Thứ Hai, 31 tháng 8, 2015
Revisiting CPR Survival Rates Depicted on Popular TV Shows
Jaclyn Portanova and colleagues at the USC Davis School of Gerontology have just published "It Isn’t Like This on TV: Revisiting CPR Survival Rates Depicted on Popular TV Shows" in Resuscitation. Compared to Diem & Lantos' similar 1996 study, accuracy rates of television CPR depictions appear to not be improving.
The authors found that Grey's Anatomy and House portrayed CPR as more effective than actual rates. Overall, the shows portrayed an immediate survival rate nearly twice that of actual survival rates. Inaccurate TV portrayal of CPR survival rates may misinform viewers and influence care decisions made during serious illness and at end of life.
"Public perceptions of cardiopulmonary resuscitation (CPR) can be influenced by the media. Nearly two decades ago, a study found that the rates of survival following CPR were far higher in popular TV shows than actual rates."
"In recent years, major strides toward enhanced education and communication around life sustaining interventions have been made. This study aimed to reassess the accuracy of CPR portrayed by popular medical TV shows."
"Three trained research assistants independently coded two leading medical dramas airing between 2010 and 2011, Grey's Anatomy and House. CPR was depicted 46 times in the 91 episodes, with a survival rate of 69.6%. Among those immediately surviving following CPR, the majority (71.9%) survived to hospital discharge and 15.6% died before discharge. Advance directive discussions only occurred for two patients, and preferences regarding code status (8.7%), intubation (6.5%) and feeding (4.3%) rarely occurred."
Here is one nice counterexample:
The authors found that Grey's Anatomy and House portrayed CPR as more effective than actual rates. Overall, the shows portrayed an immediate survival rate nearly twice that of actual survival rates. Inaccurate TV portrayal of CPR survival rates may misinform viewers and influence care decisions made during serious illness and at end of life.
"Public perceptions of cardiopulmonary resuscitation (CPR) can be influenced by the media. Nearly two decades ago, a study found that the rates of survival following CPR were far higher in popular TV shows than actual rates."
"In recent years, major strides toward enhanced education and communication around life sustaining interventions have been made. This study aimed to reassess the accuracy of CPR portrayed by popular medical TV shows."
"Three trained research assistants independently coded two leading medical dramas airing between 2010 and 2011, Grey's Anatomy and House. CPR was depicted 46 times in the 91 episodes, with a survival rate of 69.6%. Among those immediately surviving following CPR, the majority (71.9%) survived to hospital discharge and 15.6% died before discharge. Advance directive discussions only occurred for two patients, and preferences regarding code status (8.7%), intubation (6.5%) and feeding (4.3%) rarely occurred."
Here is one nice counterexample:
Chủ Nhật, 30 tháng 8, 2015
Neysi Perez Buried Alive, Wakes Screaming Inside Coffin
Pregnant teenager Neysi Perez was buried alive. She was removed from her tomb and coffin after family members heard her screaming.
Her mother said she was still warm. “We were all so happy. After being declared dead for such a long time, everybody was saying that she had come back to life. We were all so happy." (Independent)
Her mother said she was still warm. “We were all so happy. After being declared dead for such a long time, everybody was saying that she had come back to life. We were all so happy." (Independent)
Kevorkian "Coma" [EOL in Art 111]
In "Coma" Jack Kevorkian depicts an unconscious patient being slowly pulled into the mouth of a macabre death mask. Helpless. The death's head resembles the opening of a CAT scan machine, a symbol of modern medical technology.
New Futility Case: Siner v. Kindred Hospital Indianapolis
The Court of Appeals of Indiana issued a decision that allows a family to proceed with its medical malpractice action alleging that a hospital's unilateral DNR order caused the patient's death. Facts
"October 26, 2007, eighty-six-year old Geraldine Siner became a patient at Kindred Hospital. Geraldine suffered from advanced dementia caused by Alzheimer’s disease and as a result could no longer care for herself. Geraldine’s son, John Siner, was designated as her health care representative and had power of attorney."
"Upon Geraldine’s admission to Kindred, and several times thereafter, John informed . . . Geraldine’s attending physician, that Geraldine was to be a ‘full code’ patient. On November 16, 2007, Kindred’s Ethics Committee decided to make Geraldine a No Code/Do Not Resuscitate (“DNR”) patient, meaning that Kindred staff would not attempt to resuscitate her in the event that she went into respiratory or cardiac arrest (otherwise known as “coding”)."
"The Ethics Committee did not receive approval from John or any other family member to change Geraldine’s status in this manner. Geraldine’s health continued to decline over the following two weeks and Kindred declined to keep Geraldine on ‘full code’ status despite her family’s protests."
Expert Testimony
Plaintiff's expert Timothy Pohlman opined both that the hospital was negligent and that this negligence caused Siner's death.
"Kindred’s Ethics Committee recommended over-riding the wishes of the family and instructions of the patient’s medical representative for full treatment, and instituted Do Not Resuscitate (DNR) order, which ruled out such alternative treatments."
"Gerri Siner was also suffering from over-whelming infection, and septic shock at the time of intake. There is no documentation produced for me that indicate SCCM Surviving Sepsis Guidelines, . . . were followed . . . . These guidelines were not followed apparently because the patient was under a DNR order."
"Full damages and suffering that more likely than not resulted from re-prioritization of treatment modalities for Gerri Siner based on her existing ‘DNR’ order that was left in place without full agreement and consent of her Surrogate decision makers . . . ."
Appellate Ruling
The trial court granted summary judgment in favor of Kindred Hospital, finding the family had failed to introduce any evidence on causation. The appellate court reversed, because Pohlman's testimony does create a disputed fact as to causation.
Thứ Bảy, 29 tháng 8, 2015
Kevorkian "Very Still Life" [EOL in Art 110]
In "Very Still Life," Jack Kevorkian's message, "though somewhat capricious, nebulous and indefinable, is clearly underscored by intense feeling. Brilliant colors highlight the melancholoy age-old balance between the warmth of life and the iciness of death, spiced with the sardonic humor of irony."
"The disquieting mood portends inescapable doom for the frail symbol of individual life and seemingly callous extinction of its evanescent aura. The age-old balance is certainly skewed."
"The disquieting mood portends inescapable doom for the frail symbol of individual life and seemingly callous extinction of its evanescent aura. The age-old balance is certainly skewed."
Supreme Court of Nevada Asked to Determine Brain Death Standards
Earlier this month, the Supreme Court of Nevada ordered a hospital to continue physiological support for a dead woman pending briefing, argument, and adjudication. (I summarize the lower court proceedings here.)
Today, the family filed its opening brief. Basically, they make two arguments.
First: "The District Court incorrectly interpreted Nevada's Uniform Determination of Death Act (NRS 451.007(1)(b). The plain language of the Act specifically requires that if there is any functions of a person's brain, including his or her brain stem, then there is no 'death.'"
Second: "The District Court failed to apply and construe the Act in a manner that makes Nevada's criteria uniform among the states which have enacted the law regarding the determination of death. NRS 451.007(3). For what appears to be the first time, a District Court has concluded that the medical standards and protocols to determine ''brain death" are set by the American Academy of Neurology. Indeed, Nevada will be the first state to make a determination of death when the person was first determined to be alive, as confirmed by an electroencephalogram (EEG), without confirmatory evidence of a subsequent flat EEG."
This is not the most eloquent or comprehensive brief. But the core argument is not crazy. The UDDA articulates a standard: "irreversible cessation of all functions of the entire brain." But it is deliberately silent on the specific criteria used to measure "cessation of all functions."
In shot, the law punts the question to the medical profession. But there is significant variability in medical practice across the country in terms of the criteria used to ascertain brain death.
Today, the family filed its opening brief. Basically, they make two arguments.
First: "The District Court incorrectly interpreted Nevada's Uniform Determination of Death Act (NRS 451.007(1)(b). The plain language of the Act specifically requires that if there is any functions of a person's brain, including his or her brain stem, then there is no 'death.'"
Second: "The District Court failed to apply and construe the Act in a manner that makes Nevada's criteria uniform among the states which have enacted the law regarding the determination of death. NRS 451.007(3). For what appears to be the first time, a District Court has concluded that the medical standards and protocols to determine ''brain death" are set by the American Academy of Neurology. Indeed, Nevada will be the first state to make a determination of death when the person was first determined to be alive, as confirmed by an electroencephalogram (EEG), without confirmatory evidence of a subsequent flat EEG."
This is not the most eloquent or comprehensive brief. But the core argument is not crazy. The UDDA articulates a standard: "irreversible cessation of all functions of the entire brain." But it is deliberately silent on the specific criteria used to measure "cessation of all functions."
In shot, the law punts the question to the medical profession. But there is significant variability in medical practice across the country in terms of the criteria used to ascertain brain death.
Thứ Sáu, 28 tháng 8, 2015
Minnesota Board of Medical Practice at Hamline
Join the Minnesota Board of Medical Practice at Hamline on September 12 for some educational sessions on health law.
The Changing Definition of What Is ‘Brain Dead’
Healthline News has just posted a nice new review of the debate over brain death. It is not 100% accurate. But it is a lucid, comprehensive, lay presentation of the issues.
I love this quote from the distinguished critical care specialist and ethicist John Luce: " The brain dead people are not as dead as we once thought they were, in the overall biological sense."
The article also notes that Calixto Machado is working on a paper, to be published before the end of the year, which will propose a new category of consciousness to describe Jahi McMath’s as-yet-unseen circumstances.
I love this quote from the distinguished critical care specialist and ethicist John Luce: " The brain dead people are not as dead as we once thought they were, in the overall biological sense."
The article also notes that Calixto Machado is working on a paper, to be published before the end of the year, which will propose a new category of consciousness to describe Jahi McMath’s as-yet-unseen circumstances.
Medicine Holding Back Death [EOL in Art 109]
The buff man of medicine holding back death itself at Fulton County Health Services in Atlanta. Are we still so confident?
Thứ Năm, 27 tháng 8, 2015
Is ICU Treatment Inappropriate? Clinicians Now Have Guidelines
Medical Ethics Advisor has just posted an article on the new "Official ATS/AACN/ACCP/ESICM/SCCM Policy Statement: Responding to Requests for Potentially Inappropriate Treatments in Intensive Care Units." There are comments from me, Gabe Bosslet, Larry Schneiderman, and Nancy Jecker.
Child's Garden for the ICU [EOL in Art 108]
Lisa Austin, Child's Garden for the ICU, 2001 (casters, steel, pine, plastic laminate, electric light, 6 x 10 x 10 ft).
Thứ Tư, 26 tháng 8, 2015
Original Art in the ICU Waiting Room [EOL in Art 107]
Ulla Darno donated this piece for the new ICU Waiting Room at Columbia Memorial Hospital in Hudson, NY with hopes of providing a more peaceful and soothing environment to others during times of stress.
Thứ Ba, 25 tháng 8, 2015
Original Art in the ICU [EOL in Art 106]
Judith Margolis created these "Panels" for Faraway Places, a project that placed original art made specifically for the Intensive Care Units of Hadassah Ein Kerem Hospital in Jerusalem.
Canadian Medical Protective Association - End-of-Life Panel
The Canadian Medical Protective Association works to protect the professional integrity of physicians and promote safe medical care in Canada. Its annual meeting starts tomorrow in Halifax.
The meeting includes a session on "End-of-Life Care: Medical Legal Issues."
Moderator:
Panelists:
The meeting includes a session on "End-of-Life Care: Medical Legal Issues."
Moderator:
- Mr. André Picard, Health reporter and columnist, The Globe and Mail
Panelists:
- Dr. Douglas Grant, Registrar, College of Physicians and Surgeons of Nova Scotia
- Dr. James Downar, Palliative care physician and intensivist, University Health Network
- Mr. Eric van Wijlick, Senior policy advisor, Royal Dutch Medical Association
- Mr. Domenic Crolla, Gowling Lafleur Henderson, CMPA General Counsel
Thứ Hai, 24 tháng 8, 2015
Do Not Leave Definition of Death Just to Doctors
Andy Ho lucidly explains how the definition of death is value-laden, synthesizing a lot of recent philosophical and medical literature. The issue is more acute in Singapore, because organ donation is presumed and opt-out. "They make a value judgment when they say that the loss of personhood in brain death makes it really death. . . . So what is a moral issue involving life and death has been surreptitiously changed into one about a biological fact to be discovered medically."
"[T]he current public policy permitting organ harvesting from the brain dead may be resting on shaky moral grounds. . . . It deserves being reopened for debate by all. It should not be left to doctors who have no particular expertise in philosophical endeavours."
Chủ Nhật, 23 tháng 8, 2015
Prescription for Medical Students: A Day at the Art Museum? [EOL in Art 104]
A study just published in NEUROLOGY (abstract here) shows a new way to help medical students learn about dementia - at the art museum.
"A day at the museum might be a wise prescription for helping students become compassionate doctors and giving them a better understanding of how patients and caregivers continue their relationships and quality of life despite their diagnosis."
"This research adds to a growing consensus about the value of museum-based arts activities in medical education. . . . A day at the museum may well be a wise prescription, for persons with dementia and their caregivers, to be sure, but also for apprentice physicians."
"A day at the museum might be a wise prescription for helping students become compassionate doctors and giving them a better understanding of how patients and caregivers continue their relationships and quality of life despite their diagnosis.""This research adds to a growing consensus about the value of museum-based arts activities in medical education. . . . A day at the museum may well be a wise prescription, for persons with dementia and their caregivers, to be sure, but also for apprentice physicians."
Futility Dispute - Mary Jane Pierce v. B.C. Women's Hospital
In April, Mary Jane Pierce was born prematurely at 25 weeks with serious health problems. She has cerebral palsy and has suffered multiple hemorrhages that damaged her brain. Next month, a BC court will decide whether B.C. Women's Hospital in Vancouver must maintain life-sustaining treatment.
The Hospital
At some point, NICU clinicians determined that interventions to maintain Mary Jane's condition were burdensome on her body and that she has multiple seizures every day. On August 10, the physician caring for Mary Jane planned to remove the ventilator and transfer the infant to palliative care.
But on August 11, shortly before the ventilator was to be removed, a B.C. Supreme Court judge granted a temporary injunction to stop doctors from removing the life-support.
The Parents
Mary Jane's parents, Michelle Arnold and Justin Pierce of Chilliwack, B.C., say they were pressured on August 7 into signing temporary custody of their daughter over to the care of an agency under the province's Ministry of Children and Family Development.
600 Days of Death - Jahi McMath
DocBastard posts some good thoughts on brain death and the Jahi McMath case by Cory Franklin, a retired ICU physician from Cook County Hospital in Chicago. Franklin had a shorter version of his remarks in the San Francisco Chronicle.
"Any time you have a diagnosis with an outlier, it’s a good idea to review your original assumptions. In this case our assumptions about what brain death actually is."
"Any time you have a diagnosis with an outlier, it’s a good idea to review your original assumptions. In this case our assumptions about what brain death actually is."
Thứ Bảy, 22 tháng 8, 2015
Stop Futile Treatment - Be Surgeons, Not Sissies
At a recent panel discussion on geriatric medicine at Westmead Hospital (in Sydney) several leading specialists agreed doctors should be “surgeons not sissies” and objectively evaluate the prospects of successful treatment.
One surgeon, Henry Pleass, remarked: “I work quite closely with physicians in renal transplantation and I’m amazed sometimes these people are still being dialysed. . . . I think: ‘Why on earth are they doing that?’ because they are dialysing a corpse, so to speak."
One surgeon, Henry Pleass, remarked: “I work quite closely with physicians in renal transplantation and I’m amazed sometimes these people are still being dialysed. . . . I think: ‘Why on earth are they doing that?’ because they are dialysing a corpse, so to speak."
Thứ Sáu, 21 tháng 8, 2015
Man Experiencing First Real Moment of Peace in Years Resuscitated
The Onion is so funny, because it is so true.
"Interrupting the only moment of genuine peace the man had known in several decades, a team of paramedics reportedly resuscitated area resident Alan Taborsky this morning following an apparent cardiac arrest."
"Reports indicated that just as Taborsky had reached a state of complete relaxation in which he felt unburdened by his life’s troubles for the first time in recent memory, medical technicians wrenched him back into consciousness with a pair of defibrillator pads."
"Interrupting the only moment of genuine peace the man had known in several decades, a team of paramedics reportedly resuscitated area resident Alan Taborsky this morning following an apparent cardiac arrest."
"Reports indicated that just as Taborsky had reached a state of complete relaxation in which he felt unburdened by his life’s troubles for the first time in recent memory, medical technicians wrenched him back into consciousness with a pair of defibrillator pads."
Thứ Năm, 20 tháng 8, 2015
LaVecchia Brain Death Dispute Continues in NJ
The New Jersey Record continues coverage of the Michael LaVecchia brain death dispute.The family says that he was wrongly pronounced dead by St. Joseph’s Regional Medical Center. They moved him to Robert Wood Johnson University Hospital.
The newspaper story includes a family-produced video showing relatives bending Michael’s bruised index toe on his left foot, which prompted a movement they believed to be a flinch. His mother says: “He’s feeling something . . . to feel pain has to register in your brain somehow.”
Thứ Tư, 19 tháng 8, 2015
Minnesota Case Illustrates Importance of POLST
Several Minnesota paramedics are under investigation after they stopped resuscitating a nursing home patient at her husband's request. The woman had no POLST, which the paramedics could and should honor. Instead, all they had was the husband's instructions, which they could not honor.
I discussed this case briefly on FOX News and in the Pioneer Press.
I discussed this case briefly on FOX News and in the Pioneer Press.
More Brain Death Disputes - Michael Lavecchia III
13-year-old Michael Lavecchia III was pronounced brain dead at 11:55 a.m. Sunday at St. Joseph's Regional Medical Center (Paterson, NJ) after his car slammed into the back of a Mack truck. But Michael's mother, Laureen, said that she still wants treatment for her son. Interestingly, Laureen initially consented to organ donation. But then the family had the death certificate "destroyed."
As widely predicted, U.S. hospitals may be seeing more of these conflicts.
Aden Hailu - Another Brain Death Lawsuit
Many are following the ongoing (and now nearly
two-year-long) series of California lawsuits concerning the life/death status of Jahi McMath. I have collected materials from those cases here.
Less well-known is another case, just a few hours away, now being briefed to the Supreme Court of Nevada.
Aden Hailu was declared dead at St. Mary's Regional Medical Center more than four months ago, on April 17, 2015. But her family objected to stopping physiological support.
They filed a petition asking the Washoe County District Court to order the hospital to continue such support. For some reason, this all proceeded at a glacier-like pace for weeks and weeks. Eventually, the court held a hearing on June 18 and again on July 21, 2015.
On July 23, the trial court denied the petition. It issued a written order on July 30, 2015. Basically, the trial court found that the medical evidence of death was more credible than the experts who testified she was not dead.
The family is now appealing that order, arguing that the trial court abused its discretion in preferring the hospital's evidence to their evidence.
If my math is right, the opening merits brief is due August 27. The answering brief is due September 7. The reply is due September 18. A hearing will be set sometime after that.
two-year-long) series of California lawsuits concerning the life/death status of Jahi McMath. I have collected materials from those cases here.
Less well-known is another case, just a few hours away, now being briefed to the Supreme Court of Nevada.Aden Hailu was declared dead at St. Mary's Regional Medical Center more than four months ago, on April 17, 2015. But her family objected to stopping physiological support.
They filed a petition asking the Washoe County District Court to order the hospital to continue such support. For some reason, this all proceeded at a glacier-like pace for weeks and weeks. Eventually, the court held a hearing on June 18 and again on July 21, 2015.
On July 23, the trial court denied the petition. It issued a written order on July 30, 2015. Basically, the trial court found that the medical evidence of death was more credible than the experts who testified she was not dead.
The family is now appealing that order, arguing that the trial court abused its discretion in preferring the hospital's evidence to their evidence.
If my math is right, the opening merits brief is due August 27. The answering brief is due September 7. The reply is due September 18. A hearing will be set sometime after that.
Thứ Ba, 18 tháng 8, 2015
Health Care Reform in Minnesota: Mission Advanced But Not Accomplished
The Hamline Law Review has just published its Symposium Issue: Health Care Reform in Minnesota: Mission Advanced But Not Accomplished, Volume 38, Issue 2 (2015). This is the printed product from the Hamline Health Law Institute's October 2014 conference.HEALTH CARE REFORM IMPLEMENTATION IN MINNESOTA: MISSION ADVANCED BUT NOT ACCOMPLISHED: AN INTRODUCTION TO THE SYMPOSIUM
Thaddeus M. Pope
KEEPING OUR EYES ON THE PRIZE: EXAMINING MINNESOTA AS A MEANS FOR ASSURING ACHIEVEMENT OF THE “TRIPLE AIM” UNDER THE ACA
Deborah Farringer
“WHERE DO I START?” ACA COMPLIANCE IN RAPID GROWTH ENVIRONMENTS
Autumn AmadouBlegen
BEYOND THE AFFORDABLE CARE ACT’S PREMIUM TAX CREDIT: ENSURING ACCESS TO SAFETY NET PROGRAMS
Mary Pareja
GOOD MEDICINE, BAD MEDICINE, AND THE WISDOM TO KNOW THE DIFFERENCE: EFFORTS TO MEASURE AND REPORT HEALTHCARE COST AND QUALITY UNDER MINNESOTA HEALTH REFORM LEGISLATION
Daryll Dykes
DETANGLING GRADUATE MEDICAL EDUCATION FINANCING FROM HOSPITAL PAYMENT METHODOLOGIES
Lawrence Massa and Matthew Anderson
LEGAL AID INEQUITIES PREDICT HEALTH DISPARITIES
James Teufel and Shannon Mace
The Knife and Gun Club: Scenes from an Emergency Room [EOL in Art 99]
In The Knife and Gun Club: Scenes from an Emergency Room, award-winning photojournalist Eugene Richards explores the emergency room of Denver General Hospital.
A witness to terrible pain, to life-and-death decisions, and to occasional joy, Richards came to view the emergency room as a microcosm of life, where the restarting of a stopped heart hold the promise of the future, where a six-hour gunshot-wound emergency carries the hurt of assassination and war.
A witness to terrible pain, to life-and-death decisions, and to occasional joy, Richards came to view the emergency room as a microcosm of life, where the restarting of a stopped heart hold the promise of the future, where a six-hour gunshot-wound emergency carries the hurt of assassination and war.
Thứ Hai, 17 tháng 8, 2015
Lessons from the Death of Charles II [EOL in Art 98]
In 1685, King Charles II had fourteen royal physicians, all under great pressure to save his life. He endured excruciating agonies in the name of medicine before he finally expired.
330 years later, many Americans regularly get similarly torturous medicine in a futile attempt to save their lives.
330 years later, many Americans regularly get similarly torturous medicine in a futile attempt to save their lives.
- Let sixteen ounces of blood from a vein in the king's left arm
- Additional eight ounces by a method called cupping, in which the king's shoulder was cut in three places
- Enema to extract still more ill humors
- Another enema administered, only two hours after the first
- Shaved his head and smeared it with blistering camphor and mustard plasters
- Another emetic to bring up the yellow humor (bile)
- Blew a powder of Veratrum album, the poisonous rhizome of the white hellebore lily, up the king's nostrils to initiate paroxysms of sneezing
- The most massive purgative yet, to keep the bowels open during the night
- More bleeding, so they opened both jugular veins in his neck for ten ounces of ill humors
- Sweet julep of black cherry, peony, lavender, crushed pearls, and white sugar
- Forty drops of extract of human skull were administered to allay convulsions
- Rebled, repurged, flipped onto his stomach for another enema, then given the miraculous Jesuits' bark, a much-touted preparation of the day, laced heavily with quinine
- Another enema
- Another draft forced down the king's throat
Chủ Nhật, 16 tháng 8, 2015
Comforting the Dying [EOL in Art 97]
In "La Miseria" Cristóbal Rojas depicts a man sitting vigil next to a female companion suffering from tuberculosis.
POLST Designers Must Consult Medical Ethicists
At least four states enacted new POLST statutes this year: Delaware, Georgia, Kentucky, and Wyoming.
In these laws, the legislature typically delegates to the Department of Health or to a licensing board the job of developing rules and the form itself. The legislature also often directs the agency to consult with "appropriate professional organizations." These typically include, emergency medicine, hospice and palliative care, patient advocacy, and right to life. Notably, Wyoming included "medical ethicists."
In these laws, the legislature typically delegates to the Department of Health or to a licensing board the job of developing rules and the form itself. The legislature also often directs the agency to consult with "appropriate professional organizations." These typically include, emergency medicine, hospice and palliative care, patient advocacy, and right to life. Notably, Wyoming included "medical ethicists."
Thứ Bảy, 15 tháng 8, 2015
Ethics Consultation Responding to Ethics Questions in Health Care
The Veterans Health Administration has just released the second edition of Ethics Consultation Responding to Ethics Questions in Health Care. It is available for free here.
"Ethics Consultation: Responding to Ethics Questions in Health Care establishes IntegratedEthics® (IE) standards for health care ethics consultation, one of the three core functions of IE, a comprehensive and systematic approach to ethics in health care developed by the National Center for Ethics in Health Care (NCEHC) at the Department of Veterans Affairs."
"It is designed to serve as a primer, to be read initially in its entirety by everyone who participates in ethics consultation, including leaders responsible for overseeing the ethics consultation function."
"Subsequently, it can serve as a useful reference document when consultants wish to refresh their memories or answer specific questions about the standards for health care ethics consultation."
Humanities in Medicine Symposium [EOL in Art 96]
On November 15 and 16, the Mayo School of Continuous Professional Development is producing the Humanities in Medicine Symposium.
The symposium is designed to engage artists and healthcare providers who have an interest in building or expanding arts in health care.
You are invited to submit an abstract to showcase innovative and unique arts in healthcare programs, and to explore vital themes, emerging research and innovation in the field. The deadline is Monday, August 24, 2015.
The symposium is designed to engage artists and healthcare providers who have an interest in building or expanding arts in health care.
You are invited to submit an abstract to showcase innovative and unique arts in healthcare programs, and to explore vital themes, emerging research and innovation in the field. The deadline is Monday, August 24, 2015.
Thứ Sáu, 14 tháng 8, 2015
Saying No: Exploring the Ethical Dimensions of Refusals in Healthcare
On Friday, September 18, 2015 in Asheville, North Carolina, MAHEC presents "Saying No: Exploring the Ethical Dimensions of Refusals in Healthcare."
Refusals take place across the spectrum of healthcare
These are some of the many dimensions of “no” that will be explored in this highly interactive program combining case studies, lecture and participant engagement in both plenary and small break out sessions.
Refusals take place across the spectrum of healthcare
- The clinician who refuses to offer treatment believed to be futile, non-beneficial or inappropriate
- The patient who spurns a proposed discharge plan
- The family who declines to discuss changes in goals of care
- The hospital system that decides not to carry certain drugs on its formulary
- The healthcare system that refrains from providing coverage to certain regions or categories of patients.
These are some of the many dimensions of “no” that will be explored in this highly interactive program combining case studies, lecture and participant engagement in both plenary and small break out sessions.
Thứ Năm, 13 tháng 8, 2015
Death with Dignity in Washington State - 6th Annual Report
The Washington State Department of Health has just issued its sixth report on Death with Dignity.In the six years since Washington’s Death with Dignity Act went into effect and since that time, 725 adults with a terminal illness have chosen to end their lives with a physician-prescribed lethal dose of medication.
There were 176 terminally ill patients in 2014 who received a prescription to help them end their lives. The prescriptions were written by 109 different physicians and were filled by 57 different pharmacists. Of the 176 people who received these prescriptions, 170 are known to have died. Death with Dignity participation rose less than 2 percent in 2014 compared to the previous year, although more than half of those who died last year were women — up from 48 percent in 2013.
Those who died after receiving the lethal medications were between the ages of 21 to 101. As in previous years, many patients choosing to receive the medication listed the loss of independence as the reason for participating.
Thứ Tư, 12 tháng 8, 2015
Nevada Supreme Court Orders Physiological Support for Dead Girl
I will summarize the case shortly. Here is the front page of the order. Initial court filings are here.
New Mexico Appeals Court Reverses Ruling that Legalized Aid in Dying
The New Mexico Court of Appeals has just reversed a January 2013 lower-court ruling establishing the legality of physician aid in dying.
In a 144-page opinion, the three-judge panel ruled 2-1 that the district court had erred when it determined that “aid in dying is a fundamental liberty interest. “We conclude that aid in dying is not a fundamental liberty interest under the New Mexico Constitution.”
In a 144-page opinion, the three-judge panel ruled 2-1 that the district court had erred when it determined that “aid in dying is a fundamental liberty interest. “We conclude that aid in dying is not a fundamental liberty interest under the New Mexico Constitution.”
Nominate this Blog for the ABA Blawg 100
If you find this blog of value, please consider nominating it for the American Bar Association's 100 best legal blogs.
Court Declares VSED Illegal
Santhara means a fast unto death. In this practice in the Jain community a person stops eating and even drinking water and awaits death. I first discussed Santhara in a comprehensive look at VSED 2011.On Monday, the Rajasthan High Court declared the practice illegal. (Times of India)
The court called the practice punishable under section 309 of the IPC as an attempt to commit suicide. The court also ordered support to Santhara by any person punishable as abetment under section 306 of the IPC.
Interestingly, some of the argument parallels US arguments over whether AID constitutes suicide. "Jain saints argue that Santhara is a voluntary act carried out rationally and cannot be considered suicide. They say it is something one does with full knowledge and intent, unlike suicide which is typically an emotional and impulsive act."
Cheating Death - Chess Match in Seventh Seal [EOL in Art 93]
Ingmar Bergman's 1957 film "Seventh Seal" is a classic of world cinema. Knight Antonius Block return after fighting in the Crusades. On the beach immediately after his arrival, Block encounters Death.
Block challenges Death to a chess match, believing that he can forestall his demise as long as the game continues. Like many in US hospitals today, Block tries to cheat death even though that is obviously futile.
Block challenges Death to a chess match, believing that he can forestall his demise as long as the game continues. Like many in US hospitals today, Block tries to cheat death even though that is obviously futile.
Thứ Ba, 11 tháng 8, 2015
Aid in Dying Political Cartoon [EOL in Art 92]
This political cartoon from a New Jersey newspaper captures a serious flaw in the opposition to legalizing aid in dying.
Downside of Life-Prolonging Technology
A great story in Health Affairs titled "A Failing Heart And The Downside Of Life-Prolonging Technology" was reprinted in the Washington Post as "The Device Kept Him Alive, But Was the Pain and Suffering Worth It?"I especially like this excerpt" "With very few exceptions, virtually everyone in need of an LVAD is saying yes to the therapy. When such technologies were first introduced in the late 1980s, they were reserved for patients with profound cardiogenic shock and refractory heart failure, and selection criteria focused on future transplant eligibility."
"Since LVADs have become available as a destination therapy, there has been a dramatic expansion of the candidate population over the past 10 years. The total number of LVAD candidates is now estimated at around 250,000 to 300,000 individuals per year in the United States alone."
Thứ Hai, 10 tháng 8, 2015
Advance Directive on Etch a Sketch [EOL in Art 91]
Nobody literally records their advance directive on an etch a sketch. But it too often seems a reasonable representation of most advance care planning - insufficient guidance for clinicians, insufficient guidance for families.
Denying Ourselves the Right to Make Rational Choices about Death
Former Congressman Barney Frank offers his support for Medicare coverage of advance care planning. He urges changing a set of policies that not only do not advance our welfare, but also diminish it: denying ourselves the right to make rational choices about death.
Frank observes that "while there is no clear legal bar to a spouse, child or parent complying with the expressed desire of a brain-dead patient not to be kept breathing artificially, there is an aura of discouragement" from Shiavo and related arguments "that the law should prohibit any action that ended any vestige of life, even where the individual involved had expressed that preference,"
"First, with the dropping of the end-of-life counseling provision from the health care bill, fewer people are aware of the availability – and to most, I believe the desirability – of creating an advance directive with their end-of-life wishes clearly spelled out."
"Second, especially in the absence of an advance directive (but in some cases, even where there is one), some medical providers have varying degrees of reluctance to act."
Chủ Nhật, 9 tháng 8, 2015
ASBH Annual Meeting - Lots of EOL Sessions
If you are not already
planning to go, check out this huge list of sessions on EOL. And this is just a subset of those on the program.
Brain
Death
- Can the Brain
Dead be Harmed or Wronged? On the Moral Status of Brain De… - Religious Exemptions
and the Duality of Death - Are Brain Dead
Human Beings Really Dead? - Done to Death:
Yet Another Argument About Defining Death—Where Miller & …
Futility
- Non-beneficial
Treatment Cases: A Policy Approach? - Preventive Ethics
in an ICU Setting: A Pilot Study - Legal Update
2015: Top 10 Legal Developments in Bioethics - Developing and
Evaluating a Moral Distress Consult Service
ACP & POLST
- Going POLSTal: Stamping
Out Suboptimal Advance Care Planning Practices - Advance Care
Planning in Health Organizations: Moving from Voluntary to Ob - Pregnancy
Exclusions: Marlise Munoz and Limits on the Health Care Decision… - Talk to My Doctor
about End-of-Life Issues? I Didn’t Even Know I Should! - Challenges and
Strategies for Talking about Advance Directives with the Newl - Who Speaks for
This Patient? An Advance Directive Quality Improvement Pro - Innovative
Systems for Documenting Goals of Care and Life-Sustaining - Whose Decision is
it Anyway? Care Providers‚ End of Life Conversations‚ and…
Surrogate
Decisions
- End of Life Rituals
in the NICU as Analogues to the Christian Sacrament of A… - What To Do About
Incompetent Revocations: When Patients With Progressiv… - Continuing
Life-Sustaining Medical Treatment against Surrogate Wishes: Hea - The Unbefriended
Must Not Be Unprotected: Organizational and Clinical Man… - Deciding for
Patients without Proxies: Lessons Learned from a Decade of Det… - Culture and
Religion: Forces to Be Reckoned with when Parents Refuse Life… - Evaluating
Welfare in Patients Diagnosed as Vegetative with Covert Awareness - How
Neonatologists and Bioethicists Conceptualize the Best Interests Standard
Organs
- The Ethics of
Paired Kidney Donation and Kidney Chains - Cardiopulmonary
Resuscitation of Brain Dead Organ Donors: Impermissible‚… - Transplant
Candidates: Expressions of Hope or Denial?
Aid
in Dying
- Supreme Court of
Canada's Ruling in Physician Assisted Dying and Next Ste… - A Matter of Life
and Death: Physician Assistant Attitudes on Physician Assiste…
Other
EOL
- Mute Suffering in
the NICU: Sacrifice in the Pursuit of an Uncertain Future - Innovative Triage
Protocols for Pediatric and Neonatal Patients during an Influ… - Decision Making
in Pediatric Critical Care: the Neonatal, Pediatric, and Cardia… - Outsourcing End-of-Life
Care in the Newborn Intensive Care Unit - Should the Mannequin
Die During Mock Codes? The Ethics of Simulated Death - The Religious
Background and Do-Not-Resuscitate - Nurturing
Healers: A Unique Program Encouraging Reflection among Residents - Teaching the
Professionals and the Public: The Two Sides of End-of-Life Car… - Developing
Critical Thinking Skills among Premed Students in an End-of-Life - Disease Without a
Cure: Understanding Hope
Thứ Bảy, 8 tháng 8, 2015
"Dicing with Dr Death" - Philip Nitschke at the Edinburgh Fringe
See Nitschke “teaching the funny side of the right-to-die debate” to Edinburgh audiences, as well as offering demonstrations of his Destiny euthanasia machine.
The synopsis of the show reads: “From his involvement in the deaths of four real-life patients under Australia’s Rights of the Terminally Ill Act, to his fondness for the do-it-yourself approach, Philip takes his audience on a rip-roaring ride through his 20 years working with life’s one certainty: death.”
The hour-long show will discuss the history of euthanasia as well as talking about how people can get around the laws on assisted suicide.
Before each performance of Dicing With Dr Death, the audience will be required to raise their hands to agree that they will not use any of the information in the show to take their own life – though this is not legally binding.
Museum of Death [EOL in Art 89]
This is the front gate to The Museum of Death in Los Angeles.
The museum includes lots of explicit footage of autopsies and executions, gory photographs of car accidents and dismemberment. There is a whole room dedicated to serial killer art and memorabilia.
The museum includes lots of explicit footage of autopsies and executions, gory photographs of car accidents and dismemberment. There is a whole room dedicated to serial killer art and memorabilia.
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