Time of Death - New Documentary Series

Today, SHOWTIME announced at the Television Critics Association that it will launch a new documentary series, this fall, called TIME OF DEATH.  The show will take an unflinching, in-depth look at some remarkable individuals facing their own imminent mortality 

Cameras will follow brave, terminally ill individuals as they live out their final days, supported by family, friends, healthcare teams and hospice workers, who gently help guide the process. Among other profiles, the show will follow: 

• A single mother of three with Stage IV breast cancer


• A grandmother with inoperable pancreatic cancer who is also a psychotherapist who specializes in the field of death and dying


• A veteran with a rare cancer facing the end with his parents beside him


• A young woman with Stage IV melanoma

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Petition for "Mandatory Euthanasia" for Senior Citizens

EPC rightly observes that it is troubling that people were ready to sign such a petition not knowing that it was  for a Mark Dice video.

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Expiration Date - August Performances in Minneapolis

If you are Minneapolis over the next few weeks, plan to see EXPIRATION DATE.  This is a a one woman play created and performed by Candy Simmons and directed by Tyler Olsen.  



Meet Lucille.  She's young.  She's smart.  She's funny.  And she's just been given a rapidly approaching deadline.  What happens when the unthinkable becomes your harsh new reality?  EXPIRATION DATE offers an unsentimental and comedic peek into one woman's leap into the great unknown.



EXPIRATION DATE will be performed at the Minnesota Fringe Festival (Intermedia Arts, 2822 Lyndale Ave. S., Minneapolis, MN) on the following dates:

• Thu, August 1 @ 5:30pm


• Sat, August 3 @ 7:00pm


• Thu, August 8 @ 5:30pm


• Sat, August 10 @ 1:00pm


• Sun, August 11 @ 4:00pm

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Sustainability & Health - Call for Papers

The AALS Section on Law, Medicine & Health Care will host a section panel, "Sustainability and Health," at the 2014 Annual Meeting on Saturday, January 4, 2014, from 2:00 to 3:45 p.m.



This panel will explore the effects of the environment on health in western nations and the role that sustainability initiatives play with regard to wellness. The panel will be interdisciplinary, broadly spanning topics in health, environmental, and animal law and policy as well as public health, land use, and urban planning. Possible topics include: the effects of urban planning on food access and obesity, the consequences of factory farming for human health, the effects of local and sustainable food movements on human health, the health impacts of environmental laws, the environmental impacts of health laws, and the link between ground water and air pollution and illness.



Interested speakers should submit an abstract of up to 300 words electronically by August 31, 2013 to: Ani B. Satz, Chair-Elect, AALS Section on Law, Medicine & Health Care. Selected speakers will have the option of publishing original papers not committed for publication or in print prior to the Annual Meeting in a special issue of the peer reviewed Journal of Law, Medicine & Ethics.

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Stephen Hawking - Life Support Decision

Professor Stephen Hawking has revealed how he became so ill while writing A Brief History Of Time that doctors offered to turn off his life support machine.  (London Times)  



In a new film, the renowned physicist tells of how in 1985 he thought contracting pneumonia would stop him from completing the book which went on to sell 10 million copies.  But his first wife, Jane Hawking, refused to end her husband's life and demanded doctors in Switzerland return him to Cambridge.



Here is the trailer:

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Not Dead Yet Comments on Futility to NCD

This week, Diane Coleman, President/CEO of Not Dead Yet, provided public
comments on "futile care" laws and policies at the July 25, 2013
meeting of the National Council on Disability.

Coleman quotes my AJOB post "Defending Disability Discrimination."  She even concedes that "Pope is right" that the courts reject ADA cases concerning denial of life-sustaining treatment.  

Of course, Coleman obviously is not happy about this status quo.  She cites me to illustrate the current risks and dangers to the disabled, to better make the case for the NCD to take action.  

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The Sandbox Wars: End of Life Decisions, The Most Important Gift to Your Family

It is definitely a good sign to see so many new self-help books on planning for death.  It heightens social awareness of these important, yet too-often-neglected issues. 



Most recently, I took a look at The Sandbox Wars: End of Life Decisions, The Most Important Gift to Your Family.  

The book and accompanying DVD help readers prevent their families from dictating how they die.  The book takes an approach of telling true life stories that cover the big issues like legacy plans, medical power of attorney power of attorney, and family reconciliation.

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How The Law Applies To Conscience-Based Objections In The ICU

I just posted an MP3 file of my
presentation, "How
The Law Applies To Conscience-Based Objections In The ICU."  My 93 slides are here.  

This was from a symposium session at the May 2013 American Thoracic Society International Conference.  The participants in this session are all members of a broader committee that has prepared a still-in-process policy statement on conscience-based refusals.

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Match the Right Patient to DNR Order

Last summer, I proposed that POLST forms include a picture of the patient.  Library cards have included patron pictures for over a decade.  Driver's licenses much longer.  



Why did I make such a proposal?  Because there had been reports of healthcare workers linking the wrong POLST to the wrong patient.  It continues to happen.  For example, there is an ongoing inquest in the east midland city of Leicester.  



Paediatric registrar Dr Hadiza Bawa-Garba told the hearing that she interrupted attempts to resuscitate Jack Adcock without checking his identity.  She thought that he was another child with a 'do not resuscitate' order.  Dr. Bawa-Garba explained, "what was important to me was not to resuscitate a child that was not to be resuscitated."

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2014 Hastings Center Cunniff-Dixon Physician Awards

Please nominate a physician for one of the 2014 Hastings Center Cunniff-Dixon Physician Awards.  



These awards provide financial prizes to those physicians, young and old, 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.



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


• 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.



There are five annual prizes totaling $95,000; one prize of $25,000 for a senior physician; one prize of $25,000 for a mid-career physician and three prizes of $15,000 for early-career physicians.

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Medical Futility: A Cross-National Study

Two months ago, I blogged about a new book Medical Futility: A Cross-National Study.  I posted an early version of the book cover.  Here is the new and current one.  The publisher is offering a pre-release discount of 30%.

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Physician Disciplined for Poor End-of-Life Communication

Earlier this month, the Ontario Health Professions Appeal and Review Board affirmed a decision of the Inquiries, Complaints and Reports Committee of the College of Physicians and Surgeons of Ontario, counsel a physician to ensure that he has thorough discussions with patients and their families regarding care plans and end of life planning, and to document the same.

Here is the background.  On October 20, 2010, Dr. D.G.C. noted “DNR” (do not resuscitate) on
R.V.'s chart.  Three days later, on October 23, 2010, R.V.
died from a bilateral bronchopneumonia with coronary artery disease as a
contributing factor.  Nursing staff made
no attempts to resuscitate the patient when he was found with vital signs
absent.  

R.V.'s son, J.V., subsequently filed a
complaint with the Inquiries, Complaints and Reports Committee of the College
of Physicians and Surgeons of Ontario.  J.V. alleged that D.G.C. failed to accurately document DNR status, thereby preventing
resuscitation.



In response, D.G.C. explained that he had a conversation
with the family members on October 20, 2010 in which he explained that to offer
resuscitation to someone in the patient’s condition would not be “an honest
offer."  D.G.C. further explained that he documented a DNR order in the
patient’s chart following that discussion and that he was unable to explain J.V.'s differing point of view.  Finally, D.G.C. noted that resuscitation would not have
worked, given the patient’s accumulated burden of illness.

The Committee investigated the complaint and decided to counsel D.G.C. to ensure that he has thorough discussions with patients and their
families regarding care plans and end of life planning, and to document the
same.  Regarding the DNR status, the
Committee noted that entries in the chart were very brief and that it had
difficulty determining the content and context of the end of life discussion
between D.G.C. and the patient’s family. The Committee stated that it
would expect such discussions to be detailed and thoroughly documented and
decided to counsel D.G.C. regarding this aspect of his care.

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Red Roof Inn - New Suicide Suites

This short video is a caricature of the growing expansion of individual rights to hasten death.  Too bad it does not distinguish between suicides driven by depression and mental illness, on the one hand, and aid-in-dying driven by advanced serious illness, on the other hand.




Red Roof Inn Announces New Suicidal Suite

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POLST - Need for Statutory Immunity

Many question the need for statutory immunity for following the orders in a POLST.  They argue that, through clinical consensus, clinicians can get the same thing by establishing POLST as the standard of care.  But as debates in Washington state, this year, illustrated, this is often not perceived as sufficient.  

A particularly eloquent explanation appears in a concurring opinion in the ECHR case of Ternovszky v. Hungary  The Court found Hungary in violation of the Convention for failing to clarify the legal status of midwives, thus infringing women's right to a home birth.    

[W]e find it necessary to clarify why this right to respect for parental choice necessitates a minimum of positive regulation. Such choice would have been a liberty in the 19th century. As long as there is no State interference with the freedom, there seems to be no problem.

But the background assumption of classical liberalism does not necessarily work in the contemporary welfare State, especially in the medical environment. In this welfare system practically everything is regulated; regulation is the default, and only what is regulated is considered safe and acceptable. Suddenly, in the absence of positive regulation, what was a matter of uncontested private choice becomes unusual and uncertain. In a very densely regulated world some disadvantages emerge for freedoms without regulatory endorsement. . . .

Where regulation is the default, as in the medical context, lack of enabling regulation may be detrimental to the exercise of the right, and traditional non-interference will not be sufficient. This may be one of the many unpleasant consequences of living in an overregulated world. It is here that an affirmation of a liberty in positive law is warranted. . . .

[A] freedom may necessitate a positive regulatory environment which will produce the legal certainty providing the right to choose with effectiveness. Without such legal certainty there is fear and secrecy . . . .

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Dangerous Catholic Attack on POLST

My latest post over at bioethics.net, the AJOB blog, is "Dangerous Catholic Attack on POLST."

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Hospital Inspection Reports Show DNR Orders without Consent

Both the United States and England
post hospital inspection reports for public examination.  U.S. reports are
posted to Hospital Inspections.org,
a site hosted by the Association of Healthcare Journalists.  In England,
inspection reports are posted by the CareQuality Commission.
 

Both the U.S. and English databases include recent
reports citing hospitals for entering DNR orders without documented patient or
surrogate consent.  For example, in a report on Calderdale Royal Hospital in
Halifax:

We saw a Do Not Attempt
Cardiopulmonary Resuscitation (DNACPR) form in place within two of the records
we looked at. We looked at the first form dated 20 December 2012 and saw it had
been documented that a discussion had not taken place with the person using the
service about the decision not to resuscitate and their next of kin was not
available to discuss this decision. We looked at the progress notes and saw a
record of a discussion with the next of kin dated 20 December 2012 that stated
they had been informed of the poor prognosis of their relative but, there was
no entry to indicate their agreement to introduce a DNACPR form

And in report on Saint Mark's Medical Center in
Texas:

Patient #1 was
assigned a do not resuscitate (DNR) status with no documented communication
between patient (or patient's family) and physician prior to the physician
order.

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Nevada - Duty to Honor Advance Directives

The rules of the Nevada Board of Medical Examiners provide that "a person who is licensed as a physician or physician assistant shall not:"

(j) Fail to honor the advance directive of a patient without informing the patient or the surrogate or guardian of the patient, and without documenting in the patient’s records the reasons for failing to honor the advance directive of the patient contained therein; or

Oddly, this seems to imply the not honoring is okay.  The clinician just needs to "tell" the patient or surrogate that she is not honoring.  Looks like the British rule.

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10th International Conference for Clinical Ethics Consultation

The 10th International Conference for Clinical Ethics Consultation will be April 24 to 26, 2014 in Paris.  Proposals are due September 20, 2013.  

The theme is "The Patient's Voice"

The patients' rights movement has shaken medical practice since the '70s. Patients express themselves more often today and intend their voice to be heard. As a result, momentous changes emerged in the organization of care and the doctor/patient relationship.

However, many medical practices still fall far short of what would be ideally required with respect to the central place that the patient deserves. This is also true within the clinical ethics support services (CESS) themselves: the patient and/or her proxies are not always given as much voice as it is given to health care professionals.

Moreover, even if the voice of the patient is paramount, the issues surrounding it go well beyond the informed consent of competent patients.

The theme of the patients' "voice" will give everybody the opportunity to explore novel issues raised by the patients' rights movement. It will also enable us to better understand how and to what extent CESS can play a special role in fostering the patient’s voice.

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Dispute Resolution and Health Care: The Next Steps

I am delighted to be a part of this conference at Marquette, especially the panel on medical futility.



8:45 a.m. − 9:15 a.m.  KICKOFF - “What Will Change Bring?”

• Peggy Troy, R.N., M.S.N. -- CEO, Children’s Hospital of Wisconsin

9:15 a.m. – 10:30 a.m.  PATIENT NAVIGATORS

• MODERATOR -- Chris tine Harris Taylor, J.D., LL.M., Associate Director, Marquette University Graduate Program in Dispute Resolution and Center for Dispute Resolution Education; and Adjunct Associate Professor, Marquette University Graduate Program in Dispute Resolution


• PANELISTS


• Sherri Costa, M.S., R.N., O.C.N., O.P.N. -- Oncology Patient Navigator, Wheaton Franciscan Cancer Care


• Rhonda Deneka, M.S.W. -- Oncology Patient Navigator, Wheaton Franciscan Healthcare – All Saints


• Melissa A. Simon, M.D. -- Associate Professor, Obstetrics and Gynecology – General/Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine

10:45 a.m. – noon   HEALTH CARE EXCHANGES

• MODERATOR -- Eva M. Soeka, J.D., Director and Associate Professor of Law, Marquette University Graduate Program in Dispute Resolution and Center for Dispute Resolution Education


• PANELISTS


• Joanne Alig, M.A. -- Senior Vice President, Policy and Research, Wisconsin Hospital Association


• Coreen Dicus-Johnson, J.D. -- Senior Vice President, Payer Contracting and Revenue Operations, Wheaton Franciscan Healthcare


• Susan Giaimo, Ph.D. -- Visiting Assistant Professor and Director of Graduate Studies, Marquette University Department of Political Science

Noon – 1:30 p.m.   LUNCHEON   “Reflections on Dispute Resolution”

• Howard Bellman, J.D., LL.M., Distinguished Adjunct Professor, Marquette University Graduate Program in Dispute Resolution

1:30 p.m. – 2:45 p.m.   MEDICAL FUTILITY

• MODERATOR -- Mathew Pauley, J.D., M.A., M.D.R., Director, Medical Bioethics, Kaiser Permanente Fontana & Ontario Vineyard Medical Centers


• PANELISTS


• Felicia Cohn, Ph.D. -- Bioethics Director, Kaiser Permanente, Orange County; Clinical Professor of Bioethics, Department of Medicine, University of California, Irvine School of Medicine; and President-elect, American Society for Bioethics and Humanities


• Jana Craig, Ph.D. -- Director, Clinical Ethics Center, Memorial Health System; and Adjunct Associate Professor, Southern Illinois University School of Medicine Departments of Medical Humanities and Psychiatry


• Thaddeus Pope, J.D., Ph.D. -- Director, Health Law Institute, Hamline University School of Law; and Adjunct Professor, Albany Medical College

3 p.m. – 4:15 p.m.   KEYNOTE - “Trends in Health Care Conflict Resolution: Technology, Systems Design and Stakeholders”

• Leonard J. Marcus, Ph.D. - Director, Program for Health Care Negotiation and Conflict Resolution, Harvard School of Public Health

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Decompressive Craniectomy - Tough Trade-offs with Skull Removal

When a patient's brain is swelling, with nowhere to go but through the small opening at the base of her skull, herniation can crush the brainstem and can be rapidly fatal.  



In such cases, neurosurgeons sometimes remove a portion of the skull, so the brain can bulge through the opening.  The operation, called decompressive craniectomy, was performed on, among others, former U.S. Rep. Gabrielle Giffords and U.S. Sen. Mark Kirk.  (NY Times)



But decompressive craniectomy raises difficult questions regarding trade-offs between quantity and quality of life. Despite many successful recoveries, some remarkable, significant numbers of patients who receive the operation die, or are left profoundly disabled. Some are minimally responsive, with no cognitive function; others are severely disabled with impaired cognitive and motor function, but can communicate.



“All of us have seen miracles in people we’ve done this on, but the truth is we’re also probably creating a larger population of patients who are significantly disabled,” said Dr. Karin M. Muraszko, the chairwoman of the neurosurgery department at the University of Michigan.



It is difficult for surgeons to know which patients might recover and which are likely to be left barely functional. But the decision must be made under unyielding time pressure, in emergency rooms and intensive-care units and battlefield hospitals.  “We don’t want to save lives if we’re saving people to a state where they can’t function,” said Dr. S. Andrew Josephson, a neurologist and the chairman of the ethics committee at the University of California San Francisco Medical Center.

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Aging Behind Bars

Source: Criminal Justice Degree Hub

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A New Life for Wrongful Living

In a forthcoming Symposium issue of the New York Law School Law Review, Nadia Sawicki is publishing "A New Life for Wrongful Living."  

Like me, Sawicki is "ultimately optimistic" about claims for the wrongful prolongation of life.  It was a pleasure to be a part of this Symposium, last November, with Professor Sawicki.  Here is the abstract:

A patient has an indisputable right under federal and state laws to set forth her wishes for end-of-life medical care in an advance directive or other legal document, or by way of a health care proxy. Such directives are legally binding in that they can be used to enjoin a medical provider from administering life-sustaining care against the patient’s wishes. However, if a medical provider wrongfully provides treatment in contravention of the patient’s directive, the force of this directive essentially vanishes – for the past few decades, patients in such situations have been unable to recover in tort for the injury of suffering unwanted life-sustaining treatment, commonly referred to as the tort of “wrongful living” or “wrongful prolongation of life.” 

For years, the right to set limits on the care one receives at the end of life has been described as an “illusory protection,” a “false promise,” and a “right without a remedy.” Countless scholars have written critically about the failure of tort law to accommodate claims of wrongful living, described as recently as 2011 as “a cause of action that has not gained traction.” Judging by the most recent legal scholarship, patients seeking ex post enforcement of their wishes to refuse life-sustaining medical treatment essentially have no legal recourse. 

This Article is the first to offer an ultimately optimistic perspective about the viability of tort claims for wrongful prolongation of life. A variety of recent developments – including favorable jury verdicts, settlements, supportive judicial commentary, and proposed legislation – suggest that plaintiffs seeking recovery for a wrong that has traditionally been considered non-compensable may have greater success in the future. 

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ASBH Law Affinity Group Meeting

The ASBH Law Affinity Group will gather at the ASBH Annual Meeting from 11:30 a.m. to 12:45 p.m. on Friday, October 25, 2013.  Based on the results of a survey distributed to the membership, the agenda for this gathering consists of the following two items.  



(1)  We will use the first 45 minutes to facilitate networking.  It has proven valuable at past meetings for participants to meet (in at least a “speed dating” format) forty or more other lawyers working on bioethics in a wide range of capacities and positions.  



(2)  At 12:15 p.m., we will transition to the following substantive session by Sally Bean, J.D., M.A., Ethicist & Policy Advisor, Sunnybrook Health Sciences Centre, University of Toronto, Joint Centre for Bioethics. 

The Supreme Court of Canada heard Brian Cuthbertson, et al. v. Hassan Rasouli on December 10, 2012.  A ruling is expected sometime in the summer or fall of 2013.  The Rasouli end-of-life case addresses whether a patient’s or surrogate’s consent is required to withdraw life-sustaining treatment, if the physician determines that the particular treatment (i.e. mechanical ventilation) no longer provides medical benefit.  

Sally Bean is one of the Ethicists at Sunnybrook Health Sciences Centre in Toronto, Ontario, the hospital where the Rasouli case arose.  In her 20-minute presentation, she will provide an overview of the legal pathway of the case.  And Ms. Bean will address the impact of the Supreme Court of Canada decision on Sunnybrook, on Canada, and even on the United States.  The final ten minutes of the session will be reserved for open Q&A.

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AARP Video on How to Manage End-of-Life Wishes

Inside E Street is a nonpartisan program by AARP that is focused specifically on policies and issues affecting those 50-plus.  



This week's show is on "The Conversation."  The guests are

• Charles Ornstein, senior health care reporter and president of the Association of Health Care Journalists


• Ellen Goodman, the cofounder of "The Conversation Project

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New Hampshire Vetoes Bill to Establish End-of-Life Decisions Study Committee

Yesterday, Maggie Hassan, the Governor of New Hampshire, vetoed H.B. 403.  This bill would have established a committee to study end-of-life decisions.



The Governor explained that she saw "no need for the study committee."  Legislation concerning end-of-life decisions, she noted, is already approached "seriously and thoughtfully, always seeking to include the input of those who understand these issues best: doctors, patients, advocates for the elderly and those who experience chronic conditions or disabilities, and the people of New Hampshire."



The Governor may be right about the inclusiveness.  That is hopefully part of any state's legislative process.  But many states (e.g. Maryland) have still materially benefited from their end-of-life decisions committees. 

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Hospice Ethics Symposium

Hospice care is one of the fastest-growing segments of the U.S. healthcare system, a trend that is expected to accelerate as the median age of the population continues to rise over the next three decades.  



On September 10, 2013, NYU Langone Medical Center and the Visiting Nurse Service of NY will host a symposium, offering clinicians, administrators, and others an opportunity to learn about, reflect upon, and develop capacities to address some of the ways in which giving and receiving hospice care opens up questions of value and meaning.



Welcome & Introductory Remarks

• Arthur L. Caplan, PhD

Developing An Ethics Program in Hospice Organizations: The VNSNY Experience

• Timothy W. Kirk, PhD Ethics Consultant, VNSNY Hospice & Palliative Care


• Randi Erin Seigel, JD, VP of Compliance and Regulatory Affairs, Visiting Nurse Service of New York

Moral Reflection and Deliberation in Interdisciplinary Care Teams: Identifying and Addressing Moral Distress at the Team Level

• Terry Altilio, LCSW, Social Work Coordinator, Department of Pain Medicine and Palliative Care, Beth Israel Medical Center


• Nessa Coyle, RN, PhD, Consultant – Palliative Care and Clinical Ethics in Oncology

Dying by Design: Hospice and the Human Good

• Bruce Jennings, MA, Director of Bioethics, Center for Humans and Nature

Integrating Bioethics Mediation into Hospice Practice

• Nancy Neveloff Dubler, LLB, Consultant for Ethics, NYC Health and Hospitals Corporation

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Cuthbertson v. Rasouli - Supreme Court Media Lock-up

This week, the Supreme Court of Canada accepted a request for a media lock-up.  This seems like a great idea for newsworthy opinions of general public interest like Rasouli.



Basically, for a period of time before the decision is publicly released, reporters are locked in a room in the courthouse and given advance copies of the opinion.  The reporters agree not to transmit their stories until the doors are reopened.



The benefit of a lock-up is immediate coverage that is both accurate and rich.  The media is able to get a deeper understanding of the complexity of the case.   Reporters get a chance to absorb the opinion, ask questions of the court's Executive Legal Officer, and work on their stories without the fear that someone could scoop them during the embargo.

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National Aging & Law Institute - Scholarships

The AARP Foundation is awarding 10 scholarships to attend the 2013 National Aging and Law Institute, November 8-10, 2013, in Washington, D.C.  



Scholarships are $1,000 to pay for registration and the cost of travel expenses.  Scholarship applications are due by August 2, 2013.

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Marie Curie Cancer Care Seeks Public Affairs Manager

The Policy & Public Affairs team at Marie Curie Cancer Care is looking for a new Policy and Public Affairs Manager.



The team is responsible for developing and influencing palliative and end of life care policy across the UK.  They are now seeking to increase their policy and public affairs capacity in each country to enable them to meet the demands of the complex environment within which Marie Curie works.  



If you are ready to direct the work of the charity in the area of policy and public affairs, playing a vital role throughout the UK, being a catalyst for collaboration with all the relevant organisations and people who can improve end of life care, then this job is for you.

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Healthcare Providers Fined $4 Million for Medically Unnecessary Interventions

Julie Kovach, M.D.

Julie Kovach, a Michigan cardiologist, has just won a $4 million False Claims Act lawsuit against Jackson Cardiology Associates, its owner, cardiologist Jashu Patel, and against Allegiance Health Hospital, all located in Jackson, Michigan.  (USDOJ Press Release)



Dr. Kovach alleged that Dr. Patel and Jackson Cardiology cardiologists performed medically inappropriate cardiac procedures, including invasive catheterizations at Allegiance Health.  Specifically, she alleged (and had evidence) that Dr. Patel ordered catheterizations for patients based on findings from nuclear stress tests that he improperly read as positive.  Three-quarters of these patients had no significant heart blockages.  Dr. Kovach also alleged that Patel and Jackson Cardiology performed a variety of other office-based medically unnecessary tests.  



The U.S. Attorney for the Eastern District of Michigan stated:  “This case is especially important because the defendants unnecessarily subjected patients to invasive and potentially harmful procedures.  We urge other health care professionals with knowledge of medically harmful procedures to come forward, either by calling our office and asking to speak to the criminal or civil health care fraud coordinators, or through the qui tam whistleblower mechanism."  



Soon  enough, as I have predicted, we will see a False Claims Act action in which clinician administered unwanted or medically unnecessary life-sustaining treatment.  

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My Gift of Grace - Card Game to Facilitate Advance Care Planning

In 1860, Milton Bradley started producing the Game of Life.  Now, 153 years later, Philadelphia design company Action Mill is coming out with "My Gift of Grace."  



My Gift of Grace is a game that helps families and friends have important conversations about death, dying, and what they want at the end of their lives. It helps people get unstuck.  Players pull cards that are broken into three categories -- actions, statements, and questions.  "Do you want to live as long as possible, or be as comfortable as possible?" says one card. "What activities make you feel most alive?"

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Robbie Robinson v. Thai Hospital

Robbie Robinson (32) is fighting for his life in a Bangkok hospital today after falling from a high-rise building on June 22.  (Irish Independent)  Doctors have told Robbie’s grief-stricken family  that there is no hope, and have urged them to turn off his life-support.  



But despite hospital staff telling them their son would not survive his catastrophic head injuries, Robbie's mother said there was hope, and they were praying for a miracle.  "We know he’s a fighter, he’s a real fighter. He’s the strongest of all of us and his heart is beating away. . . .  We are realists but when it’s your child, you just don’t want to let them go."



Here is Robbie's mother calling into RTE Radio.  

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This Is How You Die

What if a machine could tell you cryptically but with 100% accuracy how you are going to die?



THIS IS HOW YOU DIE is a new short fiction anthology, filled with stories and comics about a world in which a machine can predict how you die.  It just takes a drop of blood from a finger. Then it spits out a sliver of paper upon which are printed, in careful block letters, the words “DROWNED” or “CANCER” or “OLD AGE” or “CHOKED ON A HANDFUL OF POPCORN.”  Nothing else. No dates, no details. And it’s always — always — correct.

This is How You Die - watch more funny videos      

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ABA Top 100 Blawgs

I would be delighted if one or more satisfied readers of this blawg (law blog) nominated it to be listed among the ABA Top 100 Blawgs.  



Use this simple form.  Nominations due by Aug. 9, 2013.

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N.Y. Hospital Nearly Took Organs from Living Woman

Doctors at St. Joseph's Hospital Health Center in Syracuse, New York were about to remove organs for transplant from Colleen S. Burns, 41, whom they thought was dead.  Then she opened her eyes. She was alive. 

Burns had been in a deep coma from taking an overdose of drugs. Hospital personnel failed both to wait long enough and to conduct enough tests to determine death.  (CMS Report; Modern Healthcare; Syracuse Post-Standard)

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Minnesota Advance Care Planning Conference

On Thursday, July 18, 2013, the Twin Cities Medical Society and Honoring Choices Minnesota will host an all-day conference on advance care planning at the Ramada Plaza Minneapolis.  Here is the agenda:



8:30am Check-in/Registration

9:00 Welcome

• Sue Schettle, Twin Cities Medical Society

9:05 Keynote: "Re-framing Advance Care Planning: the Allina Story"

• Penny Wheeler, MD, Allina Health

9:50 Panel Discussion: Advance Care Planning Program Coordinators

• Patty Bresser, PhD (Light the Legacy)


• Gloria Cade, RN (Allina)


• Jim Heymans, MSW, LICSW (HealthEast), Mary


• Lou Irvine (HealthPartners)


• Lynn MacKenzie (Light the Legacy) 


• Heidi Meyers, RN, BSN, MBA/HCM (Fairview),


• Bob Newby (HealthEast)


• Dawne Sipe, RN, MA (Park Nicollet)

10:40 Spotlight on Allina's Life Course Program

• Sandra Schellinger, RN, MSN, ANP, Allina Health

11:00 Panel Discussion: Advance Care Planning Across Cultures

• Miguel Ruiz, MD 


• Mohamed Hagi-Agen, MD, HealthPartners

11:40 Attracting Diverse Communities: Recent Advance Care Planning Highlights

• Barbara Greene, MPH, Honoring Choices Minnesota

12:00pm Networking Lunch

1:00, Minnesota's Advance Care Planning Outcomes: Common Denominator and Health Disparities Oversight

• Barry Cohen, PhD, Rainbow Research

1:20 Panel Discussion: Target Populations for ACP, in Light of Morbidity and Mortality Data

• Joe Amberg, MD (Allina)


• Merryn Jolkovsky, MD (CentraCare/Light the Legacy)


• Vic Sandler, MD (Fairview)


• Craig Svendsen, MD (HealthEast)

1:50 HealthPartners Report on 1-Page Health Care Directive

• Kate Kellet 


• Christine Sylvester, RN,HealthPartners

2:05 Multicultural Advisory Committee Recommendation: A Shortened Directive

• Barbara Greene, MPH, Honoring Choices Minnesota

2:10 Panel Discussion: Pros/Cons of Using an Abbreviated Health Care Directive

• Ken Kephart, MD (Fairview)


• Joe Sicora, MD (North Memorial)


• Tom von Sternberg, MD (HealthPartners)

2:50 Medical and Spiritual Community Perspectives on End of Life

• Shukri Hassan (International Institute of Minnesota)


• Bernie Goldblatt (Adath Jeshurun Congregation) 

3:25 Keynote: "A Personal Perspective of Advance Care Planning"

• Michele Kimball, AARP Minnesota

3:55 Closing comments

• Kent Wilson, MD, Honoring Choices Minnesota

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Six Year Anniversary for Medical Futility Blog

Today marks six years of blogging on the Medical Futility Blog.  



I am delighted to have received a half million direct visits, plus hundreds of thousands more through syndicated re-posts on Westlaw, Bioethics.net, and Wellsphere.



The topics covered on this blog remain some of the most pressing, yet unsettled, in our society.  Consequently, I expect to continue this blog as a supplement to my book chapters, law reviews, medical journal, and bioethics journal articles.  



Thank you for your comments, your suggestions, and your support.  I look forward to our continued engagement on these tough and important issues.

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Death Hastened Despite No Terminal Illness

In a recent European Court of Human Rights case, Alda Gross claimed a right to aid-in-dying.  While Ms. Gross has no known pathological condition or clinical illness, she contended that she has the right to assisted suicide because she’s a frail elderly woman and has no desire to continue life. 



The Gross case highlights an pervasive legal limitation that now seems disjointed with medical reality.  Most jurisdictions where aid-in-dying is expressly authorized (e.g. OR, VT, WA) require that a patient have a terminal illness to be eligible for the service.  Similarly, many jurisdictions require the patient to have a terminal illness before a surrogate can legally decide to withhold or withdraw life-sustaining treatment.  



But like Ms. Gross, most of us do not die from a terminal illness.  We die from organ failure or from frailty.  It is time to update and expand the legally recognized triggering conditions for making end-of-life treatment decisions to hasten death.

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Elder Abuse Damages Capped at $500

In California, a violation of the Patient's Bill of Rights carries a penalty of just $500.  Seem low?  Well, that's not all.



A new appellate opinion, Nevarrez v. San Marino Skilled Nursing, confirms that "$500 is the maximum that can be recovered in a civil action under this provision, regardless of how many rights are violated or whether such rights are violated repeatedly."  



Yes, a resident can still sue for tort damages.  But the extremely low civil penalties amount sends a very bad symbolic message.

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POLST Vocabulary - A Summary

Last year, I published a reasonably comprehensive review of how POLST is being adopted across the country.  I observed that "while the POLST paradigm is established or developing in almost every U.S. state, it goes by at least 14 different names."  That number is now at least 15.  



Like variation in form color (pink, green, yellow), this variation in terminology is not material.  But it is important to remember that even with different names, most of these programs share the same paradigm.  



POLST stands for three different terms. 

1. In most of the states, POLST stands for physician orders for life-sustaining treatment.  


2. In Minnesota and Montana, POLST stands for provider orders for life-sustaining treatment.  


3. In Pennsylvania, POLST stands for Pennsylvania orders for life-sustaining treatment.  


4. And in New Jersey, it stands for Practitioner orders for life-sustaining treatment.

The remaining states use 11 additional acronyms.  Two are similar to POLST:

1. Vermont uses COLST (clinical orders for life-sustaining treatment).


2. Delaware, Maryland, Massachusetts, New York, Ohio, and Rhode Island use MOLST (medical orders for life-sustaining treatment).

Four other acronyms focus on scope of treatment

rather than on life-sustaining treatment:

1. Idaho, Indiana, South Carolina, Tennessee, Virginia, and West Virginia use POST (physician orders for scope of treatment).


2. Louisiana uses LaPOST (Louisiana physician order for scope of treatment).


3. Alaska, Colorado, Kentucky, New Mexico, and North Carolina use MOST (medical orders for scope of treatment).


4. Iowa uses IPOST (Iowa physician orders for scope of treatment).


5. Nevada uses SMOST (summary of physician orders for scope of treatment).

Four final acronyms are far more different:

1. Kansas and Missouri use TPOPP (transportable physician order for patient preference).


2. Utah calls its POLST a death with dignity order.


3. Illinois legislated that POLST “may be referred to” as the department of public health uniform DNR advance directive.


4. The Veterans Health Administration refers to POLST as SAPO (state authorized portable orders).

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