One Chance to Get It Right: Improving People’s Experience of Care in the Last Few Days and Hours of Life

The Leadership Alliance for the Care of Dying People has just released a 168-page report: One Chance to Get It Right: Improving People’s Experience of Care in the Last Few Days and Hours of Life.The report is focused on 5 Priorities for Care.  These priorities are that, when it is thought that a person may die within the next few days or hours:This possibility is recognised and communicated clearly, decisions made and actions taken in accordance...

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A Good Death: A Reflection on Ombudsman Complaints

The Irish Office of the Ombudsman has just released a new report:  A Good Death: A Reflection on Ombudsman Complaints.The report covers several types of complaints:Communications Patient Autonomy Specialist Palliative Care Support for Families and Friends Post-Mortem Examination Returning the Deceased Person’s Belongings Managing Complaints&nb...

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Margot Bentley Does NOT Have Capacity to Revoke Her Prior Instructions to VSED

In the Spring 2014 issue of the Journal of Clinical Ethics, I criticized the British Columbia court's decision in Bentley. The court said that because Bentley swallowed when she a spoon was inserted in her mouth, she has the capacity to make the decision about whether to eat and drink.  But Bentley is in stage 7 Alzheimer's.  The case is now on appeal.Strolling through Dartmouth's Hood Museum, this morning, I was reminded of this...

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Decision Guides on Life-Sustaining Treatment

The California Coalition for Compassionate Care has released Decision Guides on several forms of life-sustaining treatment. Decision Guides explain the complex topics of life-sustaining treatments, using consumer-friendly language with evidence-based information. The Guides were developed with the help and guidance of healthcare professionals, and reflect the latest research on these interventions.TOPICS INCLUDE: artificial hydration, cardiopulmonary...

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Shocked: Adventures in Bringing Back the Recently Dead

Not too long ago, there was no coming back from death. But now, with revolutionary medical advances, death has become just another serious complication.As a young medical student, Dr. David Casarett was inspired by the story of a two-year-old girl named Michelle Funk. Michelle fell into a creek and was underwater for over an hour. When she was found she wasn’t breathing, and her pupils were fixed and dilated. That drowning should have been fatal....

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French Kevorkian Acquitted, Just Like Jack

Nicolas Bonnemaison is a French doctor who actively ended the lives of seven terminally ill patients on their request.Bonnemaison, a former emergency room doctor, was accused of "poisoning particularly vulnerable people" – five women and two men who died between March 2010 and July 2011.Like the multiple Michigan juries that acquitted Jack Kevorkian, this week, a French jury acquitted Bonnemaison of all charges. Jurors accepted Bonnemaison’s...

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UK Supreme Court Judgment & Video on Assisted Suicide

Here is the judgment (also here) in R. (Nicklinson & Lamb) v. Ministry of Justice and a video of the court issuing the judgment. The court stops just short of making a declaration of incompatibility with human righ...

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Conseil d'État - Judgment on Vincent Lambert

Five years ago, 39-year-old fireman, Vincent Lambert, was left in a vegetative state by a motorcycle accident.  His doctors, his wife and most of his brothers and sisters believe that Mr. Lambert has no proper life and no prospect of recovery. They believe that he should be allowed to die.  But Mr. Lambert’s devout Catholic parents, one sister, the French government and a lower court believe that his life should be preserved. Today...

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Tracey v. Cambridge Hospital - Duty to Consult ALREADY the Law in USA

The recent UK Appellate judgment in Tracey v. Cambridge University Hospital establishes a duty on the part of clinicians to consult with patients or surrogates before writing a DNR order.  Notably, British physicians have a duty to consult even though they do not ultimately need patient or surrogate consent to write a DNR order.  I am pleased to observe that this rule has already long been settled law in the United States.  Both where clinicians have the right to write a DNR order without consent (e.g. Texas; California) and where...

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Casey Kasem's Living Will Did Not Work for Dementia: How to Make Sure Your Advance Directive Works

Check out this new video by Stanley Terman.Casey Kasem received the diagnosis of Lewy Body Dementia in 2007. He created a Living Will with expert legal advice and the wishes he expressed in his 2011 revision were consistent. So why didn't this expression of end-of-life wishes prevent him from extreme suffering during the last chapter of his life?  Why was his designated proxy/agent forced to go to court twice? Why did the man who communicated with such a great voice, in the end, have NO voice?Similarly, why did the British Columbia Supreme...

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70% of Americans Support Euthanasia: Changing Legal Climate for Physician Aid in Dying

A recent Gallup poll shows that 70% of Americans Support Euthanasia.  These survey results help explain the unmistakable trend toward legalizing more end-of-life options and expanding individual liberty regarding the manner of death.  A few weeks ago in JAMA, my co-authors and I reviewed the "Changing Legal Climate for Physician Aid in Dying."   Already since then, Quebec enacted Bill 52, legalizing physician aid in dying.  And...

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More Surrogates Challenged over End-of-Life Treatment Decisions

Last week, the "wife versus daughter" conflict over the treatment of Casey Kasem got worldwide attention.  And, hopefully, that coverage will prompt more and better advance care planning.  Still, family conflicts over end-of-life treatment remain common.  For example, take this week's case from Jefferson County, Texas.Last Sunday, 54-year-old Terry Martin's heart stopped beating.  His estranged wife, Debi, permitted Baptist Beaumont Hospital to discontinue life-sustaining treatment.  But she's been estranged...

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11th Annual International Conference on Clinical Ethics & Consultation (ICCEC)

The 11th Annual International Conference on Clinical Ethics & Consultation (ICCEC) will be in New York City, from 20-22 May 2015.  The theme is "Improving Quality and Professionalism of Clinical Ethics Education & Consultation."  Recently clinical ethicists and professional associations have attempted to professionalize our field by developing codes of ethics and proposing formal accreditation of clinical ethicists. Simultaneously, training programs developed new methods for teaching and assessing competency in clinical ethics...

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Treating Patients in PVS is Unreasonable Obstinacy

This may the the holding of the French Council of State in the case of Vincent Lambert.  The 17 judges will announce their decision on Tuesday, June 24.  (Le Figaro; Le Monde)&nb...

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Detoxifying the Concept of Rationing

In the Journal of Clinical Ethics 25, no. 2 (Summer 2014): 116-9, James Sabin has a piece titled "Detoxifying the Concept of Rationing."  Sabin argues that Andrew Hantel’s proposal for dealing with cancer drug shortages exemplifies the kind of clinician-led discussion of rationing that the U.S. political process requires. Sabin argues that the U.S. will not get a grip on healthcare cost escalation until we set true budgets for healthcare....

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Paternalistic Opposition to Court Judgment in Tracey

I was surprised to see this letter, titled "Useless Resuscitation," printed in this morning's Daily Telegraph (emphasis added).SIR – Do Not Resuscitate orders (report, June 18) are usually in the patients' best interests. Dying is hard and often unpleasant. Why do it twice in quick succession? But doctors now have a legal obligation to inform and consult with patients and relatives if they wish to place such an order. This is desirable but often impractical.The same doctors do not have an obligation to provide cardiopulmonary resuscitation if they...

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Do Clinicians Always Need Consent to Stop Life-sustaining Treatment?

Do Clinicians Always Need Consent to Stop Life-sustaining Treatment?  I will answer this question, tomorrow morning, in a webinar for the Arizona Bioethics Network.  I will address the question in the context of two situations: brain death and persistent vegetative state.  My slides are posted he...

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Lawyers & Clinicians: Ethical Obligations to Older Adult Clients & Patients

Join us at Hamline University, on Wednesday July 9, for an expert presentation on "Lawyers & Clinicians: Ethical Obligations to Older Adult Clients & Patients."The Minnesota Board approved this event for 1 ethics CLE credit.  This event also qualifies for social work and nursing continuing education credits.PROGRAM DESCRIPTIONRepresenting older adults presents especially difficult and tricky ethical questions.  For example,...

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Tracey v. Cambridge University Hospital - Duty to Consult on DNR Orders

Almost three years ago, David Tracey filed a lawsuit against Cambridge University Hospital.  Tracey alleged that CUH clinicians wrote a DNR order for his wife without her consent and without any discussion with her.Today, Tracey finally obtained a favorable judgment from the Court of Appeal.  I posted a copy of the judgment here.   Although British law makes clear that the final word on such issues lies with medical staff, there...

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Even Patients with Advanced Illness Have REVERSIBLE Medical Problems

Here is a great short case study and reminder that even among people with advanced illnesses, it is often reasonable to treat reversible medical problems.Even if the patient has previously completed a POLST or advance directive declining aggressive interventions, it might be appropriate to discuss addressing problems like UTIs, especially if the treatment is not too burdensome and there is a good chance of recovery.  The author concludes that it is often reasonable to try a time-limited trial of more intensive treatment, with a plan...

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Films on Death & Dying

This site collects some excellent documentaries and other films on death and dying.  Many, including previously broadcast shows from Frontline and PBS, are available for fr...

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Student Bioethics Prizes

Two student prizes are offered through the Australasian Assiciation of Bioethics & Health Law ConferencesThe John McPhee prize in health, law and ethics: a topic related to health, law and ethicsThe Max Charlesworth prize in bioethics: ethical issues arising in relation to medicine, the health sciences or health care in general from any of the disciplines that offer a perspective on such issues, including philosophy, bioethics, law, social theory,...

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Palliative Care Fast Facts - Now for iOS

Since 2000, Fast Facts and Concepts has provided concise, practical, peer-reviewed, and evidence-based summaries on key topics important to clinicians and trainees caring for patients facing life-limiting illnesses.Fast Facts are designed to be easily accessible and clinically relevant monographs on palliative care topics. They are intended to be quick teaching tools for bedside rounds, as well as self-study material for health care professional...

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The ‘Unbefriended’ Challenge PA/LTC

I am quoted and cited in this nice front-page coverage of the challenge of the unbefriended in the post-acute and long-term care setting.  I am delighted to see the issue getting this attention.  Medical decision making for incapacitated patients and residents without surrogates remains a very big yet under-examined problem.  I am working on an update that summarizes 2014 legislative responses.&nb...

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Dying with Dignity in the Intensive Care Unit - NEJM Poll

The New England Journal of Medicine is conducting a poll on an ICU case.  Read the case below and decide how decisions should be made about this patient’s further treatment.  Participate in the poll and, if you like, submit a comment supporting your choice. The editors’ recommendations will appear on the NEJM site along with a link to the related review article, on June 26.Presentation of CaseA 77-year-old man whose...

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Justice Based Reasons for Resisting Inappropriate Demands for Antibiotics and ICU Treatment

Last week, the LA Times printed this true story: A fellow with a cold came to see Dr. John Santa asking for antibiotics. Santa carefully explained that antibiotics wouldn't do the man any good because his cold was caused by a virus, and antibiotics only work on bacterial infections. The patient stomped out of the office, fulminating bitterly . . . .Every day, in offices all around the country, patients request antibiotics that will do them no good, and all too often their doctors, unlike Santa, prescribe them. "Sadly,...

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National Right to Life Convention to Address End-of-Life Medicine

The National Right to Life Convention is June 26-28, 2014, in Louisville, Kentucky.  Several sessions address end-of-life medical issues.  I would love to better appreciate what is a perspective nearly 180 degrees different from my own.  Alas, I will be in New Hampshire at an informed consent conference.Denial of Treatment Against Your Will: The Battle We’re in Danger of Losing -- Burke Balch, J.D., Tony Lauinger, Elizabeth Graham,...

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Texas Right to Life Sues Senator Bob Deuell over Medical Futility Bill

Do NOT mess with Texas Right to Life.   In the run-up to this year's Republican primary runoff, Texas Right to Life produced radio ads that were critical of Senator Bob Deuell's sponsorship of SB-303.  One of the ads is available here.SB-303 was a bill that would have improved the procedural fairness of the Texas Advance Directives Act. The radio ads, characterizing Deuell's bill as "an expansion of euthanasia,"were apparently...

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UK Court of Protection - Model for End-of-Life Treatment Dispute Resolution in USA

What can the United States learn from British jurisprudence on end-of-life treatment conflicts?  Two things.  First, the Court of Protection regularly authorizes clinicians to withhold or withdraw life-sustaining interventions in a certain range of clinical circumstances.  For example, this week, Mr Justice Mostyn said it would be lawful for doctors not to resuscitate a man if he suffered a "cardio-respiratory arrest" and lawful not...

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World Right to Die Conference

Plan to attend he 20th World Right to Die Conference in Chicago, September 17-21, 2014.Hear about the exciting developments in Scotland from Peter Warren, legislative assistant to the late, great Margot MacDonald.  Attend Chris Docker's seminar on methods of self-deliverance.Also meet the courageous leaders of the movement in Quebec who are close to changing the law in that mostly Catholic province as well as legal and other development in the...

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Florida Fines Nursing Home for Violating DNR Order

Tampa Bay Times reports that the Florida Agency for Health Care Administration has fined Jacaranda Manor nursing home $16,000 after workers performed CPR and used a defibrillator on a 75-year-old man who had a "do not resuscitate'' order on file. I posted a copy of the order here.As a result of the investigation, the St. Petersburg facility has retrained its staff, state records say. Records don't make clear what happened to the resident,...

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Revitalizing Informed Consent Law

My latest post "Revitalizing Informed Consent Law" is now up over at the AJOB blog, bioethics.n...

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Medicare to FINALLY Cover Advance Care Planning?

The federal government may finally better reimburse doctors for talking to Medicare patients and their families about “advance care planning.  (I have carefully reviewed the history of expanded Medicare coverage here.)The proposal is headed toward reconsideration.   The American Medical Association soon will issue recommendations on what doctors should be paid for advance care planning. Every year, the AMA makes reimbursement recommendations...

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