11th Annual International Conference on Clinical Ethics Consultation

The 11th Annual International Conference on Clinical Ethics Consultation is being hosted by the Bioethics Program of Union Graduate College & Icahn School of Medicine at Mount Sinai, in New York City from May 20-22, 2015.  



The schedule is full of interesting and relevant clinical ethics issues.  If you go to ASBH, you should consider going to this too.  

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When Are You Dead?

I am re-posting this press release from Southern Illinois University on some talks I am doing there next week.



CARBONDALE, Ill. -- A lecture next week at Southern Illinois University Carbondale will examine the question of when a person is legally dead.

Thaddeus M. Pope, director of the Health Law Institute at Hamline University School of Law, will present the 2015 John & Marsha Ryan Bioethicist-in-Residence lecture at the Southern Illinois University School of Law Center for Health Law and Policy.

Pope will address “When Are You Dead? Expanding Objections to Brain Death and Recommended Responses” at 5 p.m., Wednesday, March 4, in the courtroom in the Hiram H. Lesar Law Building.  The lecture is free and the public is encouraged to attend.

Media Advisory

Reporters, photographer and camera crews are welcome to cover the lecture. To make arrangements for interviews or for more information on the lecture, contact Alicia Ruiz, the law school’s director of communications and outreach, at 618/453-8700.  For the lecture in Springfield, contact Karen Carlson at 217/545-2155.

W. Eugene Basanta, the law school’s Southern Illinois Healthcare professor emeritus and health law and policy center director emeritus, said Pope will examine how the law defines death and the associated implications.



For several decades, neurological brain death has been legally established in the United States and throughout the world. Yet laws in California, New York and New Jersey require hospitals to continue physiological support, such as a ventilator, and there is an increasing push for similar accommodations in other states. Defining death is, at least in part, a cultural issue. Furthermore, it can have practical consequences for care providers and policymakers, Basanta said.



For example, a clinician and hospital can deem a patient is dead and move to take them off a ventilator, but then be threatened with a lawsuit by the family if that occurs. “There can be real practical challenges. The more we can do from a health care standpoint; the more technology we have, the more challenges we face,” Basanta said.



Pope will meet with the ethics committee from the Southern Illinois Healthcare hospitals on Thursday, March 5.  At 8:30 a.m., Friday, March 6, Pope will discuss futile care and the role that physicians play in a presentation entitled “Medical Futility-Policy Implications,” at the SIU School of Medicine’s South Auditorium, 801 N. Rutledge St., Springfield.



Pope, an associate professor of law, is chair of the Association of American Law Schools Section on Law, Medicine and Health Care. He speaks throughout the world and has a blog on futile care and end-of-life treatment.



This is the 11th bioethicist-in-residence lecture, and the ninth since John G. and Marsha C. Ryan endowed the visiting lecture series.



Founded in 2006, The John & Marsha Ryan Bioethicist-in-Residence supports an annual residence and lecture by a law or medicine ethics scholar for the SIU schools of law and medicine. The selected presenter visits classes at both schools and organizes interdisciplinary educational activities for students, residents and faculty. The presenter also interacts with students and offers a public lecture on the scholarship as it relates to law and medicine.

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ASBH Call for Proposals Ends March 6

The ASBH 17th Annual Meeting will be October 22-25, 2015 in Houston.  The call for proposals will close at 11:59 pm Pacific Time, Friday, March 6, 2015.

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 the spirit of collegiality and
inclusion, and we welcome proposals on the theme of “ethics and creative expression” and
others in every submission category. 

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Who Gets To Decide When To End Life Support?

Bobbi Kristina Brown, daughter of the late Whitney Houston, is on life support after being found unconscious in her Georgia home. As the media speculates over her condition, who should get to decide when to take a patient off life support?  



This 16 minute HuffPost video provides a nice analysis.  They used high quality guest experts like Alan Meisel (law, ethics) and Randy Curtis (critical care medicine, ethics).

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Rasouli v. Cuthbertson - Part II

On Friday, the Court of Appeal for Ontario dismissed Hassan Rasouli family's appeal in a lawsuit separate from, though closely related to, the October 2013 Supreme Court of Canada decision in Rasouli v. Cutbertson.



In October, 2010, Mr. Rasouli suffered debilitating complications following surgery at Sunnybrook Hospital. He was kept alive by mechanical ventilation. Physicians Brian Cuthbertson, Gordon Rubenfeld and Richard Swartz recommended the withdrawal of mechanical ventilation from Mr. Rasouli.  His family opposed that decision.



As a result of that disagreement, two applications were commenced in the Ontario Superior Court of Justice – one by the Rasouli family and one by the physicians – over the issue of whether the physicians required the consent of Ms. Salasel, her husband’s substitute decision-maker, or the approval of the Consent and Capacity Board (CCB), to withdraw the life-sustaining measures from Mr. Rasouli. Those cases proceeded to the Supreme Court of Canada which, in its October, 2013 decision, held that the physicians were required to seek Ms. Salasel’s consent to the withdrawal of the life-sustaining measures, failing which there had to be a ruling by the CCB



In January 2013, the family commenced a separate action. In it, they sought $1 million in special damages and $1 million in general, aggravated and punitive damages for intimidation, assault, negligence, abuse of process, breach of contract and breach of fiduciary duty. The Statement of Claim specifies that the special damages sought consist of the approximately $500,000 in legal fees spent “to keep Hassan alive”. Mr. Rasoui's wife and two children also sought $250,000 each for the intentional infliction of mental suffering.



In May 2014, the Ontario Superior Court of Justice denied these claims, since they were already adjudicated in the case that went to the Supreme Court.  On Friday, February 20, the Court of Appeal agreed.

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Clinicians Want Legal Certainty

I like this quote from the Minnesota Supreme Court:  “We sympathize with conscientious and dedicated physicians and health care professionals confronted almost daily with legal uncertainty in what, for them, is accepted medical practice.”  



When the court said this in 1989, Minnesota had not yet adopted a statute confirming that death can be determined by not only cardiopulmonary but also by neurological criteria.  But the same sentiment could be applied to all sorts of clinical situations.



Much of my own scholarship is animated by the same desire expressed by the Minnesota Supreme Court.  I want to provide more clarity, so that clinicians are not "chilled" from doing what they judge (or even know with certainty) is the medically and ethically appropriate course of action.

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Brain Death Conference (Video)

It was a pleasure to be a part of "Brain Death" : Facilitating Family/Hospital Dialogue about Death by Neurological Criteria, a half-day conference last month in Los Angeles.



The conference was sponsored by the SOUTHERN CALIFORNIA BIOETHICS COMMITTEE CONSORTUIM (SCBCC) in collaboration with LMU BIOETHICS INSTITUTE.  A video of the proceedings is now available.

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Mandated Disclosure of Medical Futility Policies

Following Michigan and several other states (see, for example, here and here), new Oregon legislation would require hospitals to disclose their medical futility policies.  



S.B. 524 provides in part:



"A health care facility that has a policy concerning the provision of life-sustaining procedures that are not likely to benefit a patient’s or resident’s medical condition shall make the policy available in writing. The facility must provide the written policy to any patient or resident who is admitted to the facility within 12 hours of the admission."

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Health Care Ethics Consultation: Practice-Based Intensive Training

Health Care Ethics Consultation: Practice-Based Intensive Training - with Mary Faith Marshall and Ellen Fox.  Friday, March 20 to Monday, March 23, 2015, at UVA.

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The Cruzan Case 25 Years Later: Its Legacy & Its Future

The University of Pittsburgh Center for Bioethics and Health Law is presenting its 24th Annual Medical Ethics Update: "The Cruzan Case 25 Years Later: Its Legacy & Its Future" on Friday, March 27, 2015.  



Keynote Address: 

• “When Doctors Can’t or Don’t Say No” - Barron Lerner, MD, PhD

Other Lectures and Panels:

• End-of-life decisionmaking


• Palliative care and communication at the end-of-life


• Breakthrough Drugs/Break the bank prices


• Addressing conflict with families at the end-of-life


• Legislation that interferes with the doctor-patient relationship


• When is futile care futile?


• Advance directives – problems and prospects


• Conflict resolution in health care


• End-of-life care in individuals with severe persistent mental illness


• HIPAA – collaboration between clinicians and law enforcement in threat management and crisis intervention

Online registration here.  More information here.  

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Medical Futility: Top Two Formal Mechanisms for Resolving Intractable Disputes

I will be at NYU Langone Medical Center on February 26, discussing "Medical Futility: Top Two Formal Mechanisms for Resolving Intractable Disputes." 

This is a comparison of the effectiveness and fairness of (1) the dispute resolution procedures in the Texas Advance Directives Act and (2) the Ontario Consent & Capacity Board.

The following day, February 27, I will discuss closely related issues at the Quinnipiac-Yale Dispute Resolution Workshop.

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Advance VSED for Dementia

A few weeks ago, the issue of advance VSED (voluntarily stopping eating and drinking) was highlighted in the New York Times.  This week, the topic was also addressed by NPR.  And Robin Marantz Henig, who has done a superb job covering other bioethics issues, is doing a piece for the New York Times Magazine.  



The issue of advance VSED is important, yet remains unsettled and under-analyzed.  Hopefully, this attention will spur more thoughtful analysis and guidance.

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Jahi McMath to Ask California SOS to Rescind Death Certificate

Alex Padilla

The family of Jahi McMath plans to file a request next week with Alex Padilla, California's secretary of state, asking him to rescind the death certificate so the family can return to Oakland and receive care for their daughter.  (NJ Advance Media)



In October 2014, the family tried to achieve the same objective through a court filing in the Alameda County litigation against Oakland Children's Hospital.  But the judge suggested that the family should first petition the relevant state agency.  

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Brain Death: Clinician Duties to Accommodate Objections and "Treat" the Dead

This Friday, February 13, 2015, from 12:15 pm to 1:30 pm, I will present "Brain Death: Clinician Duties to Accommodate Objections and 'Treat' the Dead." 



This will be at the University of Minnesota Center for Bioethics.  2-530 Moos Tower, 515 Delaware Street, Minneapolis.

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Minnesota "Let's Talk Now Act" Advance Care Planning Grant Program

Dozens of end-of-life bills are being introduced each week in legislatures across the country.  These address issues from registries, POLST, guardianship, surrogates, and aid-in-dying.  I cannot report on all of these.  But I do want to mention one piece of new legislation in my own backyard: Minnesota.



 S.F. No. 410 would create Minnesota Statutes, section 145.99, the "Let's Talk Now Act." This would establish a grant program to encourage advanced care planning and appropriate money for the grants.  S.F. No. 407 also appropriate money for the same purpose but does not specify the program in detail.

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Policies and Payment Systems to Improve End-of-Life Care

On March 20, 2015, the Institute of Medicine will convene "National Action Conference: Policies and Payment Systems to Improve End-of-Life Care" at the National Academy of Sciences Building in Washington, DC.



This meeting will bring together health leaders, policy makers, and other stakeholders to discuss how the recommendations from the IOM report Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life could be implemented and what barriers exist that might prevent them from becoming a reality.  



The conference will feature panels on national policy issues, including

• Opportunities and challenges for health care systems, providers, insurers, hospice and palliative care organizations, patient groups, and quality standards organizations


• The integration of financing for medical and social services near the end of life


• Improvements to public and private payment systems to facilitate high-quality care

Confirmed speakers include:

• Christine Cassel, President and Chief Executive Officer, National Quality Forum


• Patrick Conway, Deputy Administrator for Innovation & Quality, Centers for Medicare and Medicaid Services (CMS), Chief Medical Officer, CMS


• Atul Gawande, Surgeon, Brigham and Women’s Hospital, Professor, Department of Health Policy and Management, Harvard School of Public Health, Professor, Department of Surgery, Harvard Medical School


• Rebecca Kirch, Director, Quality of Life and Survivorship, American Cancer Society


• Harold Paz, Chief Medical Officer, Aetna


• Judy Peres, Director, Improving End of Life Care, Pew Charitable Trusts, Member, IOM Committee on Approaching Death: Addressing Key End-of-Life Issues


• Philip A. Pizzo, Professor of Pediatrics and Microbiology & Immunology and Former Dean, Stanford University School of Medicine, Co-Chair, IOM Committee on Approaching Death: Addressing Key End-of-Life Issues


• J. Donald Schumacher, President and Chief Executive Officer, National Hospice and Palliative Care Organization


• David Stevenson, Associate Professor of Health Policy, Vanderbilt University


• Richard Umbdenstock, President and Chief Executive Officer, American Hospital Association


• Bruce Vladeck, Senior Adviser, Nexera, Former Administrator, HCFS


• The Honorable David M. Walker, Former U.S. Comptroller General, Co-Chair, IOM Committee on Approaching Death: Addressing Key End-of-Life Issues


• Senator Mark Warner 


• Steven E. Weinberger, Executive Vice President and Chief Executive Officer, American College of Physicians

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Brain Death - Six Minute Video Description

I like this 6-minute video explanation of brain death.  It was produced by the Halachic Organ Donors Society, an organization devoted to saving lives by increasing organ donations from Jews to the general population (Jews and non-Jews alike).

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