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 efforts2.  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...

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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. &nb...

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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 meeti...

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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...

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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...

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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...

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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."DescriptionThis 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...

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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. &nb...

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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 articlesin JCE.  It is included in the 2010 Patient Protectionand Affordable Care Act.  And it has been getting significant attentionin 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 systemsacross...

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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....

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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...

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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. &nb...

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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 websi...

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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...

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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...

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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...

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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...

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Medical Futility: Useful Tool or Dangerous Weapon?

"Medical Futility: Useful Tool or DangerousWeapon?"  Good title for a free noon CME this Thursday at WakeForest Baptist Medical Cent...

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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...

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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 malfuncti...

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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....

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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 appropria...

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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: Normal 0 false false false EN-US X-NONE X-NONE MicrosoftInternetExplorer4 w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true" DefSemiHidden="true" DefQFormat="false" DefPriority="99" LatentStyleCount="267"> w:LsdException Locked="false"...

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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 840,000people aged 66 or older who died in 2000, 2005, or 2009.  They looked atwhere seniors died, what medical services were provided during their last 90days 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,...

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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...

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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." &nb...

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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 he...

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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 guar...

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Medical Practice Guidelines and the Legal Standard of Care

OnThursday, March 7, 2013, Hamline University's Health Law Institute welcomesMaxwell Mehlmann, the Arthur E. Petersilge Professor of Law and Director of theLaw-Medicine Center, Case School of Law, and Professor of Biomedical Ethics,Case School of Medicine.5:00 – 6:00 p.m. Presentation and Q&A6:00 - 7:00 p.m. ReceptionAnderson Center, Room 111/112American medicine has long fought to control the standard of carethat physicians are expected...

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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...

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Definition of "End of Life"

StephenDrake, a well-informed advocate for Not Dead Yet, posted the following comment to mypost on Wednesday, "Minnesota 's FourPending End-of-Life Cases."  It is a good question, and I willrespond to it here.I'veprobably 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 arepretty standard - involving guardianship in the first (although some cases inother states have involved withholding treatment from people under guardianshipexpected to recover) in number 1...

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