Final Exit Network - 10 Year Anniversary

The Final Exit Network is ten years old this month.FEN is an all-volunteer organization serving members in all 50 states who:Are suffering from intolerable medical circumstances Are mentally competentWant to end their livesMeet FEN's official, written criteriaFEN offers guidance and the most current information known for self-deliverance when the member is ready to choo...

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Minnesota's New Medical Marijuana Law: Now What?

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Religiously Affiliated ICU Patients Receive More Aggressive End-of-Life Care

A study just published in the August 2014 issue of the Journal of Surgical Research finds that religiously affiliated intensive care unit patients receive more aggressive end-of-life care in the ICU. Yet this high-intensity care does not translate into any significant difference in survival.Study ObjectivesPrevious studies have already demonstrated that religious patients receive more aggressive end-of-life care. In this study, the Vanderbilt...

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Jahi McMath Still Responding to Verbal Commands

Jahi McMath was declared dead both by multiple neurologists and by a California court in December 2013.  Yet, just days ago her mother made the following announcement to the crowd at the New Beginnings Community Center's summer gala event at the Long Island Aquarium:  "She has good days and bad days. . . . Some days I ask her to move her left hand, or her right hand and she does...I'm her mom and I know that my daughter is in...

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Providence Institute for Human Caring

Providence Health & Services is establishing the Providence Institute for Human Caring under the leadership of Dr. Ira Byock.  Based at Providence TrinityCare Hospice in Torrance, Calif., the new institute will support clinicians, patients and families across the five states that Providence serves and others nationwide.The institute will bring greater attention to the personal side of illness, dying, caregiving and grieving. Its goal...

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Brain Death Is a Flash Point in End-of-Life Law, Ethics and Policy

My latest post over at the American Journal of Bioethics blog is now posted here:  "Brain Death Is a Flash Point in End-of-Life Law, Ethics andPolic...

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Death: Why the Brain Matters (Video)

This spring, UCLA hosted a mini symposium titled "Death: Why the Brain Matters."  Happily the video is now available.  The speakers were Alex Capron, Professor, Law and Medicine, USCJames Hynds, Senior Clinical Ethicist, UCLA Health SystemPaul Vespa, Director, Neuro ICU, RRUCLA Medical Cen...

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Elder Mediation Training in Minneapolis

Next month, the Mediation Center at Hamline University will offer a 20-hour, three day Elder Mediation Training, on September 25, 26 and 27.This program will expand your skills into the growing field of Elder Mediation. The workshop covers strategies for facilitating adult family conversations around issues like:Living arrangementsCaregivingFinancial planningMedical decisionsAdult guardianship mediationMental capacityWills and estate planningMulti-party mediationMediation intake. Janeen Massaros and John Lundblad will also cover...

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Supreme Court of Canada - Assisted Suicide Oral Arguments on October 15

Lee CarterOn October 15, 2014, the Supreme Court of Canada will hear oral arguments in the case of Lee Carter, et al. v. Attorney General of Canada, et al.  Written  Factums of key parties are available here.The plaintiffs were terminally ill patients seeking physician aid in dying.  Ms. Kay Carter and the applicant Ms. Gloria Taylor both suffered from intractable and progressive diseases and are now deceased. They had joined...

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Ethics, Law & Clinical Practice - Spectrum Health 2014 Ethics Conference

If you will be in or near Grand Rapids, Michigan on Friday, September 5, 2014, come to Spectrum Health's 2014 ethics conference for clinicians: “Ethics, Law and Clinical Practice" at the Calvin College Prince Conference Center.This is a one-day symposium addressing the ethical complexities in health care today. Conference sessions and networking opportunities are designed to increase awareness and provide strategies to clinicians from all disciplines...

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Minnesota v. Final Exit Network - Assisted Suicide Case Resumes

The Minnesota assisted suicide case against the Final Exit Network begins again at 9:00 a.m. on September 8, 2014, in the Dakota County Judicial Center in Hastings. In June 2014, the Supreme Court of Minnesota denied the State's petition for review of the Court of Appeal's September 30, 2013 decision in favor of FEN.  The Supreme Court also dissolved the stay of proceedings in the trial court, which has been in effect since March, 2013.  The case now resumes in the trial court as if the defendants faced a new...

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Nursing Homes Rank as Worst Setting For End-of-Life Care

Reported end-of-life care experiences are typically worse in the nursing home setting, according to the latest results of a recent CMS survey developed and field tested by RAND.The Hospice Experience of Care Survey measured experiences of patients and their caregivers in three hospice settings: Nursing home (including both skilled and regular nursing facilities)Home care (including assisted living facilities) Inpatient care (acute care hospitals and freestanding hospice IPUs).The overall ratings were:Home = 92.2Hospital = 93.0Nursing...

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"Critical Gaps" in Legal Knowledge of Doctors Practicing End-of-Life Medicine

Queensland researchers led by Ben White at the Australian Centre for Health Law Research, Queensland University of Technology (where I'll be tomorrow), have just published research in the Medical Journal of Australia demonstrating "critical gaps in the legal knowledge of many doctors who practise end-of-life medicine."The study focused on (1) the validity and effect of advance directives and (2) the authority of substitute decisionmakers....

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Over-Optimistic Portrayal of Life-Supporting Treatments in Newspapers and Internet

Several Taiwanese researchers have just published a new study:  "Over-Optimistic Portrayal of Life-Supporting Treatments in Newspapers and on the Internet:  A Cross-Sectional Study Using Extra-Corporeal Membrane Oxygenation as an Example."From the article's conclusion:  Newspapers and the Internet have the potential to influence patients' knowledge and attitudes toward medical decision-making by providing over-optimistic...

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Hospitals Should Let More Elderly Patients Die

In an interview with BBC-4, consultant cardiologist James Beattie (Heart of England NHS Foundation Trust in Birmingham) argues that hospitals should let more elderly patients die.  Several papers report on the radio interview.  The Daily Mail title is provocative: "Let More Elderly Die . . . Patients with Low Quality of Life Should Not Be Saved."  Salon reports with the less provocative title "Let the Dying Die."But the sensationalism is misplaced.  The statistics and recommendations are...

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Technology Helps Advance Care Planning - Universal Advance Digital Directive

A radio news report, yesterday, reviews Texas-based My Directives and its Universal Advance Digital Directive (uADD).Easy to CreateMyDirectives makes it easy to create a state-of-the-art emergency medical directive.  You can answer questions in your own words or pick from a selection of the most common answers. Add your thoughts with as much detail as you wish. You can even add your own video responses.East to ShareYou can share your...

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Less than Half of Mayo Clinic Heart Surgery Patients Have Advance Directives

Less than half of the patients who underwent a risky heart surgery at the Mayo Clinic between 2008 and 2012 completed advanced directives. (JAMA Internal Medicine 8/4/14)Aortic StenosisMayo researchers focused on patients with aortic stenosis, which occurs when the main artery to the heart does not open all the way. The problem causes poor circulation and can lead to death.Aortic stenosis can be treated by either (1) opening the patient's chest...

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Health Care Reform Implementation in Minnesota: Mission Advanced But Not Accomplished

A valuable conference on October 24, 2014 in Saint Paul:  "Health Care Reform Implementation in Minnesota: Mission Advanced But Not Accomplishe...

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People First Language Legislation

Last week, Delaware enacted H.B. 416.  The legislation creates no new rights or duties.  But like new legislation in many other states, it improves the vocabulary and terminology in existing law relating to people with disabilities.  People First Language (“PFL”) legislation is part of a national movement to promote dignity and inclusion for people with disabilities.  PFL specifies that the order of terms used to describe any...

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UK Quality Review: Many Patients Not Offered DNAR Option

Last week, the Local Clinical Commissioning Groups, the Leicestershire Partnership NHS Trust and the University Hospitals of Leicester NHS Trust published an innovative "quality review" examination of the health system in Leicester, Leicestershire and Rutland.Among other findings, the reviewers found that patients did not always receive the most appropriate type of end of life care, including palliative care and the use of DNAR orders....

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New Life for Haleigh Poutre after PVS

The Boston Globe has a wonderful profile of the life of Haleigh Poutre.  Her story powerfully illustrates the limits of prognostication for some critically ill patients.  During the early 2000s, Haleigh had been abused by her adoptive parents.  Eventually, in 2005, when she was 11 years old, Haleigh was brought to a local ED with a severe brain injury.  She was soon diagnosed in a persistent vegetative state, and the Massachusetts...

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101 Hospital Policies on End-of-Life Care

In accordance with new state regulations finalized in December and effective this spring, the Washington Department of Health has posted around 100 hospital policies related to end-of-life care.  While some are heavily redacted (and thus probably not compliant with the law), many are complete.  These should be helpful to other hospitals across the country as models and templates for policy drafti...

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