DHHS Seeks Dementia Patient for Advisory Council on Alzheimer's Research, Care, and Services

HHS is soliciting nominations for a new, non-federal member of the Advisory Council on Alzheimer's Research, Care, and Services. Specifically, the position is for someone with a diagnosis of Alzheimer's disease or a related dementia. Nominations should include the nominee's contact information (current mailing address, e-mail address, and telephone number) and current curriculum vitae or resume. Nominations submitted within the past 6 months...

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Unilateral Medical Decision Making in Australia and New Zealand

In an article forthcoming in the Journal of Law and Medicine, Lindy Willmott, Benjamin White, and Jocelyn Downie examine the law in Australia and New Zealand that governs the withholding and withdrawal of ‘futile’ life-sustaining treatment.  The authors concluded that the general legal position is that doctors are able to determine unilaterally when treatment is futile and so need not be provided. This is either because futile treatment is not in a person’s best interests or because not providing such treatment does not breach the criminal...

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Defending Disability Discrimination

My latest blog post for AJOB's bioethics.net, "Defending Disability Discrimination," is available he...

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World Federation of Right to Die Societies - 2014 Conference

The World Federation of Right to Die Societies will hold its 20th conference from September 17-21, 2014 in Chicago.  The theme is "Dignity, Choice, Control around the World."  The Conference will highlight the universality of the death with dignity movement and the vitality of member organizations around the world.  The tentative schedule includes:Solutions for the elderly seeking a peaceful death New Zealand’s proposal for an...

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Therapeutic Obstinacy in an Intensive Care Unit: Perspectives from Doctors and Nurses

It appears that the medical futility debate in Brazil looks much like that in the United States.  I just read this article by Karla Cristiane Oliveira Silva and colleagues called "Therapeutic Obstinacy in an Intensive Care Unit: Perspectives from Doctors and Nurses" (2012 Escola Anna Nery Revista de Enfermagem 16(4): 697-703) (PDF here).Here is the abstract:Therapeutic obstinacy is not a sufficiently studied theme in Brazil, especially on the...

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Parents' Conscience vs. Clinician Conscience

Philadelphia prosecutors have charged Herbert and Catherine Schaible with 3rd degree murder after their son Brandon died when the parents turned to faith healing instead of medicine for highly treatable problems.  This is typical in these cases, because the parents exceed the scope of their discretion to determine best interests.  Interestingly, it seems that in some states a clinician could act on her conscience based objection.  That...

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Medical Futility: A Cross-National Study

This summer, World Scientific Publishing will release Iranian physician-bioethicist Alireza Bagheri's new book, Medical Futility: A Cross-National Study (Sept. 2013) (300pp).   Most of the current books (e.g. Schneiderman & Jecker 2011) on medical futility focus on the United States. This book provides extensive international perspectives, allowing healthcare professionals to see how different countries approach the issue...

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New CCB Futility Dispute: Rodrigues v. Sunnybrook

The Toronto Star reports on yet another futility dispute (the fifth by their count) at Sunnybrook Health Sciences Centre.  It was recently heard by the Ontario Consent & Capacity Board.  Joaquim Silva Rodrigues has been at the Sunnybook ICU since August 2012.After he was diagnosed with progressive supranuclear palsy two years ago, 73-year-old Rodrigues repeatedly told his family that he wanted to live. "Don’t let me die.  Stop...

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Council of Europe Seeks Input on Medical Futility Guidelines

The Council of Europe Committee on Bioethics has released for public consultation its "Draft Guide Concerning the Decision-making Process Regarding Medical Treatment in End-of-Life Situations."  The following sections are particularly relevant to medical futility.27. The implementation or continuation of any treatment requires a medical indication.However, other aspects must be taken into account when assessing whether a form of treatment...

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Michigan Medical Good Faith Provisions Act - Passes Senate & House

Earlier this week, the Michigan House passed S.B. 165.  It looks like the bill is now on its way to Michigan Governor Rick Snyder.  As I have explained elsewhere (e.g. here), this legislation does not really change hospitals' legal obligations.  The PSDA already requires almost every U.S. hospital to disclose its futility / non-beneficial treatment policies. Here are the provisions of the Michigan bill.  Oddly, it looks like...

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ICU Variability in Decisions to Limit Life Sustaining Therapies

Yesterday, at the ATS, Caroline M. Quill, MD, a fellow in Penn's department of Pulmonary, Allergy, and Critical Care at Penn Medicine, presented (and here) "Variation Among ICUs In Decisions To Limit Life Sustaining Therapies."Quill's team found substantial variation in decisions to forgo life-sustaining therapies rates among 153 ICUs in the United States.  This suggests that many factors unrelated to the patient or family may be affecting such decisions.  Patient factors such as severity of illness, age, race, and functional status...

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Hospice and the Triple Crown

Orb won the Kentucky Derby earlier this month.  But on Saturday, while heavily favored, Orb was handily defeated at the Preakness Stakes.  Again this year, there is no Triple Crown winner.While horse racing has not seen a Triple Crown in 35 years, hospice regularly achieve its own triple crown.  Indeed, it is almost too good to be true.  But it is true.  Hospice helps patients (1) live longer, (2) experience a better quality...

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Is there Room for Conscientious Objection in Critical Care Medicine?

Tomorrow morning from 8:15 to 10:45 a.m., at the Philadelphia Convention Center, I will be participating on an ATS panel titled "Is there Room for Conscientious Objection in Critical Care Medicine?" 8:15 AM - Welcome and Symposium OverviewM. Lewis-Newby, MD, MPH 8:25 AM - Reasons for and against Accommodating Conscience-Based Objections in the ICUM. Wicclair, PhD  8:50 AM - How the Law Applies to Conscience-Based Objections in...

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Catholic Medical Association White Paper on POLST

The Catholic Medical Association (CMA) has just published a 35-page White Paper on POLST in the May issue of the Linacre Quarterly.The CMA White Paper is titled “The POLST Paradigm and Form: Facts and Analysis.”  It reviews the origin and stated goals of the POLST program, and analyzes a wide range of arguments favoring or opposing POLST.  The White Paper also examines whether the POLST paradigm will provide real solutions to challenges...

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Choosing Wisely - Top 7 List in Critical Care Medicine

This morning, at the ATS conference in Philadelphia, Scott Halpern, MD, PhD, MBE, presented "Top Ways to Reduce Low Value Care in Pulmonary and Critical Care Medicine."  Halpern leads the ATS's Choosing Wisely Task Force. "Choosing Wisely is designed to have physicians take the high ground in reining in the costs of their practices versus leaving that in the hands of external policymakers. . . .  There are a lot of diagnostic...

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Texas Medical Futility - No Change Again

For the past four legislative sessions in Texas (2007, 209, 2011, and now 2013), a broad group of stakeholders has sought to revise Texas Health & Safety Code 166.046.  Some want to make the law more fair (.e.g. longer notice periods).  That is what S.B. 303 would have done.  Others, like Texas Right to Life want to completely repeal provisions allowing clinician to unilaterally refuse life-sustaining treatment.  Unfortunately,...

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Oklahoma Requires Provision of Futile Treatment

Many states are working to find ways to permit or encourage clinicians to avoid providing non-beneficial treatment.  In contrast, Oklahoma has specifically mandated that clinicians provide non-beneficial treatment, if that is what the patient's surrogate wants.  I blogged about the Oklahoma law here.  I posted a copy of the law here.  Elsewhere, I have explained that Oklahoma's Nondiscrimination in Treatment Act makes Oklahoma...

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Patients Wins Lawsuit against VA for Terminal Misdiagnosis

Sometimes, one is delighted to find out that one's physician has made an error.  That is what happened to Mark Templin.  Clinicians at the Montana VA misdiagnosed him with brain cancer.  They prescribed two drugs and ordered hospice care.Templin believed he was dying.  So, he quit his job, sold his pickup truck, celebrated a "last" birthday, and bought a prearranged funeral service.  He even contemplated suicide. Templin...

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Eight Advance Care Planning Lessons that Took Me 30 Years to Learn

Charlie Sabatino, director of the ABA Commission on Law and Aging since 1984, has a new article in the Senior Lawyers Division magazine EXPERIENCE, titled "Eight Advance Care Planning Lessons that Took Me 30 Years to Learn."  While full text is for members only, here are the subheadings of the 8 lessons:Most Advance Directives Aren't Worth the Paper on Which They Are WrittenThe Only Real Legal Task of Advance Care Planning Is Appointing and...

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Nurses Use Extreme Treatments For Patients; Less Agressive Options on Themselves

A new study in the InternationalNursing Review comparesnurses' end-of-life treatment preferences in Hong Kong, Ireland, Israel, Italyand the USA.  Nurses in every country consistently chose a more aggressiveoption for patients than for themselves.&nb...

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Texas Bishop Supports Texas Medical Futility Bill

KFDA - NewsChannel 10 / Amarillo News, Weather, Spo...

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Court Holds Restrictive Swiss Aid-in-Dying Law Violates Human Rights

When it rains it pours.  In addition to the news out of Vermont, today the European Court of Human Rights issued its opinion in the case of Gross v. Switzerland.  Alda Gross has no known pathological condition or clinical illness.  But she contends that she has the right to assisted suicide because she’s a frail elderly woman and has no desire to continue life.  Swiss authorities refused to provide Gross with...

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Lawsuit for Resuscitating Patient against Her Wishes

A month ago, I blogged about Marjorie Mangiaruca's daughter's lawsuit against a Florida hospital and nursing home for resuscitating her mother against her wishes.  I also included this case in my 83-page analysis of unwanted treatment.  Yesterday, the local Fox television station ran this report on the ca...

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Minnesota Supreme Court Hears Arguments on Constitutionality of Assisted Suicide Statute

Minnesota has one of the nation's broadest statutory prohibitions of "aiding suicide."  The statute includes not just "assisting" but also "encouraging" or even "advising."  This broad scope could sweep in counseling and education on end-of-life options.   Yesterday, the state Supreme Court heard oral arguments in a case challenging the constitutionality of these broad prohibitions under the First Amendment.  A video of the...

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Vermont Enacts Aid-in-Dying Legislation

Vermont has become the fourth U.S. state to affirmatively legalize aid-in-dying.  (Vermont House Journal) (USA Tod...

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Legal Briefing: Patient Self Determination Act

I just finished my latest “Legal Briefing” column for the Journal of Clinical Ethics.  (I can't believe this is my already my fifth year.)  This one covers recent legal developments involving the Patient Self Determination Act (PSDA).  Enacted in the wake of the U.S. Supreme Court’s Cruzan decision in 1990, the PSDA remains a seminal event in the development of U.S. bioethics public policy.  But the PSDA has long been criticized as inadequate and ineffective.  Finally, recent legislative and regulatory changes promise to...

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Kaiser Sued for Denying Futile Treatment

Jalal Afshar was receiving cancer-related treatment at Kaiser Permanente's Los Angeles Medical Center. Doctors there gave him a mix of chemotherapy drugs similar to what some outside specialists had used.  But Kaiser's treatment didn't improve his condition.  (LA Times)Eventually, Afshar's condition deteriorated, and Kaiser's doctors said there was nothing more they could do.  Afshar said they sent a chaplain to his hospital room to...

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Today's Hearing on S.B. 303 to Amend Texas Futility Law

S.B. 303 passed the Texas Senate on April 18.  It was referred to the House Public Health Committee on April 22.  Today, that committee is holding its first hearing on the bill.  The Committee is chaired by Lois Kolkhorst.  While S.B. 303 does not fix all the due process deficiencies with Texas Health & Safety Code 166.046, it does offer some material improvements.  Hopefully, the bill will make it to the House...

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Videos Help Patients Align Treatment and Preferences

At a 1990 Senate finance subcommittee hearing on the Patient Self Determination Act, Senator Danforth testified: "I think that if many people were shown video tapes 10 years before of how they are going to spend the last months of their lives, they would have said, 'Please, do not let this happen to me.'"More than two decades later, Senator Danforth has been proven right.  Patients shown advance care planning videos better appreciate their options...

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Risk of Abuse to the Few Does Not Justify Limiting Liberty of the Many

One leading argument in opposition to the legalization of aid-in-dying is the risk that some might be pressured to, or otherwise involuntarily or non-voluntarily, hasten their deaths.  But all the available evidence indicates that this is a very, very small risk.  Moreover, it is one that can be mitigated through tested safeguards far less restrictive and liberty-limiting than an outright ban.  I am reminded of Representative Brian...

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Vermont to Legalize Aid-in-Dying

It is exciting to be in Vermont this week.  I am in Burlington.  But just down the road in Montpelier, the State legislature is poised to become the first in the United States to affirmatively authorize physician aid-in-dying.  (Washington and Oregon were by referendum.  Montana was by court decision and Medical Board rules.)  I am looking across Lake Champlain into New York.  I am reminded that it was there, 20 years...

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NEW Hastings Center Guidelines for Decisions on Life-Sustaining Treatment and Care Near the End of Life

The Hastings Center has published a revised and expanded second edition of its Guidelines for Decisions on Life-Sustaining Treatment and Care Near the End of Life.  This major new work updates and significantly expands The Hastings Center's 1987 Guidelines on the Termination of Life-Sustaining Treatment and Care of the Dying. Like its predecessor, this second edition will shape the ethical and legal framework for decision-making on treatment...

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How Not to Die - Revolutionizing End-of-Life Care

Angelo Volandes is exploring the role of visual media in medical decision making.  He is lending his expertise to efforts surrounding advance care planning. One of his research questions is determining whether, as part of the ACP process, patients can realistically imagine future health states which include difficult and uncomfortable hypothetical scenarios. Volandes' work was profiled in this recent, inspirational 7-page article in THE...

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Ethics vs. Legality of Deactivating Cardiovascular Implantable Electronic Devices

A colleague suggested that my blog post about Lars Noah's new article on deactivating CIEDs lacked an important piece of context.  While Noah may be right that the legal literature has neglected the issue, the issue of deactivating cardiac devices was thoroughly addressed in a set of authoritative guidelines published in 2010.  Rachel Lampert et al., "HRS Expert Consensus Statement on the Management of Cardiovascular Implantable Electronic Devices (CIEDs) in Patients Nearing End of Life or Requesting Withdrawal of Therapy, 7 HeartRhythm...

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Legality of Deactivating Implanted Cardiac-Assist Devices

Lars Noah addresses an increasingly relevant issue that has been largely neglected by legal academics.  In "Turn the Beat Around?: Deactivating Implanted Cardiac-Assist Devices," Noah observes that with the growing utilization of pacemakers, ICDs, and LVADs, physicians increasingly encounter patients who ask that their still-functioning devices get turned off.  Noah notes that most medical ethicists equate deactivation with the permissible...

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Writing Policies on End-of-Life Treatment

I am delighted to transition, this month, from writing scholarship to writing policy.  Hopefully, one's scholarship informs the development of professional, institutional, and public policies.  (I am always delighted to get messages confirming that it does.)  But that is an indirect path to improving health outcomes.  It is particularly rewarding to participate more directly in developing policies.Coming up for me in the next...

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