Death Class - New Show Coming to NBC

In development since April, "Death Class" has finally landed at NBC, according to the Hollywood Reporter.



The drama will center on Norma Bowe, a nurse who decides to teach a new class on death and dying at a New Jersey college.  Unexpectedly, the class becomes immensely popular among students and helps many of them to cope with their personal and family problems.



The drama is adapted from the book "Death Class: A True Story About Life" by Erika Hayasaki.  This description of the book appears applicable to the TV show: "Year after year, Norma Bowe faces a waiting list of students wanting to get into her death class at a college in New Jersey. Beyond the probing about last wills and good-bye letters and class trips to mortuaries and cemeteries is the underlying truth that a good, long stare at death can trigger a deeper appreciation of life."



"Death Class" will star Jennifer Carpenter as teacher Norma Bowe.

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Advance Care Planning Tools That Educate, Engage, and Empower

In the current issue of Public Policy & Aging Report, Charlie Sabatino, American Bar Association Commission on Law and Aging, has contributed "Advance Care Planning Tools That Educate, Engage, and Empower."



Sabatino reviews a variety of pathways, tools, workbooks, and decision aids have been emerging to facilitate advance care planning and to enable documentation of one’s goals and wishes. He focuses on tools that actively engage users or at least lead users through questions that result in a work product.



The issue also includes several articles on the Campaign to End Unwanted Medical Treatment.

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Minnesota Network of Hospice and Palliative Care - 2015 Conference

The Minnesota Network of Hospice and Palliative Care (MNHPC) is the state's leading hospice and palliative care network. It brings together providers, business partners, individuals and donors to increase knowledge, access services, and strengthen advocacy for people living with a serious illness or experiencing the end of life.

MNHPC will hold its 2015 Annual Conference April 19-21, 2015. Please follow this link to learn how to submit a proposal by November 17.

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Jahi McMath - Prematurely Fostering Mistrust

Jahi McMath was adjudicated as legally dead in December 2013.  Her family has yet to deliver any cogent, definitive evidence that supports changing her diagnosis. Can they?  Will they?



If Jahi's family can establish (with independent expert evidence) that she no longer satisfies the criteria for death, that will be tremendously significant.  It will highlight the need to re-attend to the clinical tests by which we ascertain the complete cessation of brain function.  Public confidence in the current diagnosis will be seriously undermined.



But it is worth noting that public confidence is already being undermined - with just the mere suggestion and bald assertion that Jahi may be responsive.  Take, for example, this recent article in the National Catholic Register.



In short, it is one thing to establish an actual refutation, to show that someone can be alive even after a "correct" application of criteria for determining death by neurological criteria.  It is quite another to question the diagnosis based on spurious videos and unsubstantiated allegations. 

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More Secret DNR Orders in UK - Barbara Gibson

In the UK, clinicians may write a DNR order without consent, if they deem that to be in the patient's best interest.  But clinicians must still consult with the patient or family.  In other words, they may write a unilateral DNR order.  But they may not write a "secret" DNR order.

 

Yet, as I have recounted on this blog more than a dozen times, this continues to happen.   One of the most recent cases occurred in August 2014 at Ayr Hospital.

In an apology letter to the family, the said: “I wish to offer my sincere apologies again on behalf of all the staff concerned for the distressing events you have described, and wish to reassure you that lessons have been learned and that practice around DNACPR decisions are being reviewed and improved as a matter of urgency across the organization. . . .  It is evident from the review of Mrs Gibson’s medical records, and discussions with staff involved, there were failures in communicating the medical decisions around resuscitation to Mrs Gibson and yourselves.”

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Must we all die with forced hand-feeding in Advanced Dementia? Will others honor our Living Will?

A nice video by Stanley Terman reviewing the Margot Bentley case now on appeal in British Columbia.

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Brittany Maynard Urges Palliative Care Specialist to Stop Misrepresenting Her Case

Brittany Maynard urges palliative care specialist Ira Byock to stop misrepresenting her case prior to his debate with Compassion & Choices President Barbara Coombs Lee on the Diane Rehm Show this week

.

In comments that Brittany posted on the website for Rehm’s nationally-syndicated NPR show, she denied claims by Byock and other opponents of death with dignity that Compassion & Choices is using her to advance the aid-in-dying movement. Rehm read part of Brittany’s comments during her show. 



“I am Brittany Maynard and it concerns me that Dr. Ira Byock will speak on my ‘behalf’ at all again. I watched a special on PBS where this same individual spoke about my case as though he knew personal details about me, saying some things that were quite frankly not true.



“For example, he said that a gentle death would be available to me easily through hospice, unfortunately that would be after a great length of time, with lots of suffering (physical and emotional), and loss for my young body. He is right that this is not being accomplished successfully for many terminally ill Americans on a widespread basis across our country. This needs to change too, I agree with him there."



“But perhaps most disturbingly, Byock claimed that Compassion & Choices had somehow taken advantage of me through ‘exploitation’ and that I feel compelled to die now based on public expectations. I DO NOT, this is MY choice, I am not that weak. The day is my choice, I have the right to change my mind at any time, it is my right. I am very confident about this. This is a patient right that is critical to understanding Death with Dignity."



“The claim of exploitation is utterly false considering I had gone through the entire process of moving, physician approval for DWD [death with dignity], and filled my prescription before I EVER even spoke to anyone at Compassion and Choices about volunteering and decided to share my story. I support the organization because I support the cause. I believe this is a healthcare right and CHOICE that should be available to ALL terminally ill Americans."



“I made my decisions based on my wishes, clinical research, choices, discussions with physicians, and logic. I am not depressed or suicidal or on a ‘slippery slope.’ I have been in charge of this choice, gaining control of a terrifying terminal disease through the application of my own humane logic. We as a country have real issues with the way doctors are trained to speak about, educate and embrace realities of death."



“As a terminally ill patient, I find it disrespectful and disturbing when people discuss my personal health with details that are not accurate to push an agenda. My request is that physicians speak only what they directly know to be factually true and have a right to discuss. The best change for all our community, physicians and patients, will come from us pulling together and developing policies to protect the severely ill based on honesty, education, and humane treatment of suffering."



“I wish nothing but peace and healing for whom it is available, and a peaceful passing of comfortable choice for whom it is not.”

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Medical Overview of Brain Death (Video)

Adam Webb at Emory provides an excellent and accessible overview of the medical and ethical issues involved in brain death in this recent webinar for the Southeast Chapter of the Society of Critical Care Medicine.

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Making Decisions for Others - Surrogates & Unrepresented Patients (May 7-8, 2015)

Ethical dilemmas commonly arise in healthcare regarding patients who are unable to make their own medical decisions.  

• Who is best positioned to speak for these patients, and what decisions should we allow them to make? 


• What if the patient has no friends or close family members, or close relatives disagree on the best course of action? 


• Should there be a limit on what parents can decide for minor children? 

Cases involving decisions by others are often the most difficult cases that health care providers confront.  Yet policies pertaining to such decisions are frequently problematic, and education for providers about these issues is rarely prioritized.



The UAMS Intensive Healthcare Ethics Workshop for 2015 aims to bring together an interdisciplinary group of scholars to share research and experiences about decision-making for others. The workshop is designed for only a limited number of participants in order to be highly interactive, and will include keynote speaker and small group sessions, as well as submitted papers and posters.   

Submit proposals here by January 12, 2015.  

KEYNOTE SPEAKER

Jessica Berg, JD, MPH

Interim Dean, Professor of Law and Biomedical Ethics, and Associate Director of the Law-Medicine Center

Case Western Reserve University

PLENARY SPEAKER

Douglas B. White, MD, MAS

UPMC Endowed Chair for Ethics in Critical Care Medicine and Director, Program on Ethics and Decision Making in Critical Illness

University of Pittsburgh Medical Center

WORKSHOP DIRECTOR

D. Micah Hester, PhD

Chief, Division of Medical Humanities, Clinical Ethicist

University of Arkansas for Medical Sciences and Arkansas Children’s Hospital

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Today Is Jahi McMath's Birthday

Today, October 24, is Jahi McMath's birthday.  She is 14 years old today.  Or is she?  


It is hard to tell, because there remains uncertainty over whether she is alive or dead.

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Supreme Court’s Decision in Tschumy: Told from the Front Line by the Lawyers Who Litigated the Case

The Minnesota State Bar Association is presenting:  "The Supreme Court’s Decision in Tschumy: Told from the Front Line by the Lawyers Who Litigated the Case."  



The Minnesota Supreme Court recently issued its long awaited opinion in the important case of In re: the Guardianship of Jeffers J. Tschumy.  In a divided opinion, the Court found that a professional guardian can order the removal of life-support from patients without court review, as long as there is no dispute about that decision among interested parties.  The case raised the difficult issue of what powers a guardian has over removing life support when a patient has no hope of recovery.  



Please join the Health Law Section for a discussion of the Supreme Court’s decision by the two attorneys who litigated this important matter.

• Michael J. Biglow, Law Offices of Michael J. Biglow


• Robert A. McLeod, Lindquist & Vennum LLP

Friday, November 21, 2014, 8:00 AM to 9:00 AM

River Room / Town and Country Club  Saint Paul

Please join us for breakfast beginning at 7:30 a.m.

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VA Hospital Mistakenly Places DNR Order on Roland Mayo

The Sacramento, California Veterans Affairs Medical Center has admitted to mistakenly placing a do-not-resuscitate armband on patient Roland Mayo.  (USA Today)







The patient's daughter said that he was hospitalized for a stent replacement in his carotid artery but that complications from previous cancer surgery required a second operation. After that surgery, the patient began vomiting and choking on the vomit.



The VA explained that the arm band did not contribute to a delay in the response of the code team, which attempted to resuscitate the patient within minutes of the code being called.

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Barbara Mancini: Innocent of Assisted Suicide

The Hamline Health Law Institute and Compassion & Choices are pleased to host:

Barbara Mancini: Innocent of Assisted Suicide
5:30 p.m. Reception

6:00 p.m. to 7:00 p.m. Presentation
Thursday, November 13, 2014
Kay Fredericks Room, Klas Center, Hamline University

As reported by 60 MINUTES this week, Nurse Barbara Mancini was arrested and prosecuted for "assisting a suicide" in Pennsylvania for simply handing her terminally-ill father his morphine. Join us to hear from a noted death with dignity activist and about her family's yearlong ordeal. Learn about end-of-life care, your rights as a patient, and your health provider's responsibility under the law.

This event is free and open to the public.  But please RSVP here. Please share this information with anyone you think may be interested.

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North Dakota Personhood Amendment - Impact on End-of-Life Care

On November 4, North Dakota residents will vote on eight ballot initiatives, one of which would amend the state constitution.



If passed, the ballot initiative would add a new section to article I of the North Dakota Constitution:  "The inalienable right to life of every human being at any stage of development must be recognized and defended."



Planned Parenthood observes that this language is quite "sweeping as it contains no exceptions what so ever; not life of woman, health of woman, rape or incest. This could also ban access to birth control and to In Vitro Fertilization (IVF)."  Indeed, this language is so broad (requiring the protection of life "at any stage," it may also impact end-of-life care.



North Dakota Choose Life has contested the claim that the amendment will affect end of life care.

  

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Jean Davies - Successful VSED

Octogenarian Jean Davies, who is also a right-to-die campaigner, successfully used VSED to hasten her death.  



She stopped drinking water on 16 September and passed away on 1 October.  (Sunday Times; Independent; Guardian).



The former maths teacher, 86, did not have a terminal illness, but suffered a range of conditions that made her life uncomfortable including chronic back pain and fainting episodes.  



Davies received care throughout her fast from her GP, who agreed to treat her to alleviate the symptoms of starvation and dehydration after consulting his defence union.  The defence union said that if someone has capacity then it is their choice.



Unfortunately, much of the media attention paints VSED as an unfortunate and tragic choice, necessitated by the illegality of aid in dying.  

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VSED Interview - Not Here by Choice with Phyllis Shacter

The End-of-Life University has an online interview series that provides valuable resources and inspiration for the end of life.  



On October 23, 2013 (1:00 ET), join Dr. Karen Wyatt and her guest Phyllis Shacter, an advocate for natural dying through voluntary stopping of eating and drinking (VSED.) 



Phyllis will discuss the story of her husband Alan who made the choice to stop eating and drinking rather than progress into the later stages of Alzheimer's disease. 



In this interview you will learn:

• Factors that must be considered before making a decision for VSED as a means of dying with dignity


• The role a caregiver must play in this type of decision


• A personal perspective on the process of dying when a choice for VSED has been made

Phyllis Shacter is an advocate for broadening the perspective about the choices available to people leading up to and during the dying process. Phyllis grew into this role through years of a long journey with her beloved husband Alan whose health declined slowly but steadily in the last six years of his life. 

Alan died in April 2013 when he decided to voluntarily stop eating and drinking (VSED) so he did not have to live into the late stages of Alzheimer's. Phyllis draws on her experience as a consultant and public speaker as a means to spread this very important, but not widely known, message.

For more insight into what led up to Alan's decision to VSED, you can also watch Phyllis' TEDxBellingham talk which she gave in November 2013.

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"Brain Death" : Facilitating Family/Hospital Dialogue about Death by Neurological Criteria

The Southern California Bioethics Committee Consortium (SCBCC) in collaboration with LMU Bioethics Institute is presenting "'Brain Death' - Facilitating Family/Hospital Dialogue about Death by Neurological Criteria."



This is a half-day conference for healthcare professionals, bioethical scholars, policymakers, and the public.  It will be on January 18, 2015, from 8 am to 12 pm, at Loyola Marymount University, Ahmanson Auditorium.



8:00-8:30 am    

Registration & Breakfast

8:30-8:45 am    

Welcome and Introduction

8:45-9:15 am    

Rabbi Jason Weiner, BCC: The Jewish view of defining death and brain death

9:15-9:45 am    

Andy Lampkin, Ph.D.: Dialoguing with the African American community on the subject of death by neurological criteria

9:45-10:45 am  

Thaddeus Pope, J.D, Ph.D.: Legal duties of California healthcare providers to accommodate objections to determination of death by neurological criteria

10:45-12 pm     

Panel Discussion

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Jahi McMath Family Gathering Better Evidence Refuting Death Diagnosis

In an October 8 filing with the Alameda County Superior Court, Jahi McMath's family has acknowledged Dr. Fisher's concerns and criticisms with the evidence that it presented earlier this month.  



In response, the McMath family has asked the court for four weeks time to "undertake some of the testing which Dr.Fisher says is missing."  



If the complete and proper testing confirms what the "preliminary" data suggested (i.e. that Jahi is not now dead), that is an extraordinary and remarkable result with significant implications for medical practice, law, and policy.

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What If You Had To Keep PAYING Life Support Machine To Stay Alive?

In this short proof-of-concept film a woman copes with a terminal illness while a machine keeps her alive. And whenever time is up, her lover must pump more money into the machine.



Director Jason Ho and his co-writer Andrew Post are hoping to turn Into Dusk into a longer film. As it stands, though, it works as a brief fable about individuals bearing the financial burden of their medical care.

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Barbara Mancini Assisted Suicide Case

Pennsylvania nurse Barbara Mancini was prosecuted for allegedly helping her terminally ill, 93-year-old father overdose on a bottle of morphine. While the charges were ultimately dismissed, the prosecution harmed Barbara, her father, her family, hospice patients, and all terminally ill patients.



This morning (Sat), I am discussing the case at the ASBH Annual Meeting in San Diego.



Tomorrow (Sun), Barbara will discuss the case with Anderson Cooper on 60 Minutes.



Then, on November 13, Barbara will make a public presentation at Hamline University in Saint Paul.

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Death by Neurologic Criteria 1968 - 2014: Changing Interpretations

The December 2014 issue of the Journal of Critical Care includes a special section titled "Death by Neurologic Criteria 1968 - 2014: Changing Interpretations."



The future of death

Brian Wowk



Where have we been? Where are we going? Initiatives to improve uniformity of policies, integrity of practice, and improve understanding of brain death within the global medical community and lay public

Sam D. Shemie, Andrew Baker



Analysis of the reports of high-level commissions that have comprehensively reviewed US public policy on brain death

W. Andrew Kofke



Death as a biological notion

Calixto Machado

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Minnesota Sentences Melchert-Dinkel to 178 Days in Jail for Assisted Suicide

Even in the five states (MT, NM, OR, VT, WA) where aid in dying is legal, assisted suicide is not.  



Aid in dying is for capacitated, terminally ill patients like Brittany Maynard.  In contrast, assisted suicide occurs under less controlled and less justifiable circumstances.  



Case in point:  William Melchert-Dinkel, who was just re-sentenced in Minnesota for preying upon suicidal people — encouraging two to take their lives.

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Dying in America: IOM Recommendations and Next Steps for Stakeholders

On September 17, 2014, the Institute of Medicine released the report Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life, in which an expert committee identified “persistent major gaps in care near the end of life that require urgent attention from numerous stakeholder groups.” The committee made comprehensive recommendations in the areas of care delivery, clinician–patient communication and advance care planning, professional education and development, payment systems and policies, and public engagement and education.



On November 10, 2014 (1:00 ET), the IOM will present a webinar that will review the recommendations, explore possible next steps and barriers to implementation, and provide an opportunity for stakeholder groups to join the conversation. (Register here)  The webinar will feature brief presentations and an extended Q&A session with: 

• Philip Pizzo (committee co-chair), Stanford University School of Medicine


• David M. Walker (committee co-chair), Former U.S Comptroller General


• Christian Sinclair (committee member), Gentiva Health Services (through September 2014)


• Adrienne Stith Butler (study director), Institute of Medicine

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Family Update on Jahi McMath

This was posted to Facebook today:



"MESSAGE FROM JAHI'S MOTHER, NAILAH:

Hello Everyone, I wanted to take this time out to thank you all for every donation every prayer and every positive thought you send Jahi's way. Jahi is physically stable. All of her organs are fully functional, her skin is flawless and all of her joints are nice and loose. She is a real life sleeping beauty."



"She is alot more responsive to my voice now than what she used to be. If you catch her at the right time she confirms that she knows left from right a leg from an arm a thumb from an index finger ect...... Once she follows the command it seems to just wipe her out so I try not to over do it but sometimes I'm so excited I can't help but to keep pushing her. It is amazing to me how something so small as a wiggle of a finger can mean so much!!!"



"I love my daughter very much and I have watched her progress from December until now. There is definitely an improvement. She recently just had an MRI done and it does show damage but it also shows brain structure and blood flow. She had a lot of other test done as well and they confirmed what I already knew. JAHI CAN HEAR ME!!! Her EEG shows brain waves which I was told she didn't have when she was in California."



"I can not express the happiness I felt when I seen with my own eyes that my daughter had a brain with structure. I was told previously that it would be liquefied or have holes in it because it had been without blood flow and oxygen for 9 months. That is not the case with my daughter. Every person is different and every person heals differently."



"Jahi has also started puberty!! She started her menstruation a couple of months ago and it comes on time and last 3-5 days like any normal female. If you really think about it Jahi is capable of giving life how can the dead give life?"

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Supreme Court of Canada Hears Arguments on Aid in Dying

Tomorrow, the Supreme Court of Canada hears arguments on whether terminally ill Canadians have right to a doctor-assisted death.

Twenty-one ago, the court upheld the law that criminalizes physician and in dying.  But, as many of the more than 20 intervener briefs observe, much has changed over the past two decades.



Two British Columbia women, Gloria Taylor and Kay Carter, launched the original lawsuit back in 2011.  The trial court's decision remains one of the most masterful and comprehensive examinations of the arguments and evidence.  

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New Jersey Urges Medicare Coverage for Advance Care Planning

A New Jersey Senate Concurrent Resolution urges CMS to provide reimbursement to physicians for advance care planning consultations with Medicare participants.  A related bill (S.2435) would provide Medicaid coverage.  Here is the text of the resolution:



WHEREAS, Advance care planning is the practice of making explicit written instructions to caregivers, family and friends on measures for delivering health care and for preserving that adult’s dignity in the event that the adult is unable, because of incapacity, to make those instructions known when needed at a later time; and



WHEREAS, Advance care planning provides support for patients and their families making difficult life decisions; and



WHEREAS, Advance care planning ensures that the patient’s informed end-of-life health care choices are known, documented, and respected; and



WHEREAS, Advance care planning provides competent adults with a legal tool to designate a health care agent and express preferences about health care options to go into effect only after the adult loses the ability to make or communicate health care decisions, including deeply personal decisions about end-of-life care; and



WHEREAS, Advance care planning includes the use of advance health care directives, health care powers of attorney, and medical orders for life-sustaining treatment that can be administered effectively within the health care system; and 



WHEREAS, Studies funded by the Agency for Healthcare Research and Quality have shown that individuals who talked with their families or physicians about their preferences for care had less fear and anxiety, felt that they had more ability to influence and direct their medical care, believed that their physicians had a better understanding of their wishes, and indicated a greater understanding and comfort level than they had before the discussion; and 



WHEREAS, New Jersey has helped promote and facilitate advanced care planning in this State with the enactment of the “New Jersey Advance Directives for Health Care Act,” P.L.1991, c.201 (C.26:2H-53 et seq.) and the “Physician Orders for Life-Sustaining Treatment Act,” P.L.2011, c.145 (C.26:2H-129 et seq.); and 



WHEREAS, An increasing number of private health insurance plans reimburse physicians for advance care planning discussions held with patients, but the federal Medicare program and most state Medicaid programs do not; and 



WHEREAS, The Specialty Society Relative Value Scale Update Committee, a body of the American Medical Association that advises the federal Centers for Medicare & Medicaid Services on Medicare physician reimbursement, has recently recommended that Medicare begin to cover advance care planning discussions; now, therefore,



BE IT RESOLVED by the Senate of the State of New Jersey (the General Assembly concurring):  This Legislature respectfully urges the Centers for Medicare & Medicaid Services to provide reimbursement to physicians for advance care planning consultations with Medicare participants.

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Barbara Mancini: Innocent of Assisted Suicide - November 13 in Saint Paul

The Hamline Health Law Institute and Compassion & Choices are pleased to host:



Barbara Mancini: Innocent of Assisted Suicide

5:30 p.m. Reception

6:00 p.m. to 7:00 p.m. Presentation

Thursday, November 13, 2014

Kay Fredericks Room, Klas Center, Hamline University



Nurse Barbara Mancini was arrested and prosecuted for "assisting a suicide" in Pennsylvania for simply handing her terminally-ill father his morphine. Join us to hear from a noted death with dignity activist and about her family's yearlong ordeal. Learn about end-of-life care, your rights as a patient, and your health provider's responsibility under the law.



This event is free and open to the public: RSVP here. Please share this information with anyone you think may be interested.

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Tim Quill on "Near-Futile" Treatment

In the October 2014 edition of Medical Ethics Advisor, Timothy Quill notes that when treatments might possibly help a little and they have some very small potential utility, patients can typically get access to these.



This may change down the road.  "But we aren't even close to being there as a profession or as a society."  Bioethicists can fully inform the involved parties of the risks, benefits, and limitations of a near-futile treatment.  "But if the patient or family really wants a treatment and there is some utility, ultimately they are going to get it."

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Texas Medical Association Defends Advance Directives Act

Konni Burton is running for the Texas State Senate as a Tea Party candidate.  She recently took a position on the end-of-life medical disputes.



Burton sent a campaign mailer that stated: “As State Senator, Konni will fight to protect the elderly and disabled patients from doctors who want to administer life-ending procedures.”  (Star Telegram)  This is an attack on Texas Health & Safety Code 166.046, the so-called Texas "medical futility law."



A letter from the Texas Medical Association Political Action Committee attacks Burton for her opposition to the 1999 law.  

• "Do you know one single doctor who proposes to do such a thing? In my house, we would call that murder."


•  "By this statement alone, Burton proves she is totally out of touch with the reality of medical care."


• "Burton has demonstrated repeatedly that she is an enemy of the physicians of Texas."

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Lucas Moore: 23-week 520-gram Baby Survives

Lucas Moore was born prematurely at 23 weeks weighing 520 grams, just 0.7 of an ounce over the hospital’s 500 gram cut-off point for intervention. (Telegraph)



With severe health problems – including a bleed on the brain and a hole in his heart – Lucas’s chances seemed dire, and doctors warned there was a high chance of him suffering disabilities as a result.  



But Lucas defied predictions and has now celebrated his first birthday.  The Daily Mail suggests that the case will fuel the debate over guidelines governing whether hospitals try to save the lives of extremely premature babies.

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The Law and Ethics of Dementia

Just published:  The Law and Ethics of Dementia, edited by: Charles Foster, Jonathan Herring, Israel Doron



Dementia is a topic of enormous human, medical, economic, legal and ethical importance. Its importance grows as more of us live

longer. The legal and ethical problems it raises are complex, intertwined and under-discussed. This book brings together contributions from clinicians, lawyers and ethicists - all of them world leaders in the field of dementia - and is a comprehensive, scholarly yet accessible library of all the main (and many of the fringe) perspectives. 



It begins with the medical facts: what is dementia? Who gets it? What are the current and future therapeutic and palliative options? What are the main challenges for medical and nursing care? The story is then taken up by the ethicists, who grapple with questions such as: is it legitimate to lie to dementia patients if that is a kind thing to do? Who is the person whose memory, preferences and personality have all been transformed by their disease? Should any constraints be placed on the sexual activity of patients? Are GPS tracking devices an unpardonable interference with the patient's freedom? These issues, and many more, are then examined through legal lenses. The book closes with accounts from dementia sufferers and their carers. It is the first and only book of its kind, and the authoritative text.



The book is divided into five main sections:

1. Medical Fundamentals


2. Ethical Perspectives


3. Legal Perspectives


4. Social Aspects


5. Patient & Carer Perspectives

Twelve of the 44 chapters are in the legal section:

23. A Legal Overview Mary Donnelly

24. Assessing Capacity Lesley King and Hugh Series

25. Best Interests and Dementia Jonathan Herring

26. Proxy Decision-Making: A Legal Perspective Winsor C Schmidt

27. Being and Being Lost: Personal Identity and Dementia Jesse Wall

28. Dementia, Autonomy and Guardianship for the Old Margaret Isabel Hall

29. Restriction of Liberty Michael Schindler and Yael Waksman

30. Research on Patients with Dementia Phil Bielby

31. Dementia and Carers: Relationality and Informal Carers’ Experiences Rosie Harding

32. End-of-Life Care Ofra G Golan

33. Health Care Resource Allocation Issues in Dementia Keith Syrett

34. The Use of New Technologies in the Managementof Dementia Patients Karen Eltis

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George Watson - End-of-Life Pathway without Consultation

Liz Watson claims doctors put her terminally ill husband, George, on an 'end of life pathway' without telling her, denying her the chance to share his final days with him.  (Daily Mail; Edinburgh News)



Medical notes showed doctors started Mr Watson's end of life treatment at 11:00 am on August 6 and were supposed to discuss it with family at 4:00 pm - which Mrs Watson maintains "never happened."

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BMA Updates "Decisions Relating to Cardiopulmonary Resuscitation"

On Tuesday, the British Medical Association, in conjunction with Resuscitation Council (UK) and the Royal College of Nursing, published a new guidance, a revised edition of Decisions Relating to Cardiopulmonary Resuscitation.



The guidelines identify the key ethical and legal issues that should inform all CPR decisions. Key points emphasized in the new guidance include:

• The value of making anticipatory decisions about CPR as an integral part of good clinical practice


• The importance of involving people (or their representatives if they are unable to make decisions for themselves) in the decision-making process


• That when CPR has no realistic chance of success it is important to make decisions that are in the best interest of the patient, and not to delay a decision because a person is not well enough to have it explained to them or because their family or other representatives are not available


• The importance of careful documentation and effective communication of decisions about CPR.

The guidance also warns against adopting the ‘default position’ of providing CPR, as this potentially denies patients the opportunity to refuse treatment they may not want or that, for many, may not offer overall benefit.  BMA medical ethics chair John Chisholm said: "It is our primary role to benefit patients and, when treatment can no longer achieve this, it is right to avoid invasive and burdensome interventions that will not be successful."

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Dolan Press Release on Postponing Jahi McMath Hearing

The following is an unedited press release issued by Christopher Dolan, McMath family attorney.  I have posted a copy of the referenced documents here.



Christopher Dolan, McMath family attorney, has asked Alameda County Superior Court Judge Emillo Grillo to postpone tomorrow’s hearing regarding Jahi McMath’s status as brain dead so that the team of international brain death experts presented by McMath’s attorneys can have time to read and react to a new statement issued by Dr. Paul Fischer, the physician who originally testified as to Jahi’s brain death. 



This comes following yesterday’s re-appointment of Dr. Fischer as a court consultant by Judge Grillo. McMath’s attorneys have objected to Dr. Fischer’s appointment saying that Fischer had a conflict of interest, and a legal bias, as it is his original determination which is being examined in light of the new facts. No decision on the objection to Dr. Fischer has been issued.



Fischer, immediately upon re-appointment by the court issued a letter supporting his earlier determination stating that the fact that the brain had not liquified, Jahi had started her period (menarche), the evidence that there was cerebral blood flow, the recorded movements of Jahi’s body in response to commands, and the presence of electrical activity in her brain as recorded by EEG had no effect on his opinion.



Despite the sworn declarations of Dr. Calixto Machado, who’s CV demonstrates he is international recognized as a Board Certified expert on brain death; Dr. Alan Shewmon, a former Chief of Neurology at UCLA-Olive Medical Center who’s CV details vast experience as an expert on pediatrics and brain death in children; Dr. Charles Prestigiacomo who’s CV, shows his expertise in brain injury as a Board Certified Neurologic surgeon and Chair of Department of Neurosurgery at Rutgers University; Dr Ivan Mikolaenko, who’s CV details his expertise in brain injury as a Johns Hopkins trained Neurointensiveist/Neurological Consultant; and Dr. Phil DeFina, who’s CV demonstrates his education and experience as the Chief Scientific Officer of the International Brain Research Foundation, Dr. Fischer has indicated that none of the information provided by these experts, who all swear that Jahi McMath is not brain dead, has any effect on his prior opinion.



McMath’s lawyer, Christopher Dolan, asked to have tomorrow’s hearing taken off calendar and be rescheduled for the near future stating “we want to address any concerns that Dr. Fischer has in an effort to demonstrate that, with an open and transparent dialogue between healthcare professionals, only one conclusion can remain: that Jahi McMath is not brain dead.”  



Dolan said “I can understand what a difficult place Dr. Fischer finds himself in as he is the doctor who originally diagnosed Jahi as brain dead. We are not seeking to fault Dr. Fischer’s original exam. Experts say that Jahi’s brain swelling would have given the impression of brain death at that time. What we do want to do is to bring all the evidence forward to be looked at critically, and not defensively, as this is an important medical and legal debate which goes far beyond Jahi. In that regard, in the past, I had approached Dr. Fischer to share this information with him. He did not return my communications. So it is just within the last 24 hours that I have learned of Dr. Fischer’s concerns. To avoid this lapse in communication in the future, today I have requested that the Court permit all of the doctors to conference together as this is an area of science and medicine, with many world class scholars and practitioners involved.”  



Dolan said “We would like to take this out of the arena of adversarial proceedings and into an area of open dialogue and discussion between health care professionals. I’m a lawyer, not a doctor, it would be nice if the doctors could work as doctors without lawyers involved.”



Children’s Hospital has objected to Dolan’s request. In response to Children’ s Hospital’s objection Dolan stated “the McMath family hopes that a way can be found to have the medical community, including Dr. Fischer, productively and thoughtfully engage with Drs. Machado, Shewmon, Mikolaenko, Prestigiacomo, DeFina and Labkovsky and others who have sworn that she is not brain dead. These world class physicians, in saying that Jahi is not brain dead, do not do so lightly, Indeed, Dr. Machado is a staunch defender of the concept of brain death he just believes, unequivocally, in this case, Jahi is not brain dead.”



Dolan said, “the stakes are so high Jahi’s request to be restored to the status of a living person should not be determined technically by the choice of one test over another but, instead, based on well accepted medical principals and Jahi’s presentation which is consistent with a person who is not brain dead. To make sure that the Court has all information, including that which Dr. Fischer says is lacking, we are postponing tomorrow hearing and we will be approaching the court for a further hearing date in the near future.”

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Hamline University Health Law Institute - Annual Report

This is the annual report, or "2014 Highlights" of the Hamline University Health Law Institute.  



It summarizes the accomplishments of our faculty and students over the 2013-2014 academic year.

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