Compassion & Choices Minnesota End-of-Life Event

COMPASSION & CHOICES OF MINNESOTA will be hosting an event on Sunday, September 8, 2013, from 1:00 to 3:00 p.m. at the First Unitarian Society – Chalice Room, 900 Mount Curve, Minneapolis, MN.  This event is free and open to the public as well as to Compassion & Choices members.Roland Halpern, Regional Campaign & Outreach Manager will speak about the history of the organization, recent legislative successes, and future prospects...

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New Hampshire Needs a Default Surrogate Statute

New Hampshire is in the minority of states with no default surrogate statute.  In New Hampshire, as in nearby Vermont and Rhode Island, when individuals lose decision making capacity and have not completed an advance directive, it is unclear exactly who should be making medical treatment decisions for that individual.Consequently, treatment decisions may need to be made by a court.  But nobody, not even judges, thinks that is a good process....

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Texas Futility Law Protects Clinicians' Conscience Rights

While Texas House Bill 1464 (Feb. 2013) died in the 83rd Legislature, it was designed to amend Texas Health & Safety Code 166.046.  Since 1999, that section has required hospitals to continue life-sustaining treatment for only 10 days after determining that such treatment is "inappropriate."  H.B. 1464 would have deleted the 10-day time period and required treatment until transfer.  What I found interesting (even surprising)...

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Vermont’s New Normal: End-of-Life Care & Physician Aid in Dying

On October 29, 2013, the Vermont Ethics Network is holding a day-long discussion about end-of-life care in Vermont with the passage of Act  39 (Vermont’s new law on patient choice and control at the end-of-life).  The day’s presentations will focus on:Understanding Vermont’s law: An Overview of Act 39. Ethical issues surrounding aid in dying and the impact on patients, providers and organizations.Implementation issues and lesson learned...

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Lord Horder: Prolong Life, Not Dying

I was pleased to discover that the archive of the BMJ is freely available in digital format all the back to 1857.  In these archives I was pleased to find the following quote attributed to Thomas Horder, physician to several British kings and prime ministers."It is the duty of a doctor to prolong life and it is not his duty to prolong the act of dying."Lord Horder apparently made this remark in a speech before the House of Lords when it was...

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Online RN Certificate in Palliative Care

The California State University Institute for Palliative Care has announced an RN Certificate in Palliative Care, the first, eight-week online program designed specifically to introduce RNs to the knowledge needed to practice palliative care.The course curriculum covers the history of palliative care, palliative care for various disease states, complex pain and symptom management, ethics, care of special populations, palliative care in various...

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Medical Futility in the 19th Century

Nearly 2500 years ago, Hippocrates advised physicians to refuse to treat those who are "overmastered" by their diseases.Debates over medical futility were especially vigorous between 1987 and 1996.  And they continue to this day.  But I was pleased to discover a new (to me) reference from the 1800s.Theodor Billroth was a Viennese surgeon, generally regarded as the founding father of modern abdominal surgery.  In 1863, he pubished...

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SIU Seeks Health Law Professor

Southern Illinois University School of Law seeks to fill up to four full-time tenure-track or tenured faculty positions to begin in the 2014-2015 academic year. With a range of curricular needs, the School of Law welcomes applications from candidates with a wide variety of interests including Health Law, as well as Contracts, Torts, Legislative and Administrative Process, Family Law and other courses.Rank & Title:  Assistant, Associate,...

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New $2.5 Million Centre for Research Excellence in End of Life Care

Professors Lindy Willmott, Ben White, and Fiona McDonald at the Queensland University of Technology are part of a team of ten researchers who have just secured $2.5 million in funding to establish a Center for Research Excellence in End of Life Care. The National Health and Medical Research Council (NHMRC) funded interdisciplinary Centre for Research Excellence (CRE) will be located at QUT and will generate new knowledge about health service...

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Tony Yahle Pronounced Dead; then Wakes Up

I periodically blog about "miracle" cases in which the patient has a wholly unexpected recovery.  For example, see here, here, and here.  Worldwide print, broadcast, and internet media are now covering yet another "miracle" case.On August 5, clinicians at Kettering Medical Center in Ohio pronounced Tony Yahle dead after a 45-minute code.  At that point, Yahle was truly flatlined.  He had no electrical motion, no respiration, no heart beat, and no blood pressure.  The family was about to view Yahle's body when...

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Medical Futility at ASBH Meeting

The ASBH Annual Meeting is exactly two months away.  Here are four sessions related to medical futility:An Aid to Addressing Medical Futility Cases(THU 10/24 2:45-3:45)Carol L. Powers, JD, Community Voices in Medical Ethics, Rowley, MAPatrick T. Smith, MDiv MA, Gordon-Conwell Theological Seminary, South Hamilton, MAPaul C. McLean, Community Voices in Medical Ethics, Boston, MAMartha Jurchak, PhD MS RN CS, Brigham and Women’s Hospital, Boston, MAThe Frequency and Cost of Futile Treatment in Critical Care(FRI 10/25 10:30-11:30)Thanh N. Huynh,...

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Victim's DNAR Order Does Not Break Causation

I blogged about the Eddie Cortez Smith case when it was before the intermediate appellate court in Minnesota last Fall.  That court rejected a drunken driver's claim that he was not responsible for the death of a 93-year-old woman killed in a 2010 crash because her "do-not-resuscitate" order kept her from potentially life-saving medical care.  Last week, the Minnesota Supreme Court affirmed. &nb...

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PA Court Refuses to Appoint Guardian to Override Patient Wishes

I have defended (here, here, and here) surrogate selection as a mechanism for resolving medical futility disputes.  But there are certainly limits.  Two of the most obvious are these.  First, a surrogate cannot consent to stopping LSMT when the patient herself specifically requested it.  Second, the provider should not even be turning to a surrogate when the patient still has capacity.Remarkably, St. Luke's Hospital in Allentown,...

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Oncologist Criminally Charged for Over-treating End-of-Life Patients

Based on a criminal complaint and indictment filed in the U.S. District Court for the Eastern District of Michigan, Dr. Farid Fata may be one of the most irresponsible doctors in the United States.  He is being charged with defrauding Medicare by billing for lots of medically unnecessary chemotherapy. Particularly interesting is a supporting affidavit by an FBI agent.  It specifically notes, in several different paragraphs, that aggressive...

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ACT Recommendations on "Futile Care"

The Australian Capital Territory Local Hospital Network Council has a legislative mandate to consult with the community on any issues affecting the satisfactory delivery of health services, and the overall performance of the local hospital network at least once per year, prior to presenting the ACT Health Minister with the Council’s Annual Report.In a recent report, the Council made the following recommendation:Regardless of consumers having an ACP,...

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Medical Futility Comprises Significant Fraction of Ethics Consults

In a piece forthcoming in the Journal of Oncology Practice, Andrew G. Shuman and colleagues at Memorial Sloan-Kettering Cancer Center reviewed clinical ethics consultation databases at two institutions from 2007 through 2011 that related to adult patients with cancer.  They identified a total of 208 eligible patient cases. The most common primary issues leading to ethics consultation were:Code status and advance directives (25%)Surrogate decision making (17%)Medical futility (13%)Furthermore, the authors identified:Communication lapses in...

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Cleveland Clinic Fellowship in Advanced Bioethics

The Cleveland Clinic, in partnership with Case Western Reserve University, University Hospitals Case Medical Center, MetroHealth Medical Center and the Louis Stokes Cleveland VA Medical Center, invites applications to the Cleveland Fellowship in Advanced Bioethics.  Fellows who graduate from this two-year, full-time program will comprise the next generation of leaders in Bioethics in academic institutions, health care settings, industry, and...

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Making Every Word Count for Nonresponsive Patients

Despite the apparent absence of external signs of consciousness, a significant small proportion of patients with disorders of consciousness can respond to commands by willfully modulating their brain activity, even respond to yes or no questions, by performing mental imagery tasks. However, little is known about the mental life of such responsive patients, for example, with regard to whether they can have coherent thoughts or selectively maintain...

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Unbefriended & Unrepresented Patients - Who Decides?

There is a dearth of commentary and analysis of the common challenge of making medical treatment decisions for incapacitated patients with no available surrogate.  To help fill the void, I have written about this problem here and here.  And I have another new piece still under review.  Last week, I was pleased to see a new post on the topic over at the Scientific American bl...

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Catholic Health Association on POLST

The Catholic Health Association of the United States (CHA) has devoted a major section in its latest issue of Health Care Ethics USA to POLST.  CHA explains that its decision was prompted primarily by the publication of a “White Paper” in the May, 2013 issue of Linacre Quarterly.  But it seems I too played a small part:  "Unfortunately, the Linacre article together with opposition to POLST by two State Catholic Conferences have...

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Four Must-Go Health Law Conferences

I want to encourage those working in health law (especially as academics) to strongly consider attending the following four conferences each year.(1)  As an officerof the AALS Section on Law, Medicine, and Healthcare, I hope that you are planningto attend the Section’s programs at the 2014AALS Meeting in New York City.  Thereare two sessions of interest:The Role of Nonprofits under the Affordable Care Act  (Jan 3, 10:30-12:15)The program...

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Futility - Attack on Paternalistic Predominance of the Physician's View

I just finished reading a new article by Belgian law professor Christophe Lemmens in the European Journal of Health Law, titled "A New Style of End-of-life Cases: A Patient’s Right to Demand Treatment or a Physician’s Right to Refuse Treatment? The Futility Debate Revisited."  Most of the article is a pretty standard overview of the ethical and legal landscape, but with more non-U.S. citations than I typically see.  In terms of an original...

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IOM Committee on Approaching Death: Addressing Key End of Life Issues - Public Comment

TheInstitute of Medicine (IOM) is undertakinga project that willexamine care for individuals approaching death. The committee will assess thedelivery of health care, social, and other supports to both the personapproaching death and the family; person-family-provider communication ofvalues, preferences, and beliefs; advance care planning; health care costs,financing, and reimbursement; and education of health professionals, patients,families,...

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Oregon Starts Rationing End-of-Life Treatment

Yesterday, at the monthly meeting of the Oregon Health Education Review Commission, the HERC adopted restrictions on the type of treatment that cancer patients under Medicaid can receive.  The new guidelines go into effect in October 2013.An earlier revision said patients expected to live two years or less were to have restricted treatment.  But that was revised to instead impose restrictions on terminally ill patients too weak to withstand...

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Nursing Home Disallows VSED; Gets Sued for Battery

A few weeks ago, I blogged about the case of Margot Bentley, who is suffering from advanced-stage Alzheimer’s in a Vancouver nursing home.  She has been receiving spoon feeding contrary to the directions of her family and contrary to the wishes she stipulated in a living will.  This week, Bentley's daughter and husband filed a lawsuit against Fraser Health in British Columbia Supreme Court alleging that this unwanted treatment...

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ASBH Meeting Registration Now Open

Registration for the 2013 ASBH Annual Meeting in Atlanta is now op...

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Refusing Medical Treatment Is Not Suicide, Wisconsin

Justice Prosser, one of the seven Justices on the Wisconsin SupremeCourt, recently published a concurring opinion with rather troublinglanguage.  Wisconsin already has somepretty archaic and patient-unfriendly law (and here) regarding end-of-life decisionmaking.  But I was honestly surprised toread what Justice Prosser wrote.For context, the case involved a 15-year-old Jehovah’s Witness, Shelia,who was transfused over both her and...

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Defending POLST

A few weeks ago, I charged that the Catholic attack on POLST is "dangerous."  That drew a response, not from the Catholic attackers, but from Jason Manne, another critic of POLST.  My rebuttal to Manne is now posted at bioethics.net.  Basically, we may be in agreement that there is "some" bathwater that may need cleaned up.  But neither of us is ready, like the Catholics are, to throw out the baby with that bathwat...

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Nicklinson v. DPP - Mixed Results for Right to Die in UK

Paul LambLast year, the British High Court handed down judgment in the cases of Tony Nicklinson and “Martin.”  The two men were seeking clarification of the law relating to euthanasia and assisted suicide.  The court refused the relief they sought and the matter was appealed.  Last week, the Court of Appeal handed down a 58-page judgment.  The Court of Appeal identified three main issues: Should the common law provide a defense...

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Medical Interventions Not Available on Demand unless Clinically Indicated

In a recent letter to the BMJ, Mandie Scamell and colleagues rightly observe that non-indicated medical interventions are NOT available on demand in the UK.  "NICE suggests that when requests for caesareans are based on anxiety, mothers should be offered referral to a perinatal mental health professional. The recommendation is that a caesarean section should be offered only if this fails."Scamell and colleagues criticize an article...

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New York Enacts New Health Care Proxy Law

This week, New York Governor Cuomo signed S.B. 4422.  While not dramatic as far as healthcare decision making legislation goes, it should help facilitate advance care planning.  The new law ensures that each state agency create a link to health care proxy information on state agency websites that have significant public interaction and deal with public health issues.  It takes effect January 1, 2014.Here is the full text:Any state...

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Harrison Ellmer - Miracle Recovery

Baby boy Harrison Ellmer was admitted to a children’s hospice to die after his parents were told nothing could be done to save him.  But Harrison astonished doctors by making a miraculous recovery.  I post these sorts of cases every few weeks to remind us about the limits of prognostication and to help instill humility when we declare continued treatment to be non-benefici...

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S. 1439 - The Care Planning Act of 2013

Yesterday, Senators Warner and  Isakson introduced S. 1439, The Care Planning Act of 2013.  It is similar to, but goes beyond, Rep. Blumenauer's H.R. 1173.Establishes Medicare and Medicaid reimbursement for healthcare professionals to provide a voluntary and structured discussion about the goals and treatment options for individuals with serious illness, resulting in a documented care plan that reflects the informed choices made by...

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In Denial: The Role of Law in Preparing for Death

Barbara A. Noah has published "In Denial: The Role of Law in Preparing for Death" in the Elder Law Journal 21(1):1 2013.  Here is the abstract:Only approximately 20% of Americans have engaged in any form of advance care planning and, even among older Americans, the process frequently is delayed until an acute illness provides sufficient pressure to act. End of life law, though flawed, offers some opportunity to express individual values...

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