Resolving Intractable Medical Futility Disputes in Virginia

Over six years ago, I analyzed how an intractable futility dispute might be resolved under Virginia law. Earlier this month, I explained that Virginia is considering legislation to strengthen the governing law.Today, the bill's author explains his objective.  "Del. Chris Stolle, a Virginia Beach Republican who is a doctor, was approached by other doctors to clarify state law to say a physician has the right to stop care that's medically...

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Bad Healthcare Surrogates Kill Patient for the Money - Victorino Noval

Three years ago, I blogged about the Victorino Noval case.  The case (actually multiple cases) are still being litigated.  An appellate decision issued a few days ago summarizes the key alleged facts.  Three siblings, Lourdes, Tania, and Victor, allegedly directed a hospital to take their father, Victorino Noval, off life support and administer fatal doses of morphine, without the consent of their brother, Hector Noval (Hector),...

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Oklahoma Medical Treatment Laws Information Act - The Disclosures

Last year, I blogged about the 2014 Oklahoma  Medical Treatment Laws Information Act.  This law was enacted to educate clinicians about their duties, and patients about their rights, under the 2013 Oklahoma Nondiscrimination in Treatment Act.The law went into effect on January 1, 2015.  Accordingly, the state Medical Board has posted disclosures (for clinicians and for patients) that hospitals must provide to the same extent they must...

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Texas Advance Directives Act - 2015 Legislative Session

The 2015 legislative session (the 84th) in Texas has just begun and some are getting ready to again tackle the Advance Directives Act.TADA was last amended in 2003.  Multiple bills were advanced in 2007, 2009, 2011, and 2013.  But none were enacted.  Get ready for round five.    In the January 2015 issue of TEXAS MEDICINE:  "In anticipation of another round of debates over end-of-life care, TMA's workgroup dedicated...

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Medical Benefit Is ALWAYS Patient Determined

The value or benefit of any medical intervention can be assessed on two dimensions.  First, the intervention can be assessed physiologically (e.g. does it restore function to an organ).  Second, the intervention can be assessed subjectively from the patient's values and preferences.Established legal and ethical principles hold that the patient's subjective assessment controls.  For example, while a blood transfusion may provide a physiological...

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New Mexico Court of Appeals to Hear Aid in Dying Case

In January 2014, a New Mexico trial court  ruled that patients have a fundamental right to aid in dying under the state constitution.This afternoon, the New Mexico Court of Appeals will hear oral arguments in the case, captioned asKATHERINE MORRIS, M.D., AROOP MANGALIK, M.D., and AJA RIGGS, Plaintiffs-Appelleesvs.KARI BRANDENBURG, in her official capacity as District Attorney for Bernalillo County, New Mexico, and GARY KING, in his official...

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5th International Conference on Advance Care Planning and End-of-Life Care (ACPEL)

The 5th International Conference on Advance Care Planning and End-of-Life Care (ACPEL) will be held from 9 to 12 September 2015 in Munich, Germany.  The Call for Abstracts is open until 15 Feb 2015.Already booked sessions include:Does the plan actually represent what the patient wanted? - Susan Hickman, Respecting ChoicesACP in Palliative Care Evaluation of implementation - Rebecca Sudore, UCSF School of Medicine, San FranciscoSetting...

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Death Test: Criteria for Screening and Triaging to Appropriate ALternative Care (CRISTAL)

Australian critical care physician Ken Hillman and health services researcher Magnolia Cardona-Morrell have just published a new checklist in BMJ Supportive and Palliative Care:  "Development of a Tool for Defining and Identifying the Dying Patient in Hospital: Criteria for Screening and Triaging to Appropriate aLternative care (CriSTAL)."The goal is to develop an evidence-based screening tool to identify elderly patients...

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A Better Death: End of Life Care: Doctors, Machines and Technology Can Keep Us Alive, but Why?

The Vancouver Sun has just published the first of a significant 3-part series on "A Better Death": "End of Life Care: Doctors, Machines and Technology Can Keep Us Alive, but Wh...

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Managing Conscientious Objections in Intensive Care Medicine

I was delighted to be a part of this ad hoc subcommittee of this American Thoracic Society Ethics and Conflict of Interest Committee that developed An Official Policy Statement: "Managing Conscientious Objections in Intensive Care Medicine."  It was just published in the American Journal of Respiratory and Critical Care Medicine 191(2): 219–227."Intensive care unit (ICU) clinicians sometimes have a conscientious...

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VSED & Complexities of Choosing an End Game for Dementia

On the front page of today's Science section of the New York Times, Paula Span has an important story, " Complexities of Choosing an End Game for Dementia."Can you specify in advance of severe dementia, "triggering conditions" to ensure that nobody tries to keep you alive by spoon feeding or offering liquids?Can people who develop dementia use VSED (“voluntarily stopping eating and drinking”) to end their lives by including such instructions...

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Involvement of ICU Families in Decisions: Fine-tuning the Partnership

Elie Azoulay and colleagues in Paris has just published "Involvement of ICU Families in Decisions: Fine-tuning the Partnership" in the Annals of Intensive Care.I have written a lot about the resolution of intractable end-of-life conflicts.  If the lessons and strategies in this article were followed, there would be far fewer such conflicts.Here is the abstract:"Families of patients are not simple visitors to the ICU. They have just been...

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"Being Mortal" - Atul Gawande on FRONTLINE

On February 10, FRONTLINE follows renowned New Yorker writer and Boston surgeon Atul Gawande as he explores the relationships doctors have with patients who are nearing the end of life. In conjunction with Gawande's new book, Being Mortal, the film investigates the practice of caring for the dying, and shows how doctors -- himself included -- are often remarkably untrained, ill-suited and uncomfortable talking about chronic illness and...

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Virginia to Strengthen Futile Care Law

This week, Virginia introduced a new bill (H.B. 2153) that would strengthen and clarify that state's long-standing futile care law.CURRENT VIRGINIA LAWCurrent law provides that "Nothing in this article shall be construed to require a physician to prescribe or render health care to a patient that the physician determines to be medically or ethically inappropriate. . . .  If the conflict remains unresolved, the physician shall make a reasonable effort to transfer the patient to another physician who is willing to comply with the request . ....

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Australian Medical Association Calls for Cuts to ‘Futile Care’ to Make Medicare Sustainable

Australian Medical Association President Patricia Montanaro said that needed healthcare savings could be found by cutting out “futile care” - where people were given ­expensive (and often risky) treatments with no hope of lengthening life or improving quality of life."We’re continuing to push treatments that may not be what – if you could explain them to the patient and had other options for them – what they would choos...

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Futility Conflicts Turn Violent

Sometimes, ICU physicians worry about getting sued by a family member unhappy or dissatisfied with the dim prospects of the patient.  But they do certainly get death threats too.One recent clinician-family interaction turned ugly this past weekend.  George Pickering, 59, has been charged with aggravated assault. According to court documents, he went to Houston's Tomball Regional Hospital Saturday night, where his son was in the intensive...

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But the Donor Is Not Dead: Organ Procurement Halted

Surgeons in the Bremen area of Germany were forced to stop operating on a 'deceased' patient after discovering he was not brain dead.  (Daily Mail)The team were due to harvest the man's organs for donation. But the operation was stopped as soon as the surgeons discovered their patient was still alive according to medical regulatio...

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New York May Expand Medical Facility Duty to Respect Patient's Religious Beliefs at End of Life

N.Y. Public Health Law 2803-c requires healthcare facilities to publicly adopt and to comply with a statement of patient rights.  Senator Kemp Hannon has introduced a bill that would amend the statement of patient rights.  The capitalized words are new."Every patient's civil and religious liberties, including the right to independent personal decisions and knowledge  of  available  choices, shall not be infringed and the...

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My Life, My Death, My Choice - Assisted Suicide (Scotland) Bill

The My Life, My Death, My Choice campaign has published a new video to provide the facts about the proposed Assisted Suicide (Scotland) Bill currently being considered by the Scottish Parliament.The video tackles some of the misconceptions and misunderstandings about the draft legislation.  Importantly, it is limited to those with terminal or life shortening condition.  Only those who choose to opt-in will be eligible.  And safeguards will protect vulnerable groups.The video also clearly demonstrates the breadth of support in Scottish...

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Parent in Brain Death Dispute Indicted for Murder

Juan Alejandro Lopez Rosales had been in jail for six months on abuse charges, awaiting an autopsy for his 2-month-old baby, Issac Lopez, declared dead on July 2, 2014. (Courier-Journal)  Yesterday, Louisville, Kentucky prosecutors indicted Rosales on a murder charge.Back in July, a court denied the request from Issac's parents asking the court to order the children's hospital to continue physiological support after Issac was declared...

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How should a Catholic hospice respond to patients who choose to voluntarily stop eating and drinking in order to hasten death?

The Linacre Quarterly is the official publication of the Catholic Medical Association (distinct from the larger Catholic Health Association).In a recent issue, Maureen Cavanagh published "How should a Catholic hospice respond to patients who choose to voluntarily stop eating and drinking in order to hasten death?"  Cavanagh is Manager of Ethics Services for St. Peter's Health Partners in Albany, New York.This is her abstract:  "The practice...

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European Court of Human Rights - Lambert v. France

This morning, the European Court of Human Rights held a Grand Chamber hearing in the case of Lambert and Others v. France (application no. 46043/14).  A video is available here with English translation.The case concerns execution of the judgment delivered on 24 June 2014 by the Conseil d’État (the French Supreme Administrative Court) authorizing the withdrawal of the artificial nutrition and hydration of Vincent Lambe...

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Suicide Certificates & Suicide Kits

James C. Salwitz is an oncologist who blogs at Sunrise Rounds.  He recently proposed a "suicide certificate" as a way to remove doctors "from the direct ordering of death" yet still "empower those who believe in suicide a legal outlet, as well as the tools to act."Salwitz explains:  "The suicide certificate would be a kind of application. A legal checklist, which once complete would allow the individual to die by their own hand, but in...

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ASBH - 2015 Call for Proposals

The ASBH 2015 Call for Proposals is now open.This year's theme is "Ethics and Creative Expression." ASBH represents the intersection of bioethics and humanities. It is a crossroads where we celebrate multiple disciplines and practices and professions. It is a place characterized by creative expression of every dimension of the human experience, including both suffering and healing. This meeting offers an opportunity to explore this space in...

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Debbie Purdy Denied VSED

In her final article calling for legalization of aid in dying, Debbie Purdy notes that while at "the Marie Curie Hospice, the staff have been brilliant, they would not help me to refuse food or drin...

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More Unwanted Treatment - Cassandra C - Mature Minor Doctrine

Cassandra C. was diagnosed with "stage 3/4" Hodgkin's lymphoma.  She is 17 years old.  She will die without treatment.But Cassandra refused treatment.  Pursuant to their reporting duties, Cassandra's treating clinicians notified Connecticut DCF.  For the past four weeks, Cassandra has been undergoing chemotherapy treatment at Connecticut Children's Medical Center in Hartford.  Cassandra's mother, Jackie Fortin, explains on...

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Medicine's Alarming Ethic of Preserving Life at All Costs

An anonymous article in the January 1957 Atlantic Monthly captures then emerging alarm over medicine's ethic of preserving life at all costs."There is a new way of dying today.  It is the slow passage via modern medicine.  if you are very will modern medicine can save you.  If you are going to die, it can prevent you from doing so for a very long time."A 1957 editorial in the New England of Medicine said this article should be "required reading for physicians."  It warned of "an approaching specter that looks almost as ghoulish...

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Moral Distress from "Forced Futile Care"

Ontario is what I refer to as a "red light" jurisdiction.  Clinicians always need consent to stop life-sustaining treatment, even if they are confident it is medically and ethically inappropriate and outside the standard of care. One Canadian physician blogger provides a first person perspective for why this is a problem for her professionally and personally....

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More Lawsuits for Unwanted Resuscitation

Last year, I blogged about a number of cases in which families sued, or regulators fined, healthcare facilities for resuscitating patient and residents who did NOT WANT to be resuscitated.  These cases continue.A recently filed federal complaint on behalf of 93-year-old Flora Mae Daniels alleges:  "Daniels was in respiratory failure and despite the fact that her wishes were not to be resuscitated, Golden Living Trussville negligently and wantonly ignored her wishes and the DNR and sent her back to the hospital."The complaint asserts claims...

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