former Israeli Prime Minister Ariel Sharon has been in a persistent vegetative state since suffering a massive stroke in 2006.  But now doctors say they have observed "significant brain activity" in Sharon.  (CNN)  



They are basing this on the results of experiments done with functional magnetic resonance imaging, or fMRI, showing that Sharon's brain behaves differently when he is presented with familiar sounds and pictures than with unfamiliar stimuli.  Of course, it is totally unclear what any of this means for Sharon's ability to ever again meaningfully interact with his environment.



Thứ Hai, 28 tháng 1, 2013

2nd National Nursing Ethics Conference

The 2nd National Nursing Ethics Conference will be held in Los Angeles on March 21 and 22. This conference is designed to engage front line providers in reflecting on the ethical issues encountered in daily practice. This year's conference is titled "Cultivating Ethical Awareness: Moments of Truth." Some participants at the first conference said this was the best conference they had ever attended--in nursing or bioethics.


Thứ Sáu, 25 tháng 1, 2013

Sunnybrook v. Dennis Daye - Sunnybrook Uses CCB



A few months ago, I recounted several recent cases in which Sunnybrook clinicians attempted to resolve medical futility disputes through mechanisms other than the Ontario CCB.  But, yesterday, Robert Cribb (who has been covering these issues in a long series of columns for the Toronto Star) reported that Sunnybrook physician Robert Fowler is using the CCB process to argue that Dennis Daye's wife is not making treatment decisions in his best interest.



A massive stroke left Daye with “extensive” and “irreversible” brain damage. Clinicians rate his prognosis “incredibly poor,”  Accordingly, they want to remove aggressive care such as ventilation and CPR and adopt a “more palliative approach."  But Pilar will not consent to that plan.  She wants Daye treated with traditional, plant-based medicine.





Death & Dying in the 21st Century - Podcast



This Sunday, Indiana University's radio show "Sound Medicine” will explore the way we die, what it means to have a living will, and how hospice programs can help.  Host Anne Ryder speaks with expert physicians and nurses to explore how death and dying have changed in the past decades and how advances in medical technology have redefined our last moments.




  • Ken Murray, M.D., a retired family medicine physician and author of "How Doctors Die," discusses his essay and personal experiences with death. Murray also discusses end-of-life decisions and how consumers can educate themselves on life-saving medical care.

  • Frank Ferris, M.D., discusses how death and dying are changing, thanks to shifts in medical care. Ferris is director of international programs at The Institute for Palliative Medicine at San Diego Hospice, a teaching affiliate of the University of California, San Diego School of Medicine.  

  • Joanne Harvey, MSW, hospice social worker, grief counselor and author of "Dying to Live: Embracing the Journey," discusses how family members and loved ones can have a conversation about entering hospice. Harvey also shares personal experiences from her time as a hospice social worker.

  • Anna Boiko-Weyrauch, producer of "When a Doctor Meets a Soul,” shares her father’s unusual encounter with a dying patient. Boiko-Weyrauch’s father is family practitioner Karl Weyrauch, M.D.







Thứ Hai, 21 tháng 1, 2013

Louisiana Cutting Hospice Coverage

On December 14, 2012, the Louisiana Department of Health and Hospitals announced elimination of Medicaid hospice care through June 30, 2014. The cuts go into effect February 1, 2013.  I wonder how the state economists figured this would save the state money.  Those Medicaid patients are still going to die.  But now they will die at the hospital at a reimbursement rate surely higher than hospice.



                       

Thứ Bảy, 19 tháng 1, 2013

Free Career Panel on Bioethics & the Law



The American Bar Association Special Committee on Bioethics and the Law is presenting a Free Career Panel on Bioethics and the Law  "Careers and Opportunities in Bioethics and the Law" on Wednesday, January 30, 2013, from 2:30 to 4:00 p.m., at the American Bar Foundation, 750 North Lake Shore Drive, Fourth Floor.



The nexus of bioethics and the law continues to grow and evolve, it involves a continuous and ever changing study of emerging issues, such as genetic testing, access to medical care in public health crises, cloning, designer babies, emergency preparedness, bioterrorism and research censorship, and stem cell research, to name a few, as well as the potential legal implications of such advances. As with many important areas of the law, the intersection of bioethics and the law encompasses a balancing of the protection of individual rights, the advancement of justice, and making improvements for the good of the general public. All of these important objectives can be accomplished through a variety of means and in many settings.  Our panelists will share their career paths and experiences to interested attorneys and law students.



Thứ Sáu, 18 tháng 1, 2013

Minnesota Care of the Aging Conference

On February 25, 2013 in downtown Minneapolis, MinnCLE is hosting the Care of the Aging Conference.  Sessions include:






  • The Latest Practices and Strategies for Management of Extreme Symptoms Near End of Life: Palliative Sedation and Alternatives

  • Overview of Powers and Duties of Third-Party Decision-Makers: “Who You Gonna Call?”

  • Inside the Office of Health Facility Complaints: Why Won’t They Just Go Away and Leave Us Alone?

  • Families vs. Privacy: To Tell or Not to Tell – We Have the Answers!

  • Nursing Home Admission and Discharge Disputes: Law and Litigation

  • The Power of Apology







Proceedings of 2011 Third National Guardianship Summit




The National Guardianship Network has posted the proceedings of the 2011 Third National Guardianship Summit.  All the background papers commissioned for the Summit as well as the official Summit Standards and Recommendations are available here.  Here is the table of contents for the special issue of the Utah Law Review.







PREFACE: THIRD NATIONAL GUARDIANSHIP SUMMIT: STANDARDS OF EXCELLENCE


Leslie P. Francis





INTRODUCTION


Sally Hurme, Erica Wood





THIRD NATIONAL GUARDIANSHIP SUMMIT STANDARDS AND RECOMMENDATIONS


Guardianship Summit





A CALL FOR STANDARDS: AN OVERVIEW OF THE CURRENT STATUS AND NEED FOR GUARDIAN STANDARDS OF CONDUCT AND CODES OF ETHICS


Karen E. Boxx


Terry W. Hammond





STANDARDS FOR FINANCIAL DECISION-MAKING: LEGAL, ETHICAL, AND PRACTICAL ISSUES


Robert B. Fleming, Esq


Rebecca C. Morgan





STANDARDS FOR HEALTH CARE DECISION-MAKING: LEGAL AND PRACTICAL CONSIDERATIONS


Kim Dayton





CHOOSING HOME FOR SOMEONE ELSE: GUARDIAN RESIDENTIAL DECISION-MAKING


Naomi Karp, Erica Wood





SURROGATE DECISION-MAKING STANDARDS FOR GUARDIANS: THEORY AND REALITY


Linda S. Whitton


Lawrence A. Frolik





PERSON-CENTERED PLANNING IN GUARDIANSHIP: A LITTLE HOPE FOR THE FUTURE


A. Frank Johns





STANDARDS FOR GUARDIAN FEES


Catherine Seal


Spencer Crona





THE RELATIONSHIP BETWEEN THE GUARDIAN AND THE COUR


Mary Joy Quinn


Howard S. Krooks





CREATING AND SUSTAINING INTERDISCIPLINARY GUARDIANSHIP COMMITTEES


Julia R. Nack


Carolyn L. Dessin


Judge Thomas Swift






Thứ Năm, 17 tháng 1, 2013

IOM Committee on Transforming End-of-Life Care

The Institute of Medicine's new Committee on Transforming End-of-Life Care is holding its first meeting on February 20 and 21, 2013, at the National Academy of Sciences building located at 2101 Constitution Avenue N.W., in Washington, D.C. There will be a public session from 1:00 p.m. to 5:00 p.m. on February 20. 



The agenda will feature discussion of the committee’s scope of work and previous Institute of Medicine reports that addressed end-of-life care. There will also be an opportunity for public comments on issues that the committee will address in its work. Individuals who wish to attend and who would like to provide comments are asked to register by Friday, February 15.  Interested parties may also submit to EOL@nas.edu any materials they believe the committee should consider in its work.  



The IOM is also seeking feedback on its provisional committee assignments.  PalliMed has some thorough and insightful comments on the committee composition.  


Thứ Ba, 15 tháng 1, 2013

2013 Hastings Center Cunniff-Dixon Physician Awards


The Hasting Center has
announced the 2013 winners of the Hastings Center Cunniff-Dixon Physician
Awards.  





The purpose of these five prizes (one to a senior physician, one
to a mid-career physician, and three to early-career physicians) is to foster
those skills and virtues by providing financial prizes to those physicians who have shown their care of patients to be exemplary, a model
of good medicine for other physicians, and a great benefit in advancing the centrality
of end-of-life care as a basic part of the doctor-patient relationship.





Here is the rationale for the award:  Care for patients at
the end of life has long troubled American medicine, not only in its failure to
provide good palliative care, but also in the relationship between doctors and
patients. Many efforts to remedy this situation have emerged: 




  • A growing and
    strengthening palliative care movement,

  • Better understanding of the situation
    of patients at the end of life, 

  • A sharper focus on the values and behavior of
    physicians in their care of the dying, 

  • A more general effort to gain
    medical recognition that end-of-life care is just as important as care during
    all other phases of life. 





Great progress has been made, but there is still a
distance to go. As the number and percentage of people who die from chronic and
degenerative diseases increase, the physician skills and virtues necessary to
provide good end-of-life care also increase.




Thứ Hai, 14 tháng 1, 2013

Third Cambridge Consortium for Bioethics Education




The Third Cambridge Consortium for Bioethics Education will be held from June 19 to 21, in Paris.  Registration is available here.







In April 2010, Cambridge University Press held the first Cambridge Consortium for Bioethics Education in New York. Leaders in the field were invited to initiate a shared dialogue addressing such questions as: 




  • Why are we doing this? 

  • What goals are we trying to achieve? 

  • Where is bioethics education taking place? 

  • How well are we doing? 

  • What next?  





Tackling those questions continued at the Second Consortium, held in Paris 2012. Delegates from 20 countries reported on bioethics from around the world and discussed proposals for general objectives of bioethics education in various academic programs. 

Expanding this work continues at the Third Consortium where the focus is on "how to" methods of teaching bioethics. Through collective information and shared experiences participants will move forward as an international community of bioethics educators. 




Thứ Sáu, 11 tháng 1, 2013

The Suicide Shop



Late last year, the 2012 French animated film, "The Suicide Shop," was circulating among film festivals in Canada and elsewhere.  Hopefully, it will soon be generally available.



In a grey and brown Paris of oppressive concrete towers and rain-soaked streets, everyone, even the pigeons, is miserable. The one paradoxical ray of hope is a quaint little old-fashioned back-alley boutique known as The Suicide Shop, where the Tuvache family are delighted to help customers end their suffering.  The shop sells poisons, nooses, rusty razor blades, seppuku swords and other life-taking paraphernalia, aimed at every budget. For a homeless customer, it’s a simple plastic bag and a piece of tape, compliments of the house.





Thứ Năm, 10 tháng 1, 2013

Zfat v. Joe DiMaggio Children's Hospital - Orthodox Jews Ask Court to Order Hospital to Continue Life Support



About a year ago, 19-year-old daughter, Danielle Zfat was diagnosed with a brain tumor.  On Nov. 25th she was admitted to Joe DiMaggio Children's Hospital in Florida.  On Jan. 1st her condition worsened and she was placed on life support. 



As of January 3, 2013, the physicians at the hospital indicated that they would be removing all medical systems which supported Danielle's life.  



But Danielle and her family are Orthodox Jews who believe they cannot withdraw life sustaining devices once they are in place. Danielle's mother explains:  "Our way to believe as a Jew . . . is that everything goes through the heart. As long as the heart beats, the soul is in the heart, and therefore she is alive."  "When God decides to take her, then he will take her. She's breathing, she's alive. She's up there alive, breathing. Take care of my daughter please. Give her life. Don't cut her off. Anybody can share any support. Please."




The family's attorney, Moshe Rubenstein, has filed an emergency motion in court.



WSVN-TV -



Thứ Tư, 9 tháng 1, 2013

Son's Perspective on Using VSED to Hasten Death

The following is an essay by Marc Newhouse on his mother's use of VSED.  Marc Newhouse is a former cellist, nurse, and English teacher.  He is now a book author who blogs at Life, Death and Iguanas.





In April of 2010, my mother made a hard, but unquestionably
good decision.





She was 89, frail, almost blind, and thought she might have
Alzheimer’s.





The idea of a slow, relentless deterioration—especially in a
nursing home—was intolerable to her. A fine poet, she had combined wit with
reason all of her life.





She had also supported physician-assisted death for years.
“If my doctor cannot legally euthanize me, as I would much prefer him or her to
do, I authorize the suspension of all fluids and nourishment until I reach my
end,” she wrote in her health directive, decades before in the 80’s. And she named
me her health agent.





So there we were, she and I and my niece, in April of 2010,
as the doctor pronounced the sentence. Or rather, watched as I did.





“We’re wondering if you might be starting Alzheimer’s,” I
said, and recounted the stories of the confusion, the agitation, the odd
behavior that the family had seen.





“We have an agreement,” she snapped, fixing me with her blue
eyes.





We did. I would do anything to keep her from years of
suffering in a nursing home.





The problem was what. A noose? Stop all the meds? What was
the best way to achieve a good death?





One alternative emerged—helium. It’s legal, it’s lethal,
it’s virtually untraceable. So we three brothers had a plan: we would be there
as my mother took the bag, placed it over her head, and—with her own
hands—started the flow of helium that would end her life in seconds.





“That’s assisted suicide,” said my oldest brother, a
prize-winning journalist, “and whatever it is morally, it’s probably illegal.”





Later—he wrote an email. “I cannot and will not lie in a
court of law.”





Was it a threat?





We took it as one. And so the family erupted in rancorous
battle, and the presumed-Alzheimer’s continued.





Finally, we saw that there was only one alternative—one way
for my mother to sidestep the nursing home and achieve a good end.





VSED. That’s voluntarily stopping eating and drinking.





Which, initially, I thought cruel. I had been a nurse for a
decade, and the traditional wisdom is that a death by dehydration is agonizing.





I did the research—there were reports that it had been done,
and that it was not as uncomfortable as I had assumed.





It took a few days of scrambling, but at last we found a
doctor who would support my mother’s decision. The doctor handed me a box of
Kleenex as my mother matter-of-factly said, “I know that I might have a few
more years, that this could be depression and not Alzheimer’s. But so what? I’d
still be blind, not able to move, not able to read or write. Most of my old
friends are gone, and my younger ones are busy.”





The doctor wrote a consult for hospice—they came immediately
that day, and proved to be the best team of health professionals I have ever
seen.





“Has anyone ever done this before,” I asked the nurse, on
the fifth day of the fast. “Have you ever seen this?”





“No,” she said. “Someone essentially healthy, without an
underlying disease condition like cancer, who just decides to stop eating and
drinking—no, I’ve never seen it.”





I had read that the body might produce endorphins after the
third day of the fast. I had also read that the sensation of thirst and hunger
fade and perhaps disappear after the third or fourth day.





My mother disputed that. But she also said, “it hasn’t been
too bad,” when someone asked her what it was like, to be five days without food
or drink.





The last week of her life had a serenity and depth that
affected everybody—even the man who came to pick up her corpse; he heard the
story, shook his head, and said, “that’s the way I want to go.”





She said farewell to her friends, she resolved three
unfinished pieces of business, and then, on the eighth day of her fast, she
fell into a coma.





And died three days later.





Death changes us all. And a mother’s death has a special
power.





“You’re the best writer in the family,” she had once said to
me. And so, when the ax fell and I lost my job, I did what the family
does—write.





I wrote a 35-page manual called Cheat the Nursing Home
on the process—step by step—of doing what she had done. I wrote a memoir  called Life, Death and Iguanas  on her life and death.





Mostly, I thought about the life she had lived, and the
lives she had left.





She had always stirred around, been active in the community,
given more than she had taken. And so she would want me to tell you—there’s a
comfortable, legal, morally-acceptable way to die.





And no, you don’t have to suffer the indignity of a nursing
home. You can do it as I did it: at home, with your family and pets beside you,
at the time of your choosing.





You can have a great death.




Thứ Ba, 8 tháng 1, 2013

Legal Briefing: POLST: Physician Orders for Life-Sustaining Treatment



With Melinda Hexum, I just published "Legal Briefing: POLST: Physician Orders for Life-Sustaining Treatment." in The Journal of Clinical Ethics 23, no. 4 (Winter 2012): 353-76.  Here is the abstract:



This issue’s “Legal Briefing” column covers recent legal developments involving POLST (physician orders for life-sustaining treatment.)  POLST has been the subject of recent articles in JCE. It has been the subject of major policy reports and a recent New York Times editorial.  And POLST has been the subject of significant legislative, regulatory, and policy attention over the past several months.  These developments and a survey of the current landscape are usefully grouped into the following 14 categories:

1.   Terminology

2.   Purpose, function, and success

3.   Status in the states

4.   Four legal routes of implementation

5.   Which professionals can authorize POLST?

6.   Is the patient’s signature required?

7.   Can surrogates consent to for incapacitated patients?

8.   If a POLST conflicts with an advance directive, which prevails?

9.   Is offering POLST mandatory?

10.  What are the duties of healthcare providers?

11.  What is the role of electronic registries?

12.  What is the role of the federal government?

13.  International adoption

14.  Court cases





Thứ Hai, 7 tháng 1, 2013

2013 ASBH Call for Proposals


The 2013 ASBH Call for Proposals is now open.  The 2013 ASBH conference will be held in Atlanta, Georgia.  Details regarding the call can be found on the ASBH homepage. There you will find a link to the abstract submission site as well as a PDF containing the submission guidelines, including instructions for the Student Paper Competition. ASBH is accepting abstracts until 4:00 pm (CST), March 4, 2013.  





The theme for the 2013 ASBH meeting, "Tradition, Innovation and Moral Courage," encourages participants to respond to the ways bioethics is inspired and shaped by various moral traditions, beliefs, and methodological approaches, as well as how these very traditions and practices become the foci of contemporary bioethical work bearing on moral progress and moral "innovation."  This year's ASBH theme invites members to reflect on the dialectic among moral traditions, moral inquiry, and moral innovation, and the ways that cultures identifying themselves as morally progressive might conceptualize the meaning and role of moral courage in realizing that progress.  



Thứ Năm, 3 tháng 1, 2013

Phillip Seaton Loses Case against Physician who Amputated Penis without Consent

The Kentucky Court of Appeals just issued its opinion in Seaton v. Patterson.  Seaton had sued Patterson for battery, claiming that the physician amputated his penis without consent.  Seaton claimed he consented only to a circumcision.  But a jury determined that Dr. Patterson had Seaton's consent.  The appellate court found no error in the trial proceedings.  



I am following this type of medical battery case to round out the authority in my forthcoming article:  "Clinicians May Not Administer Life-Sustaining Treatment without Consent: Civil, Criminal, and Disciplinary Sanctions."  


Thứ Tư, 2 tháng 1, 2013

Does the Concept of 'Medical Futility' Help Clinicians?




On Tuesday, Feb 5, from noon to 1:00 PM, Children’s Mercy Bioethics Center is hosting a webinar on the topic:  "Does the Concept of 'Medical Futility' Help Clinicians?"





Speakers:




  • Robert D. Truog, MD, Professor of Medical Ethics, Anaesthesiology & Pediatrics at Harvard Medical School

  • Robert L. Fine, MD, Clinical Director, Office of Clinical Ethics and Palliative Care, Baylor Health Care System

  • Thaddeus Mason Pope, JD, PhD Director of the Health Law Institute and an Associate Professor of Law at Hamline University.





Should doctors and nurses be obligated to provide treatments that they deem futile? How precise must determinations of futility be in order to ground unilateral decisions to withhold life-sustaining treatment? What rights do patients and families have to determine what treatments should or should not be provided? What should the law or public policy say about such decisions?





These three experts will briefly explain their own approach to futility cases, respond to each other, and take questions from the audience. 


The webinar is free but you must register here.




Prevention vs. Treatment - Book of the Year




A
book to which I  contributed chapter 10, "The Slow Transition of U.S. Law Toward a Greater Emphasis on Prevention,"
 was just named as one of Washington Post Wonkblog's "Books of
the Year."  
The book is Prevention vs.
Treatment: What’s the Right Balance?
 By (Halley Faust and Paul
Menzel  eds., 
Oxford
University Press, Oct. 2011).





Sarah Kliff writes:  "I spent a good part of this year writing a three-part series on the health-care law’s Prevention and Public Health
Fund, the Affordable Care Act’s $15 billion investment in preventing costly
diseases before they occur. I found Faust and Menzel’s book a hugely helpful
frame for thinking about how public dollars are spent in health care and better
understanding how the two interact."




Thứ Ba, 1 tháng 1, 2013

Poker Alice - Early Case of Overtreatment at Patient's Demand

Alice Ivers Duffield Tubbs Huckert (1851–1930), better known as "Poker Alice," was a famous poker player who talked her doctors into performing what they though was non-indicated surgery.



Poker Alice fit right in with the whiskey-swilling, cigar-smoking men who frequented the poker tables of the Old West.  She soon started swearing like the men, drinking tumbler after tumbler of whiskey and even adopted her trademark habit of continual cigar smoking. She traveled from boomtown to boomtown, exhausting the wallets of the men she played with.   



In 1930, physicians told Alice that if she were not so old, they would recommend that she have gall bladder surgery, but now they couldn't take a chance.  A life-long gambler, Alice said she was not about to stop rolling the dice now.  She instructed the surgeons to proceed with the surgery in hopes that the procedure would improve her health.  "I've been taking chances all my life.  Go ahead and operate.  I never could abode a player that bluffed out in the first round."  Unfortunately, Poker Alice lost.  The surgery was not successful and she died two weeks later.