I will be doing a webinar on "Brain Death and Futility" for the Arizona Bioethics Network on June ...
Thứ Tư, 30 tháng 4, 2014
Chủ Nhật, 27 tháng 4, 2014
MEDCAC to Review Medicare Coverage of CT Scans for Smokers
On April 30, CMS will convene the Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) to decide if Medicare will cover annual screenings for lung cancer with low-dose CT scans for current or past heavy smokers. You can view the meeting here.I am a voting member of MEDCAC and was invited to serve on this panel. But I had a prior engagement: the ASBH program committee meeting in Chicago. Too bad. This is an important and difficult issue. In December 2013, the United States Preventive Services...
Thứ Bảy, 26 tháng 4, 2014
American Afterlife: Encounters in the Customs of Mourning
Just published, American Afterlife: Encounters in the Customs of Mourning explores the experiences of individual Americans involved with death in a culture where even discussing such things is practically taboo. The book follows ordinary people making memorial choices as well as the purveyors of those choices to investigate how we memorialize our dead, where these practices came from, and what this says about us.CNN Living reviewed the...
Thứ Sáu, 25 tháng 4, 2014
Louisiana to Limit Liberty over Health Care Decisions
A few months ago, I predicted that the publicity of the Marlise Munoz case would prompt some legislative action. Specificially, I thought that other states would remove Texas-type limitations in healthcare decisions acts that restrict the liberty of pregnant patients to withhold or withdraw life-sustaining treatment. But at least in Louisiana things are moving in the opposite direction.H.B. 348 (and here is the legislative digest)...
Thứ Năm, 24 tháng 4, 2014
Summer Institute for Informed Patient Choice
Please join me and a remarkable number of more distinguished and accomplished scholars at the Summer Institute for Informed Patient Choice. Speakers are from law, medicine, bioethics, and patient advocacy. So, there will be numerous opportunities for cross-disciplinary networking & discussion. WHEN: June 25-27, 2014WHERE: Dartmouth College: Hanover Inn, Hanover, New Hampshire, USA. PURPOSE: The SIIPC...
Thứ Tư, 23 tháng 4, 2014
More Visibility and Awareness of VSED & VRFF Option to Hasten Death
I recently published my second legal analysis of VSED (VRFF) as a legal and comfortable means to hasten death. (Here is the first.) I am pleased to see the mainstream media devoting more attention to VSED. I blogged about one example here. This week, WBUR ran a story titled "Aid-In-Dying Loophole: Advocates Want You To Know You Can Stop Eating And Drinking." This was based on the story of Jackie Wilton's use of VSED...
Thứ Ba, 22 tháng 4, 2014
Hospital Patients’ End-of-Life and Care Wishes Now Part of Electronic Medical Records
Lumināt today announced a development partnership with UMass Memorial Health Care for an advance care planning technology platform to integrate patients' end-of-life directives into their electronic medical records (EMR). Lumināt's development partnership is ground-breaking because:It is the first time that advance care plans have been integrated into an EMR system. Previously, advance care plans were filed away with a patient's...
Thứ Hai, 21 tháng 4, 2014
Medicare Choices Empowerment and Protection Act (S. 2240)
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I recently blogged about the Medicare Choices Empowerment and Protection Act (S. 2240). I have since heard quite a few bioethicists criticize this bill. Much of this criticism seems appropriate. There are a lot of ill-informed and misinformed advance directives out there. If enacted, this legislation would prompt MORE of them. In short, this legislation seems focused on the volume and number of advance directives,...
Doing Everything Possible: The Best or Worst Thing about American Medicine (VIDEO)
The World Affairs Council of Philadelphia has posted a video of my March 2014 debate with Wesley Smith: "Doing Everything Possible: The Best or Worst Thing about American Medicin...
Chủ Nhật, 20 tháng 4, 2014
DHHS Will Pay You $75 to Register Your Advance Directive
Under the Medicare Choices Empowerment and Protection Act (S. 2240), which was introduced this month, the Department of Health & Human Services will pay Medicare beneficiaries $75 to register their advance directives. As I have reviewed before, most legislative and regulatory attempts have tried to promote advance care planning by paying clinicians more. Those efforts failed. In contrast, the instant bill focuses...
Thứ Bảy, 19 tháng 4, 2014
10 Common Questions (and their Answers) on Medical Futility
Four Mayo Clinic physicians have just published a high level overview of medical, ethical, legal, financial, and policy issues relating to medical futility. Here are the 10 questions. Read the article for the answers.What is the definition of medical futility?How do challenges in prognostication contribute to medical futility?What and who are the principal movers encouraging medical care that may be considered futile?What are the financial arguments that may encourage or discourage the provision of medically futile care?What are the...
Thứ Tư, 16 tháng 4, 2014
7th Annual National Healthcare Decisions Day
IT’S HERE! Today is the 7th Annual National Healthcare Decisions Day! ACTIVITIES/RESOURCES: Even if you have your own resources, please also direct patients, residents, clients, and the public to the resources at: http://www.nhdd.org There are free resources that people can care with loved ones throughout the country.FREE WEBINAR TODAY: at 3:00pm eastern, please join me, Ellen Goodman and others for an NHDD webinar. Register at:http://theconversationproject.org/LEAD...
Thứ Ba, 15 tháng 4, 2014
International Conference on End of Life: Law, Ethics, Policy and Practice - ABSTRACT DEADLINE
From August 13-15 2014, the Queensland University of Technology in Brisbane, Australia will be hosting the International Conference on End of Life: Law, Ethics, Policy and Practice. The call for abstracts closes Wednesday, April 30.ICEL 2014 will provide a global forum at which health law scholars, bioethicists, legal and health practitioners, and health law and bioethics institutions can meet to discuss and present on law, ethics,...
Thứ Hai, 14 tháng 4, 2014
The Changing Legal Climate for Physician Aid in Dying
Posted today and available for free from JAMA: "The Changing Legal Climate for Physician Aid in Dying."A summary of the trend toward legalization that I prepared with David Orentlicher and Ben Ri...
Thứ Bảy, 12 tháng 4, 2014
Very Preterm Baby Beats the Odds and Survives
Radiolab has a compelling audio story (based on earlier newspaper stories by the parents) about the medical journey navigated by the parents of a newborn infant born at 23 weeks, 6 days. At one point, an operation was required. But he surgeon initially refused to operate on the preterm infant, because surgery was "futile." But despite the odds, the baby survived - not just surgery but also the NICU st...
Honoring Choices Across Cultures: End of Life & Advanced Care Planning
On Wednesday, May 7, the University of Minnesota will host a one-day conference: "Honoring Choices Across Cultures: End of Life & Advanced Care Planning."DESCRIPTIONHigh quality advanced care planning and end of life care is essential to ensuring that patients do not receive unwanted care in their last days, weeks, and months of life. As our population ages and health care spending grows, this issue becomes more and more pressing....
Thứ Sáu, 11 tháng 4, 2014
Terri Schiavo Life & Hope Network WRONG to Defend the Dead?
The Terri Schiavo Life & Hope Network is a Pennsylvania-based nonprofit that works to "protect the lives of the medically vulnerable from the threat of imposed death."Earlier this year, the Network helped the family of Jahi McMath by "assembl[ing] a team of advocates that located a facility to provide the care Jahi needed." More recently, the Network honored the family in its award gala.I wonder if devoting resources to litigate...
Thứ Năm, 10 tháng 4, 2014
Health Care Decisions and the "F" Word: Counseling Clients about Medical Futility
Health Care Decisions and the "F" Word: Counseling Clients about Medical FutilityDate: Wednesday, April 23, 2014Format: Live WebinarDuration: 90 minutesRegister here SponsorsThe American Bar Association Commission on Law and Aging, Senior Lawyers Division and Center for Professional Development1:00 PM-2:30 PM Eastern12:00 PM-1:30 PM Central11:00 AM-12:30 PM Mountain10:00 AM-11:30 AM PacificProgram DescriptionRecent...
Who Calls the Shots? Exploring the Authority of the Principal, Agent, and Provider under a Health Care Directive
The Health Law Section of the Minnesota State Bar Association is presenting a timely CLE: "Who Calls the Shots? Exploring the Authority of the Principal, Agent, and Provider under a Health Care Directive."Date: Friday, April 18, 2014 8:00 AM to 9:00 AMVenue: Salon D / Radisson Hotel Roseville Register: HereLearn about drafting, implementing, relying on, and troubleshooting health care directives from both the provider and consumer perspectives, including identifying legal standards and desired language, honoring the wishes...
Thứ Tư, 9 tháng 4, 2014
Bentley Family Appeals British Columbia Supreme Court Ruling on Advance VSED
In early February, the Supreme Court of British Columbia issued a 44-page decision in Bentley v. Maplewood Seniors Care Society (2014 BCSC 165). I analyzed and critiqued the decision in the Spring 2014 issue of the Journal of Clinical Ethics 25(1).The family has appealed the Court's ruling to the Court of Appeal for British Columbia (Case Number CA-41600). The Court of Appeal is the highest court in the province. But it may...
Thứ Ba, 8 tháng 4, 2014
Advance Directives & Nursing Home Stays Associated with Less Aggressive End-of-Life Care for Patients with Severe Dementia
A new study in Health Affairs shows some material benefits of advance directives: "Advance Directives and Nursing Home Stays Associated with Less Aggressive End-of-Life Care for Patients with Severe Dementia."The authors found that that nearly 30 percent of patients with severe dementia remained in the community until death. Among those patients, having an advance directive in the form of a living will was associated with significantly less aggressive care at the end of life, compared to similar patients without an advance directive.Medicare...
New Book on Advance Directives
The preface of a new book on advance directives rightly notes that "many ethical and policy issues remain in need of further exploration."Part I - History of Advance Directives and Prerequisites for Validity1. Historical Review of Advance Directives (Alfred Simon) 2. Personal Capacity to Anticipate Future Illness and Treatment Preferences (Marie-Jo Thiel) 3. Advance Directives in Psychiatry (Jochen Vollmann)Part II - Defining the Scope...
Thứ Hai, 7 tháng 4, 2014
Administration of UNWANTED End-of-Life Treatment Continues
A study presented at the 2014 annual meeting of the Society of Critical Care Medicine (abstract 720) found that patients’ clearly stated wishes not to be resuscitated or placed on life support were not followed in 21 of 35 cases. The most significant factors in these unwanted intubations were intervention by patients’ families to countermand their known wishes (nine cases) an inability to locate documentation of patients’ wishes in...
Thứ Bảy, 5 tháng 4, 2014
Court of Protection Allows Clinicians to Stop Life Support over Parents' Objections
On Friday, Mrs. Justice Theis of the Court of Protection gave healthcare providers permission to stop providing life-support treatment to a sick little boy who has been in hospital all his life and on a ventilator for several weeks. ParentsThe boy's parents had asked the judge to give their son "every opportunity to live for as long as he could without causing him harm."CliniciansClinicians concluded that further life-support treatment was unlikely...
Defensive Medicine Like Crossing a Mine Field
When it comes to end-of-life treatment disputes, clinicians often think that they must cross a legal "mine field" to get to the appropriate medical course of action. Let's use this metaphor to explore the resolution of intractable end-of-life treatment conflicts.To be precise, clinicians not only believe that there is a legal mine field, they also think the field is heavily mined, such that there is a very good chance they will be blown up....
Thứ Sáu, 4 tháng 4, 2014
Never Say Never - Long Odds Sometimes Do Payoff
A few years ago, I was presenting on medical futility disputes at the Wynn in Las Vegas. To fit the scene, I included lots of gambling references. For example, in the ICU context, surrogates are often ready to "roll the dice." After all, they need not lay down a bet. Medicare and the private payers are covering the financial cost. And the nursing staff is bearing the psychic cost. Still, when the odds are anything north of zero, nothing in medicine or science can authoritative say that the patient's chances are...
Minnesota Mini Bioethics Academy 2014
The University of Minnesota Center for Bioethics is hosting a Mini Bioethics academy, open to anyone interested in learning about and discussing bioethical issues.Shades of Grey: Ethics and Controversies about Brain DeathTuesday, April 22 6:30-8:30 pmMill City Innovation & Collaboration Center – 901 S. Second St., Minneapolis, MNJennifer Needle, MD, MPH, Assistant Professor, Center for Bioethics; Assistant Professor, Department of Pediatrics, University of Minnesota Medical SchoolRecent headlines about patients who are declared brain dead but...
Thứ Năm, 3 tháng 4, 2014
What Will It Take to Revolutionize Informed Consent?
Here is a new blog post based on an interview that I did for the seventh annual Summer Institute for Informed Patient Choice (SIIPC) at the Dartmouth Center for Health Care Delivery Science: "What Will It Take to Revolutionize Informed Consen...
Thứ Tư, 2 tháng 4, 2014
After Court Battle, Hospital Withdraws Life Support Anyway - Terry Andrew Mace
Here is a quick chronological recap of the Terry Andrew Mace case:March 6: Collapsed at homeMarch 18: Estranged wife arrives from Colorado (separated for 5 years and in midst of divorce proceedings)March 20: Wife authorizes DNRMarch 22: Wife authorizes removal of CANHMarch 24: Williamson County, TX court grants TRO blocking wife's decisionsMarch 27: Court grants temporary guardianship to fatherMarch 29: Hospital puts Mace on "comfort care"April 1: Mace dies at 1:00 a.m.In short, notwithstanding the...
Thứ Ba, 1 tháng 4, 2014
Healthcare Ethics Committees Must Include a Disability Representative
Douglas Diekema will be in town on Friday, April 11, 2014. He will be speaking at the University of Minnesota from 12:15-1:30 pm in Room 3-100 Mayo (East Bank Campus of the University of Minnesota). His topic: "Ashley X Revisited: Growth Attenuation and Children with Severe Developmental Disabilities."Recall that one of the outcomes of the investigation after the Ashley X case was that the ethics committee would include a disability...
Patients Close to 100 Undergoing Risky Surgery
Patients aged close to 100 are having high-risk surgery for deadly conditions.A senior medical official said that doctors were engaging in “futile care” and wasting taxpayers’ money on risky operations “just because they can.”But the doctors performing say they are extending the lives of otherwise fit and elderly people in an era when 80-year olds “are a lot healthier” than a those of a decade a...
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