Liverpool Care Pathway: Warning for POLST?

Four months have elapsed since the report of the independent review of the Liverpool Care Pathway and the decision to phase out the Pathway over six to 12 months.  Many UK clinicians have already stopped using the LCP.  This is unfortunate since there is no appropriate replacement guidance in place.  These developments in the UK cause me some worry about end-of-life tools here in the United States.  As I read about the occasional...

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AALS Law, Medicine & Healthcare Section

I have just posted a copy of the 43-page 2013 newsletter of the Law, Medicine and Healthcare Section of the Association of American Law Schools (AALS).  Check it out.  You will see that health law and bioethics professors in U.S. law schools are doing lots of important and fascinating work.&nb...

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Supreme Court of Canada Denies Application for Leave to Appeal in Baby M

On Thursday, the Supreme Court of Canada denied the application for leave to appeal in D.L., et al. v. Director (Child, Youth and Family Enhancement Act), et al.  This was the case involving  two and a half year old Baby M who was permanently comatose and on life support  in an Alberta hospital.In September 2012, an Alberta court directed, over the objections of Baby M's parents, that she be provided only with palliative...

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Vote for Medical Futility Blog

This is your weekly reminder to VOTE for the Medical Futility Blog in the 2013 ABA Journal Blawg 100.  Polls remain open until December ...

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Prolonging Life for the Sole Purpose of Prolonging It?

"We have inadvertently trained our young doctors to consider it a virtue to prolong life for the sole purpose of prolonging it."-- James Howard Means (19...

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Hamline Health Law Institute - Video

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Scrooge on Worthwhile Life

This weekend, I made my annual visit to a local production of Dickens, A Christmas Carol.  The following exchange reminded me about the importance of humility in determining what medicine should be offered or covered."Spirit," said Scrooge, with an interest he had never felt before,"tell me if Tiny Tim will live.""I see a vacant seat," replied the Ghost, "in the poor chimney-corner, and a crutch without an owner, carefully preserved. If these...

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Medical Futility Blog Chosen as one of ABA JOURNAL'S BLAWG 100

Medical Futility Blog has been chosen as one of the ABA JOURNAL'S BLAWG 100.  Editors of the ABA Journal announced today they have selected Medical Futility Blog as one of the top 100 best blogs for a legal audience.Now that the editors have made their picks, the ABA Journal is asking readers to weigh in and vote on their favorites in each of the 7th Annual Blawg 100's 13 categories. Go to http://www.abajournal.com/blawg100 to register and vote....

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Cuthbertson v. Rasouli: Limited Guidance from Supreme Court of Canada

I just posted "Cuthbertson v. Rasouli: Limited Guidance from Supreme Court of Canada" over at the AJOB bl...

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Ethical & Legal Obligations of Hospice Staff When Their Patients Receive Aid in Dying

In 2013, the Greenwall Foundation announced the funding of a new bioethics grants program, "Making a Difference in Real-World Bioethics Dilemmas." This program is designed to support research to "help resolve an important emerging or unanswered bioethics problem in clinical care, biomedical research, public health practice, or public policy."  The Foundation explained that its goal for these grants is to have a "real-world, practical impact." Last...

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End-of-Life Care: Desensitizing or Sensitizing?

Bobby Schindler recently wrote that the "vast majority of the mainstream media, by the manner in which they report on this issue, [are] desensitizing the general public when it comes to how we treat our medically vulnerable."It never ceases to amaze me how people can look at opposite sides of the same coin and see such different things.  The same efforts that Schindler characterizes as "desensitizing" are seen and defended my many others...

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Patrik Hutzel & Intensive Care Hotline

Australian ICU nurse Patrik Hutzel has a great website and video blog directed at family members who have a critically ill loved one in Intensive Care.  His goal is to empower family members so that they can exercise power, influence decision making and stay in control of this challenging and difficult situation.  Here is one segment on medical futili...

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Pew Report: Views on End-of-Life Medical Treatments

Today, the Pew Research Center released a new report titled Views on End-of-Life Medical Treatments.The report totals nearly 90 pages.  But one of the top-line takeaways is this:  "When asked about end-of-life decisions for other people, two-thirds of Americans (66%) say there are at least some situations in which a patient should be allowed to die, while nearly a third (31%) say that medical professionals always should do everything...

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The "Indecence" of Vegetating in Cowardly Dependence

In 1888, when he was the same age as I am now, Friedrich Nietzsche wrote Twilight of the Idols, or, How to Philosophize with a Hammer (free translation).  In section 36 of the chapter titled "Skirmishes of an Untimely Man," Nietzsche addresses "morality for physicians":The sick man is a parasite of society. In a certain state it is indecent to live longer. To go on vegetating in cowardly dependence on physicians and machinations, after...

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Recognition for Medical Futility Blog

This blog was reviewed in the November 2013 issue of Internet Law Researcher (18 No. 10 at 1...

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Taiwan, Like USA, Delegates Too Much Power to Physicians

Yi-Chen Su recently published a critique of 2013 amendments to Taiwan's Hospice Palliative Care Law in the Journal of Medical Ethics.  I want to focus on his comments on Article 7.Article 7 of the revised Hospice Palliative Care Law, effective since January 2013, authorised the palliative care team, namely the physicians, to take medical decisions on behalf of incompetent terminally ill patients who did not express their wishes while still competent...

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The Growing Power of Healthcare Ethics Committees Heightens Due Process Concerns

I just posted a complete draft of "The Growing Power of Healthcare Ethics Committees Heightens Due Process Concerns" for the Cardozo Journal of Conflict Resolution.This is an extension of my 2009 article "Multi-Institutional Healthcare Ethics Committees: The Procedurally Fair Internal Dispute Resolution Mechanism."  I later critically discussed ethics committees in AJOB and in the Journal of Clinical Ethics.  The new article is largely an update and summary of the legal status of healthcare ethics committees in the United States.  Here...

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Compassion Should Prompt Us to Forgo Prolonged and Costly Treatment

In the 1950s, McGill neurosurgeon Wilder Penfield developed the "Montreal Procedure," a surgical technique that uses local anesthetic to keep the patient conscious and responding to questions while the surgeon stimulates parts of the brain. By using this method, Penfield created functional maps of the cortex (surface) of the brain.Later, in the 1960s, after he left McGill, Penfield published The Second Career.  There, he argued that "there are...

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International Conference on End of Life: Law, Ethics, Policy and Practice 2014 (ICEL 2014)

The Queensland University of Technology Health Law Research Centre, Dalhousie Health Law Institute and Tsinghua Health Law Research Centre are presenting the International Conference on End of Life: Law, Ethics, Policy and Practice 2014 (ICEL 2014). The conference will be hosted by the Queensland University of Technology Health Law Research Centre in Brisbane, Queensland, Australia from 13-15 August 2014.  The Conference will provide a...

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End of Life Care in a Changing Health Care Environment

A very nice panel presentation by Life Matters Media and the Chicago End-of-Life Coalition at Northwestern University in Chica...

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125 Notable Sites on Hospice & Palliative Care

Check out this compilation of 125 Notable Sites on Hospice & Palliative Care, featuring Medical Futility Blog.  Caring for the elderly, especially those who are ill or dying, is an important and noble career that many nurses and nursing assistants choose to pursue. NAG created this compilation to honor those who have chosen this path already, and to encourage its readers to consider the professional and personal rewards of providing comfort and care to people in the final stages of life.&nb...

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National Healthcare Decisions Day 2014

Today marks five months to National Healthcare Decisions Day, on April 16, 2014.  Please join the initiative by completing the short form here. And lead by example.  On or around Thanksgiving, please consider having “the conversation” with your loved ones.&nb...

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Making Medical Decisions for Patients without Surrogates

I am delighted that the New England Journal of Medicine is publishing my Perspective article, "Making Medical Decisions for Patients without Surrogates."  Treatment decision making for the unbefriended or unrepresented patient remains a big and persistent problem.  And few effective mechanisms are being developed to address the problem. &nb...

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Mitigating Risks of POLST Abuse Increases Other Risks

Many are concerned that POLST might be abused by surrogates or clinicians to hasten the death of patients and residents who, were they fully informed of their prognosis, would not want their death hastened.Most POLST statutes and laws have adequate safeguards to mitigate these risks.  But it is dangerous to erect too many safeguards or safeguards that are too onerous.  Once a "baseline" of safeguards is put into place, adding more offers...

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Resistance Is Futile...Or Is It?

The Borg's warning that "resistance is futile" proved wrong.  Similarly, the limits of prognostication mean that clinicians' warning that "treatment is futile" are also sometimes wro...

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UK Court of Protection vs. Ontario CCB - NHS Trust v. VT

The recent case of NHS Trust v. VT illustrates a key difference between the UK Court of Protection and the Ontario Consent and Capacity Board when it comes to the resolution of medical futility disputes.Prognosis for VTFor 10 years, VT had endured the after-effects of a stroke as well as diabetes, hypertension and kidney disease. Then, in May 2013, VT suffered a cardiac arrest. Three specialists concluded that VT had sustained a very severe brain injury and had no prospect of any meaningful recovery.  (Guardian;  Telegraph)Clinicians'...

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POLST - 3 Lesser Known Strategies for Success

Delaware Academy of MedicineIt was a pleasure to be a part of a well-attended and well-engaged conference on DMOST (Delaware POLST) yesterday.  David Barile's presentation was particularly polished and engaging.  But for those who work with advance care planning issues, much of the content from most presenters was familiar.  Like hand washing, the lessons are known.  The real challenge lies in effective implementation.  So,...

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Outrage that Medicine Cannot Halt Death

"The old acceptance of destiny has gone, and a new sense of outrage that modern advances cannot finally halt the inevitable makes care of the dying and their families demanding and often difficult, but perhaps all the more rewarding."Dame Cicely SaundersFounder of modern hospiceForeword to Oxford Textbook of Palliative Medicine (19...

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Man Left for Dead and Buried Pulled ALIVE from his Grave in Brazil

Worldwide media (e.g. Daily Mail) are reporting the case of a man left for dead and buried who was pulled ALIVE from his grave in Brazil.  In shocking scenes captured on camera, the man can be seen moving his arms and hands as he is lifted out of the ground by stunned ambulance workers.I have reported a number of "miracle" cases and cases of prognostic and diagnostic error.  But this is obviously far more dramatic and surprisi...

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Tim Bowers' Decision to Stop Life Support

On Sunday, just one day after falling from a deer stand and injuring his spine, Tim Bowers decided to end his life rather than remain paralyzed and on life support forever."This is the ideal in many ways of what medicine and medical ethics has been trying to accomplish for end-of-life care, in that, a patient who was facing the end of his life had a chance to speak for himself, and tell his wife, his family, the world, what he wanted," -- Dr. Peter...

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Medical Treatment Produces Outcome Worse than Death

"Mere death is not the bitterest, but rather when one who wants to die cannot obtain even that boon""Nay, death is not so hateful as when oneDesiring death is balked of that desire."Chrysothemis in Sophocles Elec...

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Medical Futility Procedures: What More Do We Need to Know?

Emily Rubin, MD, JD and Andrew Courtwright, MD, PhD from the Massachusetts General Hospital have a new article in the November issue of Chest:  "Medical Futility Procedures: What More Do We Need to Know?"  Here is their abstract:Unilateral medical futility policies, which allow health-care providers to limit or withdraw life-sustaining treatment over patient or surrogate objections, are increasingly designed around a procedural approach....

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Choices Doctors Would Make if Their Infant had Hypoplastic Left Heart Syndrome

The Bioethics Center at Children's Mercy is hosting a pediatric bioethics webinar this Friday, November 8th from 12-1 Central Standard Time.  Register for free here.  Dr. Alex Kon, Chief, Pediatric Critical Care Medicine and Medical Director, PICU at the Naval Medical Center San Diego will be discussing: “Choices Doctors Would Make if Their Infant had Hypoplastic Left Heart Syndrom...

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20th World Federation of Right to Die Activists

The 20th World Federation of Right to Die Activists is scheduled for September 17-21, 2014 in Chicago.  The schedule is shaping up nicely.  Here is a tentative draft:  THURSDAY, Sept 18, 20149 - 10:30 WF Delegates Conference Short Papers11- 12 WF Delegates Conference !! Short PapersLunch1:30 - 3 Innovative Approaches to Legal Change Kathryn Tucker, Legal Director, Compassion and Choices Rob Rivas, Legal Director, Final Exit NetworkCarter Case, Canada3:30 - 5 Legislative Success & Failures New ZealandCanadaAustraliaEurope 7...

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What Is a Sufficient, Valid Reason to Hasten Death?

Recent reports indicate that individuals (especially in the Netherlands) are actively voluntarily hastening their deaths for all sorts of reasons, including blindness and general frailty.  It is useful to place these requests in context by looking at the wide range of reasons that individuals passively hasten their death.  This weekend, avid outdoorsman Tim Bowers was badly hurt Saturday in a hunting accident.  The 32-year-old was...

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Brook v. Royal Bournemouth Hospital - Unilateral DNAR

Doctors at Dorset's Royal Bournemouth Hospital signed a "do not resuscitate" order on patient June Brook without informing either her or her family.  (BBC; Telegraph)This is the n+1 case of this type to be publicly reported in the UK over past two years.  But it seems perhaps a little more troubling than some of the others:Brook had been admitted with sickness and diarrhea.  But during her stay the order was issued to allow her to...

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12th World Congress of Bioethics

The 12th World Congress of Bioethics is June 25-28, 2014 in Mexico City.  The deadline for abstracts is December...

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Increase in Number of People Dying in the Place of their Choice

Delighted to see this  article title in the Guardian:  "Increase in Number of People Dying in the Place of their Choice."  A report released, today, from Public Health England, shows that about 24,000 more people died at home or in care homes rather than hospital in England in 2012 than they did four years before, reflecting the wishes of more people in their last year of life.As the Dartmouth Atlas has repeatedly demonstrated in the...

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Teaching Physicians to Do LESS for Patients at End of Life

"I have often thought it would be important to instruct physicians how to behave in cases of incurable disease: not so much to tell them what to do; rather what not to do." Letter from Johann Stieglitz to Karl F.H. Marx (15 December 182...

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Call for Taking Brain Dead off Life Support

"Call for Taking Brain Dead off Life Support" - This provocatively titled article appeared in the Saudi Gazette.  Fortunately, there is no need for such a "call" in the United States.  However, there is a louder and louder U.S. "call" for taking the permanently unconscious off life support.  Across the United States, many institutional and regional policies now define interventions for the permanently unconscious as "non-beneficial"...

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Nonbeneficial Treatment and Conflict Resolution: Building Consensus

Southern California Kaiser Permanente bioethicists Craig Nelson and Blanca Nazareth published a nice review of three years of experience with their futility policy.  Consistent with other published studies (e.g. Predergast; Garros), the rate of intractability is just 5% (5 of 92 case...

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Your Care, Your Choice - Liberty at the End of Life: DMOST

"Your Care, Your Choice - Liberty at the End of Life" is an education forum presented by a broad legal, medical, social service, and faith-based leadership group who has come together to implement a new Delaware Medical Orders for Scope of Treatment (DMOST) plan for Delawareans to use at the end of life.10:30 -10:50 amWelcome, Program OverviewSusan DelPesco, JD (Superior Court Judge (retired), Wilmington, DE)10:50 am - 11:45 amDeveloping a Successful...

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Time of Death - Showtime Documentary

What are the final weeks, days and very moments of life really like? A new Showtime documentary, TIME OF DEATH, offers an unflinching, intimate look at remarkable people facing their own mortality. Cameras follow these brave, terminally ill individuals as they live out the end of their lives, supported by family, friends, and dedicated healthcare and hospice workers who gently guide the proce...

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Patient in Vegetative State Not Just Aware but Actually Paying Attention

Scientists at the Medical Research Council Cognition and Brain Sciences Unit and the University of Cambridge just published "Dissociable Endogenous and Exogenous Attention in Disorders of Consciousness" in Neuroimage: Clinical.A patient in a seemingly vegetative state, unable to move or speak, showed signs of attentive awareness. The patient was able to focus on words signaled by the experimenters as auditory targets just as successfully as healthy...

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