Reading Hospital Resolves Futility Dispute by Replacing Guardian

In March 2012, Russell Border was admitted to the ICU at Reading Hospital and Medical Center. As a patient in the ICU, doctors placed Mr. Border on a mechanical ventilator and other forms of life-sustaining treatment. During this time, Mr. Border's treating physician and other Hospital personnel contacted his court-appointed guardian, Sharon Gray, explaining that Mr. Border's health condition was both terminal and futile.  (The court's...

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TS & DS v Sydney Children's Hospital Network (" Mohammed 's case")

I was updating my collection of adjudicated medical futility disputes when I noticed that I forgot to post a case decided at the end of 2012:  TS & DS v Sydney Children's Hospital Network (" Mohammed 's case").  In this case, the New South Wales Supreme Court refused a parental request for a terminally ill baby to be placed on a mechanical ventilator.  The nine-month-old baby, Mohammed, was severely brain-damaged, deaf and blind....

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Joanne Lynn on Comfortable & Meaningful End of Life

Joanne Lynn, MD, is a geriatrician, hospice physician, health services researcher, quality improvement advisor, and policy advocate.  She leads the Altarum Institute Center on Elder Care and Advanced Illness.  In this brief video, Dr. Lynn focuses onShaping American health care so that every person can count on living comfortably and meaningfully through the period of serious illness and disability in the last years of life, at a sustainable cost to the communityWhy are we still using 20-year-old SUPPORT data to guide end-of-life...

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Oklahoma Prohibits Critical Care Clinicians from Stopping Requested Life Support

On Friday. Oklahoma Governor Mary Fallin signed House Bill 1403.  This measure is aimed at preventing health-care providers from denying possibly life-extending treatment based on the patient's quality of life.  This makes Oklahoma join Idaho, New York, and other states that I have been calling "red light" states.Critics of H.B. 1403 said it would make for bad medicine, drive doctors from the state and increase uncompensated medical costs. Supporters said it would prevent the denial of care based on the view of a third...

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Online Capacity Assessment Curriculum for Clinicians

Rush University Medical Center’s online capacity assessment curriculum for clinicians is beginning a new enrollment session on May 13.  CME, CEU and CME credits are available.The curriculum features six modules:The importance of evaluating patients’ capacitiesKey principles and practicesThe evaluation process and contentSpecific capacities and situationWhen to conduct an evaluation yourself and when to referWorking with courts in guardianship proceedingsThe curriculum also includes videos, a pocket reference card, a glossary, and a resource...

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Burke Balch on Risks in Texas S.B. 303

Balch and NRLC seem to take a far more reasonable approach to analyzing this legislation than others accuse them of taking.  They are looking out for fairness and patient rights.  The Texas Catholic Conference, in contrast, is just concerned with whether the legislation is consistent with Catholic principles. &nb...

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Not Dead Yet Urges Federal Action on Medical Futility Laws & Policies

I was surprised to find myself in almost total agreement with these remarks that Diane Coleman made earlier this week to the independent federal agency, National Council on Disability.  As I have written, the process for unilateral refusal of life-sustaining treatment must be sufficiently fair.  Otherwise, the risk of bias (and corruption and arbitrariness) is unacceptably high.  I am not sure, as NDY is, that the risk has materialized.  But it should be mitigated nonetheless.I’m commenting today to urge NCD to take...

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Okla. H.B.1403 "Nondiscrimination in Treatment Act" Requires Futile Treatment

It looks like Oklahoma will be following Idaho in enacting a "Nondiscrimination in Treatment Act."  While the title of H.B. 1403 seems innocuous, the result is basically a mandate to provide surrogate-requested "life-preserving health care services" even when those services are non-beneficial or even harmful to the patient.  This bill passed the House in early March.  It passed the Senate two weeks ago.  It was sent to Governor...

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Equine Medical Futility - Case 2

A few weeks ago, I posted this clip of a medical futility dispute between a veterinarian and the owner of a horse.  Here is a clip from the same All Creatures Great and Small Series, depicting another vet trying to explain to another horse owner that medicine has nothing left to off...

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In re Border (Pa.) - Guardian vs. Advance Directive

Yesterday, the Berks County, Pennsylvania Court of Common Pleas issued this interesting opinion analyzing the authority of  a guardian to withdraw life-sustaining treatment when the patient has an advance directi...

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S.B. 303 Amendment to Texas Advance Directives Act Now in Texas House

Yesterday, the Texas House of Representatives received S.B. 303 from the Texas Senate.  On Thursday, the Senate passed S.B. 303 by a vote 24 to 6.  The engrossed version of the bill is available here.  If enacted, S.B. 303 would improve the "futility" provisions in the Texas Advance Directive Act, most notably by adding a reporting requirement.  But the bill fails to address the two most serious key fairness and procedural due process defects:  (1) the lack of a neutral decision make and (2) the lack of appellate revi...

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Futility Decisions Are Like Gestalt Integrations

Daan den Hollander, a clinician in the Burns Unit at Inkosi Albert Luthuli Central Hospital (South Africa) has published "Medical Futility and the Burns Patient" in Burns.  I liked this article, because so much of the debate over futility and non-beneficial care is focused on the ICU.  It is refreshing to examine the issues in a new context (burns).  I also liked the following excerpt on definitions.The philosopher Ludwig Wittgenstein once remarked that we cannot describe the sound of a clarinet, or the smell of a rose....

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Free End-of-Life Counseling

Compassion & Choices offers End-of-Life Counseling.  This is free, confidential, professional support anywhere in the country.  Compassion & Choices counselors will listen to your unique situation and answer your questions whether you want to improve the quality of life you have left, achieve a peaceful death or simply plan ahead.Over 100 expert staff and volunteers stand ready to serve in every state. We help with advance directives, local referrals, information and support on end-of-life care and decision making.  Call 800.247.7421...

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Tylenol Can Facilitate Advance Care Planning

Significant amounts of over-treatment in the United States are due to a persistent widespread failure to do advance care planning.  Most people do not want aggressive curative directed treatment at the end of life.  But most leave no instructions or informed surrogates to implement such wishes.  One reason for the lack of advance care planning is anxiety about discussing death.University of British Columbia researchers may have found...

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Legal Issues Concerning Withholding and Withdrawal of Dialysis

The dynamic Australian health law professor Cameron Stewart and a physician colleague have published "Legal issues concerning withholding and withdrawal of dialysis" in Nephrology.  The in-press article is available as a free download.  The article is a general overview of legal principles concerning healthcare decision making.  Among these, is some good analysis of medical futility.  For example:  "The law does...

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Medical Futility Policy Transparency

I have a new post on "Medical Futility Policy Transparency" at bioethics.n...

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Minnesota Court of Appeals to Decide Guardian Power to Stop Life Support

On October 18, 2012, the Hennepin County (MN) District Court issued a written opinion in In re Tschumy, holding that guardians under the court’s jurisdiction must ask the court for authorization to terminate life support.  That decision was appealed.  After some preliminary briefing on jurisdiction, the Court of Appeals has agreed to hear the case on the merits on May 15, 2013 at 10:40 a...

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Daughter Sues Florida Hospital for Failing to Implement DNAR Order

A lawsuit (docket here) filed in Polk County, Florida, earlier thismonth, alleges that LakelandRegional Medical Center failed to send a copy of MarjorieMangiaruca's DNAR order with her when it transferred her to OakbridgeHealthcare Center.  LRMC didn't tell the people transporting her to the nursing home that shehad a DNAR order and didn't alert the nursing home she was a DNAR patient.A few days after the transfer, Oakbridge nurses found Mangiaruca notbreathing and unresponsive.  What happened next should...

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New Medical Futility Cases

I have updated my collection of court and agency cases concerning medical futility disputes.  I have collected all the PDF documents together here. &nb...

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Death & Dying Cases Before the Minnesota Supreme Court - Part II

On Monday, May 13, the Minnesota Supreme Court will hear oral arguments in State v. Melchert-Dinkel. The issue is whether Minnesota Statutes section 609.215, subdivision 1, which criminalizes advising, encouraging, or assisting another to commit suicide, is unconstitutionally overbroad under the First Amendment.  In July 2012, the Court of Appeals held that the First Amendment does not bar the state from prosecuting a person for advising, encouraging, or assisting another to commit suicide by sending coercive messages to suicide-contemplating...

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Death & Dying Cases Before the Minnesota Supreme Court - Part I

This Wednesday, the Minnesota Supreme Court will hear oral arguments in State v. Smith.  A video of the arguments will be available here.  Here is a summary of the issues.Eddie Smith was driving a car at a speed of more than 50 miles per hour in a residential neighborhood when he hit another car in which 93-year-old Edith Schouveller was a passenger.  Smith had an alcohol concentration of .11 shortly after the accident. Schouveller’s spinal cord was fractured during the accident.  She spent 13 days in the hospital and was...

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Scary Frequent Violations of Patient Rights

Annette M. Browning's article in the March 2013 American Journal of Critical Care is about moral distress among critical care nurses.  But just look at this table summarizing the sources of this distress:  e.g. deception, inadequate consent.  These things happen with alarming frequen...

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Hospital Promises to "Cheat Death"

On Friday, North Carolina's CaroMont Health unveiled a new campaign "To Give Every Man, Woman and Child In Gaston County Every Opportunity To Cheat Death."  The announcement ended with this toast: "May you never lie, steal or cheat.  But if you must lie, lie with the one you love. If you must steal, steal kisses.  If you must cheat, cheat death."I have blogged before (e.g. here)about hospitals that promise miracles.  Suchrepresentations,...

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Transfer Resolves Medical Futility Case for Kesell Macias

A few days ago, I blogged that Scripps Mercy planned to stop life-Kesell Macias' life-sustaining treatment over the objections of his family.  Apparently, the hospital changed course.  It agreed to provide the family with a second opinion.  Now, Macias has been transferred to UC Irvine Medical Center.  The California Probate Code section that permits a health care provider to "decline to comply with an individual health care instruction or health care decision" also requires the provider to "make all reasonable efforts...

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Mindful Practice - Focus on Serious & Life-Limiting Illness

This looks like a valuable workshop in New York from May 1 to 4, with faculty Ron Epstein, Tony Back, Tim Quill, and Peter Sullivan.SummaryWith the aging of the baby boom generation, health care reform and advances in medical technology, clinicians face increasingly complex and difficult situations involving care of patients with serious and life-limiting illnesses. These illnesses, including but not limited to metastatic cancer, neurodegenerative diseases, heart failure and multi-organ failure, present both biomedical and personal challenges...

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6th International Symposium on Brain Death and Disorders of Consciousness

The 6th International Symposium on Brain Death and Disorders of Consciousness will be held, in Havana, Cuba, on December 3-6, 2013.  There are two main themes:BRAIN DEATHConceptual approach to human deathBD criteria in different countriesAncillary tests in BDAutonomic nervous system assessment in BDBD in childhoodAnencephalic infantsEnd-of-life dilemmas: terminal patient, euthanasia, assisted suicide, etc.Legal considerations surrounding BD and related statesPhilosophical, theological, sociological, historical and cultural considerations of...

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Minnesota Appeals Ruling that Assisted Suicide Statute Is Unconstitutional

Minnesota's criminal case against the Final Exit Network is proceeding to the court of appeals.  Back at the Dakota County criminal court in December, FEN argued that while the state may bar someone from “assisting” a suicide, it is unconstitutional for the state to ban merely “advising” or “encouraging” a suicide — as stated in the Minnesota statute — because that is pure speech.  In March, Judge Karen Asphaug found Minnesota’s law  unconstitutionally overbroad. She also narrowed the construction of the term “encouraging” to include...

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Clinicians Ignore Patients' EOL Preferences

In an alarming new report inJAMA Internal Medicine, researchers found that clinicians not only fail tosolicit patient treatment preferences at end-of-life, but even when those preferences are recorded, agreement between patients'expressed preferences for EOL care and documentation in the medical record wasonly 30%.  I address this from a legal perspective in this forthcoming law review artic...

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New Hospital Inspection Report Database by AHJC

A few months ago, I blogged about ProPublica's new tool for searching nursing home inspection reports.  Now, the Association of Health Care Journalists has launched a new website that makes federal hospital inspection reports easier to access, search and analyze.  The new site includes details about deficiencies cited during complaint inspections at acute-care and critical access hospitals throughout the United States since Jan. 1, 2011.  This effort follows years of advocacy by AHCJ to encourage federal officials...

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2014 World Federation Right to Die Societies (WFRTD) 20th Biennial Conference

Final Exit Network, host for the World Federation Right to Die (WFRTD) Societies Meeting, has announced the venue for the 2014 World Federation 20th Biennial Conference.  The date of the conference is September 17 to 21, 2014, Wednesday through Sunday, and it will be held at the Embassy Suites Downtown/Lakefront Hotel, Chicago, Illinois.The conference venue is the flagship hotel of U.S. Embassy Suites Hilton properties, an all-suites hotel with a sophisticated design concept and spectacular views of Chicago. All suites have a living room/work...

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National Public Health Week

The first week of April is National Public Health Week.  Paradigm public health issues include tobacco, obesity, and diabetes.   But many of the end-of-life issues (like persistently low rates of ACP) discussed on this blog are also public health issues.  They affect giant portions of the population, can be prevented, and can be addressed through community-wide interventio...

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Newsome v. Gunnels - Clinicians Win Medical Futility Case

A few weeks ago, the Alabama Supreme Court affirmed summary judgment in favor of a clinician in a medical futility dispute.  The parents of twins born at 22.5 weeks alleged that clinicians failed to undertake medical effort to save the babies or prevent their delivery.  The court did not issue a written opinion.  But it appears that the plaintiffs attempted to assert only a claim for intentional infliction of emotional distress (often not a bad strategy in such cases).  The defendants argued that this was really a medical malpractice...

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VSED in N.Y. Times

I was pleased to see the following brief commentary printed in yesterday's New York Times.There is a “better way to die,” and it is legal in all 50 states. It is commonly called Voluntary Stopping of Eating and Drinking or Patient Refusal of Nutrition and Hydration. My mother chose this way to end her life when she was informed that her chemotherapy and radiation treatment for oral cancer had failed and she faced a death marked by pain and occlusion of her windpipe by the tumor that grew in her jaw. She was depressed when she was told her prognosis,...

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