Aid-in-Dying May Be Legalized in 7 More States

Compassion & Choices is engaged in "seven dynamic state-based campaigns" to legalize aid-in-dying. 

1.  Massachusetts, where we could pass a law to fulfill the promise of last year’s ballot measure. We have majority support and an army of motivated citizen activists behind our efforts

2.  Vermont, where I can report that the Senate approved an aid-in-dying bill just last week! Now we must rally grassroots support behind Patient Choices Vermont to help them get it through the House and to the governor, who has promised to sign it.

3.  New Jersey, where our staff is building support for a strong bill that made it out of committee and is set for a full Assembly vote very soon. Similar legislation is before the state Senate as well.

4.  Connecticut, where an aid-in-dying bill will likely have its first committee hearing in March. State-based staff and volunteers are busy throughout the state building critical coalitions and preparing citizens to show legislators their support.

5.  New Mexico, where we seek a legal ruling that the state’s statute against “assisting suicide” does not cover the medical practice of aid in dying. Such a ruling would allow us to safely weave that medical practice into the healthcare expectations of New Mexicans and the standard of care practiced by supportive doctors.

6.  Montana, where we are currently fighting to stop a bill in the legislature that would send doctors to prison if they provide aid in dying to their terminally ill patients who request it.

7.  Hawaii, where we continue to expand our work to make aid in dying legally accessible to terminally ill patients and define it as a medical practice governed by broadly accepted medical standards of care.

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Texas Advance Directives Act - Five New Bills

As of a few days ago, there were just two bills proposing amendments to the Texas Advance Directives Act.  Now there are seven.  



In the past two days, the following were introduced:  H.B.1444 (King); H.B.1455 (Kilck); H.B.1464 (Hughes); H.B.1539 (Perry); and S.B. 675 (Hancock).  The Hughes and Perry bills, on a quick first read, appear to be the most dramatic limitations or eliminations of clinicians' current right to refuse life-sustaining treatment.  

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AABHL Conference 2013

The Australasian Association of Bioethics and Health Law (AABHL) is Australia and New Zealand’s leading organisation concerned with issues of bioethics and health law.  Its annual conference will be July 11 to 14, at the University of Sydney.  Judging by the 2011 AABHL conference that I attended, this should be a most valuable and enjoyable meeting.

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Resuscitated Despite POLST

A hearing before a Washington State Senate Committee yesterday revealed that, without immunity, healthcare providers are reluctant to comply with POLST and resuscitate residents contrary to their wishes.    



Washington probably should provide immunity for good faith compliance with POLST.  But even if the absence of such immunity, it is probably legally safer to comply with the POLST than to ignore the POLST.   In this in-progress article, I am trying to show that administering unwanted life-sustaining treatment is not a legally safe approach.

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2013 Health Law Scholars Workshop - CFP

The Center for Health Law Studies at Saint Louis University and the American Society of Law, Medicine & Ethics (ASLME) have announced the 2013 Health Law Scholars Workshop.  If you are a junior law professor in health law, you really should do this. 



The Health Law Scholars Workshop is a collegial forum in which junior faculty who are new to health law and bioethics scholarship present works-in-progress and receive in-depth advice from experienced scholars and teachers in the field of health law and bioethics.  The workshop encourages health and bioethics scholarship, fosters the professional development of emerging scholars and furthers the sense of community among health law academics. Past scholars have placed their papers for publication in preeminent law journals.



Scholars workshop their work-in-progress before a group of experienced peer reviewers and commentators. Each author’s work-in-progress accepted for the Health Law Scholars 

Workshop will be read in advance by several faculty members in relevant fields. D uring the workshop weekend, each author presents his or her paper to the full group. After extensive oral 

feedback from the readers, the floor is opened for a sustained exchange between the presenter and full group. The workshop draws health law and bioethics scholars from across the country, inviting senior faculty from a variety of law schools and disciplines to review the works-in-progress and participate in the weekend.



APRIL 1 Submission of Abstracts for Consideration

MAY 17 Notification of Selection of Workshop Scholars

SEPT. 3 Works-in-Progress Due

OCT. 10-12  Scholars Weekend

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Robert Lawrence v. Denver Health Medical Center: Impostor Surrogate Removes Life-Sustaining Treatment for Money

Felicia Lawrence charges that clinicians at the Denver Health Medical Center removed her father from life-sustaining medical treatment at the direction of a relative who was not authorized as surrogate decision maker.  This relative apparently acted to transfer assets from the patient.  

There are several other cases across the United States involving allegations of a purported surrogate hastening a patient's death for selfish financial reasons, for example: the Van Note case in Kansas City and the Norval case in Southern California.  The hospital in all these cases is probably protected from liability, unless it can be shown that its clinicians did not have a "good faith" belief in the authority of the surrogate.

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Advanced Life Extending Technologies in DC, MD, VA

The MedStar Washington Hospital Center is hosting the Annual DC, MD, VA (DMV) Regional Hospital Clinical Ethics Conference on March 29, 2013:  "Advanced Life Extending Technologies in the District, Maryland, and Virginia (DMV) Region."





Description



This CME accredited one-day conference on clinical ethics is focused on hospital clinicians and other professionals throughout the DC, MD, and VA (DMV) metropolitan region. Most hospitals have ethics committees made up of physicians, nurses, social workers, chaplains, clinical ethicists and other clinicians and administrators who address the clinical ethics needs of their own institution. This one day annual meeting brings together members of these hospital ethics committees and other health professionals to 1) establish a regional network of hospital professionals dedicated to elevating the quality of clinical care within each institution, 2) to work together to develop solutions to common ethical problems and 3) to determine whether such a network will improve the ethical quality of healthcare. show less



Objectives

• Design a self-education program for their hospital’s ethics committee to assure that all members are able to identify the values uncertainty or conflict issues as well as barriers to improving EOL care in their own hospital.


• Evaluate the current EOL education programs at each institution and design an evidence-based educational intervention to address the EOL clinical ethics education needs of its own clinicians.


• The ability to help physicians and patients recognize the need for upstream EOL discussions and for ethics committee members to be able to lead and/or participate in such discussion with patients, families, and the medical team.


• Evaluate the hospital’s policies that have explicit EOL ethics implications and either create or revise the policies to improve EOL practices.

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Second Bill to Amend Texas Advance Directives Act

I recently wrote that, in late January, a bill was introduced in the Texas Senate that would improve the fairness and transparency of those provisions in the Texas Advance Directives Act that permit clinicians to unilaterally withhold or withdraw life-sustaining treatment (without patient or surrogate consent). 

Yesterday, a virtually identical bill, H.B. 1444, was introduced in the Texas House.  Expect more bills to be introduced over the coming weeks.  

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Patient Decision Aids

My next “Legal Briefing”column, coming out soon in 24(1) Journal of Clinical Ethics, covers recent legal developments involving patient decision aids.  

This topic has been the subject of recent articles
in JCE.  It is included in the 2010 Patient Protection
and Affordable Care Act.  And it has been getting significant attention
in the biomedical literature, including a new book, a thematic issue of Health Affairs, and a recent article in the New England Journal of Medicine.  Moreover, physicians and health systems
across the United States are increasingly integrating decision aids into their clinical
practice.  Both federal and state laws play a
significant role in promoting this expanded use.  

In this “Legal Briefing” column, we categorize legal developments concerning patient
decision aids into the following five sections:

1.  Development of Decision Aids

2.  Effectiveness of Decision Aids

3.  Federal Regulation of Decision Aids

4.  State Regulation of Decision Aids

5.  Legal Concerns Regarding Decision Aids

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Dialysis for a 101-Year-Old Patient?

The February 2013 issue of Clinical Kidney Journal has a case report from Israel describing a 101-year-old male patient with chronic kidney disease, admitted to the ICU with exacerbation of heart failure and sepsis. He experienced acute deterioration of renal function, with oliguria and acidosis. 



The patient's healthcare proxy insisted that dialysis be initiated despite his extremely advanced age, citing the patient's devout religious beliefs. He underwent 56 dialysis treatments over the course of ∼4 months after which he died as a result of septic and cardiogenic shock. 



The authors suggest that their case may represent "the oldest individual ever reported to start haemodialysis." It illustrates the "ever-growing clinical and ethical challenges posed by the treatment of renal failure in the geriatric population."  Indeed, while dialysis historically began as treatment intended for younger patients, it has, over time, increasingly been extended to treat elderly patients with a high comorbidity burden. Data on the outcomes of dialysis in these patients show that in some cases it confers no benefit and may be associated with functional decline.   

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Rep. Blumenauer to Re-introduce Bill for Medicare Coverage of VACP

Representative Earl Blumenauer has been a major proponent of federal legislation to improve informed consent regarding end-of-life medical care.  As I blogged about in 2009 (e.g. here, here, and here), 2010 (e.g. here, here), and 2012 (e.g. here), Blumenauer has introduced bills that would increase Medicare coverage for voluntary advance care planning and provide grants for POLST programs.

Yesterday, the Oregonian reported that "despite the political beating the Oregon Democrat took last time, despite the blistering accusations that he wanted to set up so-called death panels and "pull the plug on Grandma," he's ready for another try."  

In a bill that Blumenauer plans to introduce by spring, "Medicare and Medicaid would pay for voluntary consultations between doctors and patients about end-of-life wishes. The bill would also provide grants to promote "physician orders for life-sustaining treatment," a type of advance directive that spells out specific preferences for medical care."

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National Healthcare Decisions Day - 2 Month Countdown

The 6th annual National Healthcare Decisions Day is two months from today, on April 16, 2013.  

Here in Minnesota, Hamline University School of Law is partnering with William Mitchell College of Law to sponsor two clinics, one at WMCL and one at the MS Society.  Other organizations across the state will also be doing education and planning.  

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A Matter of Life and Death, What Are the Choices?

The California State Assembly's Committee on Aging and Long Term Care will hold hearings on Tuesday, Feb. 19, titled "A Matter of Life and Death, What Are the  Choices?"  You can listen to the hearing through the legislature's website.

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Life Sustaining Treatment Withdrawn too Soon?

Research presented a few days ago at the International Stroke Conference suggests that life-sustaining treatment may be withdrawn from patients with intracerebral hemorrhage who may have had an "acceptable clinical outcome" had their treatment been sustained.



At hospital discharge, 4% of the patients who were to have life-sustaining measures withdrawn had an "acceptable clinical outcome" (a modified Rankin Scale score of 4 or better).  The study suggests that "self-fulfilling prognostic pessimism" could play a role in decisions surrounding life support.

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Death or Disability? The 'Carmentis Machine' and Decision-Making for Critically Ill Children

In ancient Rome parents would consult the priestess Carmentis shortly after birth to obtain prophecies of the future of their newborn infant. Today, parents and doctors of critically ill children consult a different oracle. Neuroimaging provides a vision of the child's future, particularly of the nature and severity of any disability.  Based on the results of brain scans and other tests doctors and parents face heart-breaking decisions about whether or not to continue intensive treatment or to allow the child to die. 



In this new book from Oxford University Press, paediatrician and ethicist Dominic Wilkinson looks at the profound and contentious ethical issues facing those who work in intensive care caring for critically ill children and infants.  When should infants or children be allowed to die?  How accurate are predictions of future quality of life?  How much say should parents have in these decisions?  How should they deal with uncertainty about the future?  He combines philosophy, medicine and science to shed light on current and future dilemmas.



Here is the table of contents:



Prologue 1: The temple of Carmentis 30AD

Prologue 2: The Carmentis Machine: 2030 AD

Introduction: Neuroethics and intensive care

1: Destiny, disability, and death

2: Best interests and the Carmentis machine

3: Starting again

4: Competing interests

5: Sources of Uncertainty—prognostic research

6: Managing uncertainty

7: Interests and uncertainty

8: The Threshold framework

Index

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2013 ASBH Call for Proposals

There is still time to submit your abstract to for the 2013 Annual Meeting of the American Society of Bioethics & Humanities (ASBH).  The meeting will be held from October 24-27, 2013 at the Hilton Atlanta, in Atlanta, GA. The theme for the 2013 Annual Meeting is: "Tradition, Innovation, and Moral Courage."

Details regarding the call for proposals 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.

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Alan Cargill - Another British Unilateral DNAR Order

Alan Cargill was being treated for cancer of the inner chest wall and a blood clot at the University Hospital of North Durham.  During his stay a doctor approached him and told him that he would not be revived if he took a turn for the worse.  "This doctor came to see me and informed me that I wouldn't be brought around again if anything happened. I would just be left."  Mr Cargill said the doctor gave him a form prominently marked "Do Not Resuscitate" and walked away.  (Daily Mail)  "He terrified me, to be truthful."

Katherine Murphy, Chief Executive of The Patients Association, said: "The use of DNAR orders is understandably a sensitive and deeply distressing issue.  Sadly, there have been far too many cases where healthcare professionals have failed to facilitate proper conversations with relatives and patients about how, when and why a DNAR order may be used."  

In this case, there may not have been adequate discussion about about why a DNAR order would not be issued.  But, at least in contrast to other recent cases, the patient was informed of the order.  Unilateral DNAR orders are not automatically or categorically inappropriate.  But they are inappropriate when issued without adequate transparency and compassion.  

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Medical Futility: Useful Tool or Dangerous Weapon?

"Medical Futility: Useful Tool or Dangerous
Weapon?"  Good title for a free noon CME this Thursday at Wake
Forest Baptist Medical Center.

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Georgia Legislation Proposes Novel Negligent Error Compensation System

On a first read, I like S.B. 141, just introduced in Georgia.  If enacted, this legislation (the "Patient Injury Act') would establish an alternative to medical malpractice litigation "whereby patients are fairly and expeditiously compensated for avoidable medical injuries."

Basically, a new "Patient Compensation System" agency would appoint "independent medical review panels" to determine whether a claimant has a "medical injury."  The panels will be comprised of an odd number of at least three multidisciplinary panelists.  The bill has substantial detail on claim procedures and on the internal operation of the new agency.

 

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Grace Lee Won Right to Die but Dies from Non-deliberate Cause

Grace Lee, who had a very public court battle, in October, with her parents over her right to die, has died, apparently due to a ventilator malfunction.

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Teleconference Explores Ethical Issues Surrounding CANH at End-of-Life

The St. Cloud, Minnesota Hospital Education Department will host the Hospice Foundation of America annual teleconference: Artificial Nutrition & Hydration at the End-of-Life on Wednesday, Feb. 20, from 1:00 to 4:45 p.m. at CentraCare Health Plaza, in the Windfeldt room. Registration begins at 12:30 p.m.

Artificial nutrition and hydration is the most common ethical dilemma at end-of-life care. This educational program will explore medical, legal, ethical issues and communication barriers that surround artificial nutrition and hydration. It will emphasize the need to have clear and transparent policies and communication regarding artificial nutrition and hydration to minimize misunderstandings and discord as well as moral distress and anguish for patients, family members and staff.

This event is designed for health care professionals, including nurses, chaplains, social workers, volunteers, nursing home staff, clergy, parish nurses, home health aides, caregivers and those working with death, dying, grief or bereavement, and anyone interested in end-of-life care.

• Cost is $30. Snacks and beverages will be provided.


• Contact Hour Information: This education offering has been designed to meet the Minnesota Board of Nursing continuing education requirements for 3.6 contact hours.


• Registration deadline is Friday, Feb. 15. For more information or to register, please contact the Education Department at (320) 251-2700, ext. 55642

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Medical Futility - Case of a Horse

I happened across this clip tonight.  It shows a veterinarian who concludes that a horse is dying and has an irreversible condition that is causing it enormous suffering.  The "surrogate" rejects the diagnosis and threatens to sue the vet.  He feels responsible for the horse's condition, for not calling the vet sooner when something might have been done.  Notwithstanding these objections, and in contrast to medicine for human beings, the vet proceeds to do what he thinks medically appropriate.

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Michigan Bill Requires Futility Policy Transparency

In October, I noted that Michigan had introduced a bill that would require hospitals to disclose their medical futility policies.  Yesterday, a similar bill was introduced. S.B. 165 imposes just two requirements:

1. A
   health facility or agency shall not establish or maintain a medical futility
   policy unless that policy is in writing.


2. A
   health facility or agency that maintains a medical futility policy that applies
   to the treatment of a patient or resident from birth to 18 years of age shall,
   upon request, provide a copy of that medical futility policy to the patient or
   resident, prospective patient or resident, or parent or legal guardian of the patient or resident or prospective patient or resident.

 

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Hospice Use Rises; So Does Aggressive Care

Joan Teno and her coauthors' analyzed the Medicare fee-for-service records of more than 840,000
people aged 66 or older who died in 2000, 2005, or 2009.  They looked at
where seniors died, what medical services were provided during their last 90
days of life, and how long they received them.  

In the latest issue of JAMA (free download), Teno et al. report that while more seniors are dying with hospice care than a decade ago, they
are increasingly doing so for very few days right after being in intensive
care. “For many patients, hospice is an ‘add-on’ to a very aggressive
pattern of care during the last days of life."  “

The consequence of this pattern of
going from the ICU to hospice is that "these dying patients are getting symptom control
late and can’t benefit as much from the psychosocial supports available were
there a longer hospice stay."  The authors blame both poor
communication and financial incentives.  

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Clinicians May Not Administer Life-Sustaining Treatment Without Consent: Civil, Criminal, and Disciplinary Sanctions

I have posted a DRAFT of my article, "Clinicians May Not Administer Life-Sustaining Treatment Without Consent: Civil, Criminal, and Disciplinary Sanctions."  This is forthcoming in Suffolk's Journal of Health & Biomedical Law.  I would greatly appreciate your comments and criticism.  Here is the abstract.  



Both medical and legal commentators contend that there is little legal risk for administering life-sustaining treatment without consent. In this Article, I argue that this perception is inaccurate. First, it is based on an outdated data set, primarily damages cases from the 1990s. More recent plaintiffs have been comparatively more successful in establishing civil liability. Second, the published assessments focus on too-limited data set. Even if the reviewed cases were not outdated, a focus limited to civil liability would still be too narrow. Legal sanctions have also included licensure discipline and other administrative sanctions. In short, the legal risks of providing unwanted life-sustaining treatment are not as rare, meager, and inconsequential as often depicted. In fact, sanctions for administering unwanted treatment are significant and growing.

In Section II, I quickly summarize the now well-established legal bases for the right to refuse life-sustaining treatment. In Section III, I demonstrate that clinicians regularly breach their duty to respect patients’ right to refuse. In addition to reviewing the literature, I summarize key statistical measures establishing the size and scope of the problem. Fortunately, the reports are not all bad. The prevalence of unwanted life-sustaining treatment may be shrinking with the increasing implementation of POLST. Still, the problem remains significant. 

In Section III, I identify twelve leading factors that cause clinicians to administer unwanted life-sustaining treatment: (a) inadequate advance care planning, (b) clinician misinterpretation of and confusion on advance directives, (c) uncertain validity of advance directives (d) uncertain application of advance directives, (e) demanding and conflicting surrogates, (f) uncertain status of the surrogate decision maker, (g) decision making capacity; (h) inadequate informed consent, (i) negligent maintenance of medical records, (j) vitalistic philosophy of medicine, (k) conscience-based objections, and (l) financial incentives.

In Section IV, I establish that clinicians think administering unwanted life-sustaining treatment entails little legal risk. This perception is based on three main factors. First, clinicians are often able to obtain injunctions and guardianships authorizing treatment. Second, the salience of unsuccessful cases for damages makes it appear that administering unwanted treatment entails little legal risk. Third, this perception is bolstered by the visibility of four legal obstacles to liability: (a) the rejection of the “wrongful living” cause of action, (b) the emergency exception to the consent requirement, (c) safe harbor immunity under healthcare decisions acts, and (d) conscience clauses.

Finally, in Section V, I demonstrate that this “no risk,” “low risk” perception is wrong. I show how health care providers have been increasingly subject to sanctions for administering unwanted life-sustaining treatment. I review nine theories of civil liability: (a) battery, (b) informed consent, (c) negligence, (d) intentional infliction of emotional distress, (e) negligent infliction of emotional distress, (f) breach of contract, (g) health care decisions statutes, (h) POLST statutes, (i) Section 1983, and (j) the False Claims Act. I also review administrative sanctions and criminal liability. Furthermore, not only have providers been sanctioned but also with recent increased patient protections, they are likely to be increasingly sanctioned. 

The right to refuse life-sustaining treatment has been established for decades. But, as with many principles in bioethics, like the related doctrine of informed consent, there remains a wide chasm between legal and ethical principles, on the one hand, and the reality of clinical practice, on the other. In contrast to other commentators, I have aimed to establish that the prospect for enforcement and protection of patient rights is not as dismal as commentators often depict. In fact, both private litigants and government regulators have been imposing sanctions that are increasingly severe and frequent.

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New Report: Strategies for Dispute Resolution when Expectations and Limits of Treatment Collide

The Community Ethics Committee is a Boston-based group of 19 who provide feedback on medical ethics policies to the Harvard teaching hospitals.  But the CEC does more than just this.  It also has an active blog.  And it prepares reports on medical ethics issues.  



The CEC just released its latest report titled "Strategies for Dispute Resolution when Expectations and Limits of Treatment Collide."  

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Free Webinar - Does the Concept of 'Medical Futility' Help Clinicians?

Tomorrow, at noon, Children's Mercy Bioethics Center will present the next webinar in its world class series.  Tomorrow's session is titled "Does the Concept of 'Medical Futility' Help Clinicians?: A Debate Between Truog, Fine, and Pope"  I have posted a handout copy of my slides here.

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Physician, Which Patients Will Sue You?

An article in today's American Medical News reviews what types of patients are more lawsuit prone.  And it offers some strategies for addressing legally risky patients.  



One risk factor identified is:  "If people beg for a procedure or demand treatments, that should raise a red flag . . . .  [T]he patient who is very demanding about what they want and expect you to give them, ‘or else,’ puts you on guard.”

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Medical Practice Guidelines and the Legal Standard of Care

On
Thursday, March 7, 2013, Hamline University's Health Law Institute welcomes
Maxwell Mehlmann, the Arthur E. Petersilge Professor of Law and Director of the
Law-Medicine Center, Case School of Law, and Professor of Biomedical Ethics,
Case School of Medicine.

5:00 – 6:00 p.m. Presentation and Q&A

6:00 - 7:00 p.m. Reception

Anderson Center, Room 111/112

American medicine has long fought to control the standard of care
that physicians are expected to provide to their patients. It has waged
battles on two fronts: against internal disagreements within the
profession over what constitutes proper care, and against attempts to
delineate the standard of care by forces outside the profession, such as
private health insurers, the government, and the judicial system.

In the early 1990s, forces within American medicine mounted an
unprecedented attack on both fronts, pushing for laws permitting
designated professional medical associations to articulate “medical
practice guidelines” that would define the standard of care, and more
importantly, that would serve as “safe harbors” so that physicians who
demonstrated that they had complied with the guidelines would be
protected from malpractice liability. The 1990s initiative was a failure,
but the safe harbors notion has once again resurfaced, buoyed by
expectations that new “evidence-based” medical practice guidelines will be
able to overcome the obstacles that prevented earlier success.

This presentation begins by describing the historical power struggle waged
by medicine over control of the standard of care. It then describes the
safe harbors concept and its historical background. Next, the presentation
critically analyzes the safe harbors approach and explains its scientific
weaknesses. The presentation then places the safe harbors concept in the
context of medicine’s historic power struggles.  The presentation
concludes by defining the appropriate role for practice guidelines
in malpractice disputes.

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Texas Advance Directives Act - Bill Aims to Improve Procedural Due Process

Just as in the 2007, 2009, and 2011 Texas legislative sessions, the 2013 session is sure to see a number of bills directed at amending section 166.046 of the Texas Advance Directives Act.  



The first of these bills (S.B. 303) was introduced yesterday by Senator Robert Deuell.  Deuell is a Republican and a physician.  In past sessions, his bills were among the best.  The instant bill will preserve the functionality of the 166.046 dispute resolution provision but improve its fairness.  For example, the bill would:

• Increase the notice period for the HEC meeting from 48 hours to one week.


• Increase the waiting period between the HEC decision and implementation (the transfer period) from 10 to 14 days.

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Definition of "End of Life"

Stephen
Drake, a well-informed advocate for Not Dead Yet, posted the following comment to my
post on Wednesday, "Minnesota 's Four
Pending End-of-Life Cases."  It is a good question, and I will
respond to it here.

I've
probably asked this before, but could you give me a concise definition for
"end of life" that covers all of these cases? Numbers 1 and 4 are
pretty standard - involving guardianship in the first (although some cases in
other states have involved withholding treatment from people under guardianship
expected to recover) in number 1 and ramifications of advance directives in
number 4.In number 2, in which you used scare quotes
around 'encouraging', a man was accused of having a hobby of sorts - assuming a
different identity, seeking out suicidal young people, and yes - encouraging
them to commit suicide, even advising means.Number 3 involves the Final Exit Network - which
facilitates the suicides of nonterminally ill people and even cleans up the
death scene to make it look like a natural death. At least one of the
defendants - Lawrence Egbert - admitted in an interview that he often supplies
used plastic bags for suicides to save 'clients' the expense.What single concise definition of 'end of life'
covers all of these situations? Is it expansive enough to cover the decision of
a death row inmate to halt appeals on her behalf?I'm genuinely fascinated - is there some sort of
logic in terms of what gets deemed 'end of life' and what gets called
'something else/?

I follow a great deal of professional, academic,
and popular literature that uses the noun "end of life" or adjective "end-of-life."  Most
of it uses the term to reference a consistent set of situation domains.
 Personally, I use the term to refer to situations in which decisions are made about whether to hasten or prolong life in the face of serious injury or illness.   

Yes, the Melcher-Dinkel case itself does not fit within this definition.  Indeed, it was not an "end-of-life" case back when he was convicted.  But the case is now before the state's highest court.  That court's interpretation of the assisted suicide statute and analysis of its constitutionality will affect not only Melchert-Dinkel but also others like FEN and Compassion & Choices.

The work of FEN fits within my definition.  While FEN does not limits its assistance to "terminally Ill" patients, it focuses on helping patients with serious injuries or advanced chronic diseases like cancer, ALS, AIDS, multiple sclerosis, or advanced Alzheimer’s.

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