Advance Directive - Multiple Choice Question

The Florida Bar included this question on its examination for attorneys seeking certification in health law.Patient executes a valid living will in the form suggested under Florida state law. Patient designates her oldest son, Steve, as her surrogate to carry out the provisions of her living will. In her living will she directs that life prolonging procedures be withheld and that she be permitted to die naturally with only the administration of medication...

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Palliative Care and Ethics - Difficult Decisions Near the Very End of Life

Earlier this year, Oxford University Press released Palliative Care and Ethics, edited by Timothy E. Quilland Franklin G. Miller.  The seven chapters in section IV focus on "Difficult Decisions Near the Very End of Life."Section I: Introductionand OverviewChapter 1: Introduction (Quill and Miller)Chapter 2: Hospice (Charles von Gunten)Chapter 3: Palliative Care (Susan D. Block)Section II. EthicalChallenges within Current Systems of CareChapter...

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Conference on Brain Death (Los Angeles)

If you are in the Los Angeles area, join us for "Brain Death: Facilitating Family/Hospital Dialogue about Death by Neurological Criteria."  This is a half-day conference for healthcare professionals, bioethics scholars, policymakers, and the public.  It is on January 18, 2015 from 8:00 am to 12:45 pm, in the Ahmanson Auditorium at Loyola Marymount University.8:30-8:45 am      Welcome and Introduction8:45-9:15...

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As You Wish - Virginia Advance Care Planning Website

Four Virginia health systems (Bon Secours, Chesapeake Regional Medical Center, Riverside Regional Medical Center and Sentara Healthcare) have just launched a new "As You Wish" advance care planning website.  This is a good time to make these resources more available.  The holiday season is a prime time for people to talk with their relatives about what type of treatment they want in a cris...

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The Lack of Consensus about Futility (Video)

Earlier this month, Alan Meisel presented "The Lack of Consensus about Futility" as part of the MacLean Center's 2014-2015 seminar seri...

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New Advance Care Planning Videos Show How to Avoid Premature Dying

Did Robin Williams commit suicide due to fear of Advanced Dementia? Did Brittany Maynard hasten her dying based on her fear of future unbearable pain? Did they pay the high price of premature dying—losing some remaining enjoyable life—to act while they still had capacity to control WHEN they died? Might they have lived longer had they been aware of an effective plan to die AFTER losing capacity?Psychiatrist/bioethicist Stanley Terman, PhD, MD, Medical Director and CEO of the non-profit organization, Caring Advocates, has created ​three ​new...

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Stop Unwanted Medical Treatment

Healthcare providers regularly ignore end-of-life wishes or give patients insufficient information to make medical decisions.  Check out Compassion & Choices campaign to stop unwanted medical treatment.&nb...

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Mary Welch Charged with Medical Child Abuse for Obtaining Unnecessary Treatment

A 50-page arrest warrant for Mary Anna Welch accuses her of deceiving doctors into performing needless invasive surgeries on her son, Duke. She's charged with child endangerment.  (NBC News; ABC Ne...

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Brain in a Jar - Sufficient Reason to Keep Me Alive

I share this treatment preference expressed by Atul Gawande at a recent Oregon Public Broadcasting book event."If I'm a brain in jar and I have some sort of sensory devices hooked up to me that allow me to speak, to think, to hear, to talk and to connect with other people, then keep me aliv...

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Resolving Medical Futility Disputes - Alberta follows Ontario in Chalifoux v. Alberta Health Services

This month, the Court of Queen's Bench of Alberta released an eleven-page opinion in Chalifoux v. Alberta Health Services.  This is a rather typical medical futility case resolved in a typical fashion.The PatientAva Alayla Chalifoux-Campiou was born in May 2014 with thanatophotic dysplasia.  This condition prevents her chest from being able to grow to accommodate her lungs.  Sun Hudson, the subject of one of the most high-profile...

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Martha Perez - Texas Family Charges Organs Procured BEFORE Death

I recently summarized a few cases in which a patient was either negligently or intentionally declared dead prematurely.  But this recent case reported by Fox News in Dallas Fort Worth indicates misunderstanding by the family rather than error by the clinicians.  26-year-old Martha Perez dies from injuries sustained in an car wreck involving a suspected drunk driver.  Perez was a registered organ donor and doctors told the...

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Texas Legislature to Address Marlise Munoz Dead Pregnant Situation

Yesterday, on Inside Texas Politics, Texas Representative Matt Krause said he is preparing legislation for the 2015 session that will address the situation in which a pregnant woman is on life support.  Removing life support from a pregnant woman is currently not allowed.  But if the woman is dead, like Marlise Munoz was, then stopping "life sustaining treatment" is not prohibited.  Krause plans to require the appointment of a guardian...

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Janina Kolkiewicz Wakes Up in Morgue after Pronounced Dead

On November 6, a Polish physician made a house call on 91-year-old Janina Kolkiewicz.  But after finding "no basic life functions," the physician declared her dead.  Two hours later she was taken to the morgue.The physician checked for a pulse on a forearm and neck arteries, listened for a heartbeat and the sound of breathing, and checked the pupils for reaction to light, but found none. (CBC News)Nevertheless, shortly before...

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Oregon Death with Dignity Act - 20th Anniversary

Last week marked the 20th anniversary of the Oregon Death with Dignity Act.  Ballot initiative 16 was approved in the November 8, 1994 general election. 627,980 votes (51.3%) were cast in favor, 596,018 votes (48.7%) against.  But an injunction delayed implementation of the Act until October 27, 19...

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Top 30 Bioethics Journals on Earth

This list of English-language journals was recently compiled on Udo Schuklenk's blog.  He includes the standard qualifications.Journal of Medical Ethics                                                         American Journal of Bioethics                                              ...

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First Execution under Obamacare Death Panels?

An alarming debunking of baseless and dangerous rumors at Politifa...

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Dhaka Hospital Withdraws Life Support without Consent or Consultation

Momtaz Zia was admitted to the Squares Hospital in Dhaka Bangledesh on October 19 following her second cardiac arrest. She was put on life support.Yesterday, Zia died after she was taken off life support without her family's consent, alleged family members. (Daily Star)  "They [the hospital] didn't even feel it necessary to inform me about their decision of withdrawing the life support," alleged Mohammad Ziauddin, the deceased's husband.Tanjima...

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Patients and Clinicians Discuss Only 2 of 11 Goals of Care Elements

Studies showing lackluster rates of advance care planning are nothing new.  But this new study in the Canadian Medical Association Journal is particularly disturbing.  The authors identified 11 recommended elements of goals-of-care discussions that are the most important to older adults patients in hospital with serious illness and their family members.  They found that these elements are VERY infrequently addressed by health...

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Susan Tolle Wins MacLean Center Prize in Clinical Ethics for Work on POLST

The 2014 MacLean Center Prize in Clinical Ethics, an award of $50,000, will be presented to Susan Tolle, MD, who has pioneered efforts to improve communication between health care providers and patients regarding end-of-life care.Tolle will receive the MacLean Prize, the largest award in the clinical medical ethics field, during the 26th annual Dorothy J. MacLean Fellows Conference on ethics in medicine. The conference will be held at the University...

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UK Hospital Places DNR Order without Consent or Consultation

Leon Scoble and his sister Danni say that Basildon University Hospital put a “do not resuscitate” order on their father Paul Scoble without consulting them. (Echo)On a Facebook page the family states:"The doctors have twice put a Do Not Resuscitate on our Dad, we managed to get it lifted the first time but doctors refuse to lift it now their reason for this is due to a faulty heart valve." "He needs an operation on his heart to fix two faulty...

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Taiwan End-of-Life Policies Inflict Unwanted Pain & Torture

Doctor Chen Hsiu-tan of National Yangming University Hospital said after a legislative hearing Thursday that Taiwan needs to take stock of the pain its end of life policies are inflicting on the living and those being kept artificially alive.Patients should have the right to choose to die with dignity instead of having to accept futile medical treatment, said Chen, a longtime hospice care advocate.Citing a survey, Chen said that one-third of terminally...

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Ruby Graupera-Cassimiro Survives 45 Minutes without Pulse

Ruby Graupera-Cassimiro, 40, went to Boca Raton Regional Hospital in Florida for a cesarean section on September 23.The surgery was uneventful and the baby was healthy, but Graupera-Cassimiro started to experience shortness of breath and doctors had to call a code when she stopped breathing. They tried for three hours to revive her but it was no use. She had no pulse for 45 minutes. (Sun Sentinel)  Then, her heart started beating again...

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Ethics in Neonatology Symposium

Check out this program at the Yale Club of New York on December 5, 2014: "Ethics in Neonatology Symposium."The Ethics of Refusing a Parental Request for TreatmentMark R. Mercurio Treating Newborns with Trisomy 13/18: Have Times Changed? George Hardart Panel & Audience Discussion Arthur L. Caplan (moderator)Stephen R. LathamPradeep MallyGeorge HardartMark Mercurio Ethical Concerns in Neonatal Comparative Effectiveness...

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"Lethal Malformations" and Language of "Futility"

In the October 2014 Seminars in Neonatal and Fetal Medicine, Dominic Wilkinson and colleagues discuss some of the language that is used (misused) in the context of some severe congenital malformations:  "Ethical language and decision-making for prenatally diagnosed lethal malformations."  These conditions (e.g. Trisomy 18, anencephaly, and renal agenesis) are sometimes described as "lethal malformations" or "incompatible with life."  But, as Janvier and colleagues similarly argued, babies with these conditions can and do...

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Death - a New 5 Part Series on NPR

To the Best of Our Knowledge, a nationally syndicated radio show from Wisconsin Public Radio just started a five part series on Death.  Death: The ReckoningDid you hear? There's a death movement going on in America. After decades of sanitized death, with dying, funerals, burial and grief shielded from public view, some people are now working to make death a greater part of life. In this hour, we talk with experts about how to begin these difficult...

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Six Key Themes on Life-Sustaining Treatment Decisions from Australian Jurisprudence

In the Medical Journal of Australia, check out "Withholding and withdrawing life-sustaining treatment in a patient's best interests: Australian judicial deliberations" by Lindy Willmott, Ben White, Malcolm K Smith and Dominic J C Wilkinson.  They identify six key themes from the developing body of Australian Supreme Court jurisprudence about life-sustaining treatment decisions for adults who lack capacity:Futile medical treatment is not in a patient's best interests.Treatment that is overly burdensome is not in a patient's best interests,...

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World Association for Medical Law - 21st Annual Congress

The 21st Annual World Association for Medical Law Congress will take place in Coimbra, Portugal.  The Congress will commence with a Welcome Reception Sunday evening August 2, 2015, and will conclude Thursday, August 6, 2015 followed by a Gala Dinner and Awards Ceremony.The program will consist of four topics:Ageing and Health LawInformation Technology & Health LawMigrations & Health LawIslamic Bioeth...

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2014 European Declaration on Palliative Care

Last month, policymakers and stakeholders in the field of palliative care and long-term care came together at a conference held in Brussels aiming at presenting the results of two EU-funded projects IMPACT and EURO IMPACT and developing a set of recommendations for policy, practice and research.The conference identified some main areas of improvement to be taken into account for further action. One concrete outcome of the conference was the following "Declaration on Palliative Care."2014 European Declaration on Palliative Care"Palliative care...

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Alabama Unilateral DNR Policy Challenged by Federal Class Action Lawsuit

Prisoners in Alabama Department of Corrections (ADOC) prisons have filed a federal class action for declaratory and injunctive relief to provide constitutionally adequate medical and mental health care.  One of the complaints about the prison health care concerns an alleged policy and practice to write DNR orders on prisoners without their consent.Here are relevant paragraphs from the complaint:162. DEFENDANTS THOMAS and NAGLICH have a policy...

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