Terri Schiavo died ten years ago, today, on March 31, 2005, around 10:00 am EST. An earlier court ruling had allowed her husband and legal guardian, Michael Schiavo, to authorize the removal of her artificial nutrition and hydration on March 18.
Thứ Ba, 31 tháng 3, 2015
March 31, 2005: Terri Schiavo Dies
Terri Schiavo died ten years ago, today, on March 31, 2005, around 10:00 am EST. An earlier court ruling had allowed her husband and legal guardian, Michael Schiavo, to authorize the removal of her artificial nutrition and hydration on March 18.
Thứ Hai, 30 tháng 3, 2015
Maine Legislation Would Mandate Written Consent before Stopping Life-sustaining Treatment
Four months ago, I blogged about Simon's Law, a bill that was introduced in Missouri to prohibit the unilateral withholding and withdrawing of life-sustaining treatment from children like Simon Crosier, a baby born with Trisomy 18.The bill would make Missouri a "red light" state like Ontario, Idaho, New York, and Oklahoma. In contrast, California, Texas, and Virginia are "green light" states in that they specifically permit clinicians to stop treatment (even over family objections) when they determine it is inappropriate.
This week, state Senator Cushing introduced L.D. 1117, a nearly identical bill in Maine. The Maine bill authorizes a physician to withhold or withdraw life sustaining treatment for a minor or institute a do-not-resuscitate order for a minor only if the authorized legal surrogate for the minor gives direction in writing.
"A physician may withhold or withdraw life-sustaining treatment for a minor, institute a do-not-resuscitate order for a minor or take other action that is more likely than not to lead to severe physical harm or death of a minor only if the authorized legal surrogate for the minor gives direction in writing."
"Before giving a direction under this subsection, the authorized legal surrogate shall consult with the minor's attending physician and follow all procedures required by the health care facility. The authorized legal surrogate shall also obtain a 2nd opinion from another physician with adequate expertise and experience of the minor's diagnosis, prognosis and risks and the probable result of the proposed action and available alternatives. The authorized legal surrogate may rescind the direction at any time by a communication, which takes effect upon receipt, to the attending physician or health care facility."
Chủ Nhật, 29 tháng 3, 2015
How do you want to die? A mission to make death part of popular conversation
PBS NewsHour just ran a great 10-minute profile of The Conversation Project.
A growing national movement to normalize end-of-life discussions among family and friends has gained traction in recent months. As Medicare considers whether to cover such conversations with physicians, The Conversation Project is highlighting the importance of talking openly about dying.
A growing national movement to normalize end-of-life discussions among family and friends has gained traction in recent months. As Medicare considers whether to cover such conversations with physicians, The Conversation Project is highlighting the importance of talking openly about dying.
Inertia of Clinical Practice: Impact of Tracey on DNACPR Discussions
It has been nearly ten
months since the UK Court of Appeals handed down its
judgment in Tracey v. Cambridge University
Hospitals NHS Foundation Trust.
Some predicted that the decision would have "far-reaching implications for clinical practice." But a recent study shows that "national coverage . . . did not lead to any significant
difference in the documentation of DNACPR discussions." Indeed,
"very few clinicians . . . were even aware of the case."
The authors remarked on the "inertia of clinical
practice" and the need to demonstrate the relevance of the ruling in a
"targeted teaching session." In short, even a high profile
appellate ruling is not enough to change clinical practice. The appropriate
changes and improvements must be deliberately "disseminated to the
frontline individuals."
Thứ Bảy, 28 tháng 3, 2015
Intensive Care Hotline Resource for Families of Critically Ill Patients
Most of my blogging on this site, as well as my articles and book chapters, and all concern legal rights and duties concerning medical treatment at the end of life.
But most of the communication, negotiation, and mediation about end-of-life treatment conflicts never gets (or needs to get) framed in legal terms. Disputes are usually resolved way upstream. Most hospitals have ethics consults, ethics committees, ombudsmen, patient advocates, and/or other resources.
One external resource for families of critically ill patients in intensive care is the Intensive Care Hotline. The printed and live consulting offerings are designed to help families:
But most of the communication, negotiation, and mediation about end-of-life treatment conflicts never gets (or needs to get) framed in legal terms. Disputes are usually resolved way upstream. Most hospitals have ethics consults, ethics committees, ombudsmen, patient advocates, and/or other resources.
One external resource for families of critically ill patients in intensive care is the Intensive Care Hotline. The printed and live consulting offerings are designed to help families:
- Ask the doctors and the nurses the right questions
- Discover the many competing interests in Intensive Care and how treatment may depend on those competing interests
- Stop being intimidated by the Intensive Care team and how you will be seen as equals
- Get "behind the scenes" insight to understand what is really happening in ICU
- Have peace of mind, power, influence decision making and stay in control of their Family's and their critically ill loved one's destiny
Thứ Sáu, 27 tháng 3, 2015
$1 Million Lawsuit over Unilateral DNR Order - Luong v. Toronto East General Hospital
Robert Cribb at the Toronto Star has been a diligent and articulate investigative reporter covering end-of-life medical treatment disputes. This week, he reports on a new lawsuit filed by the family of Canh Luong against Toronto East General Hospital.94-year-old Luong was admitted to TEGH in September 2014. While clinicians recommended comfort measures, that plan was rejected by her family. But by October 2014, hospital physicians proceeded without family consent. Physician Alvin Chang transferred Luong from the ICU to a general ward of the hospital. And he wrote a DNR order without the family's consent.
The case is remarkable for two reasons. First, after Cuthbertson v. Rasouli, many Canadian clinicians have become more deferential to family wishes.
Second, the lawsuit alleges that Dr. Chang did not even delay implementing the unilateral decision for a mere 24 hours to allow the family the opportunity to seek a court order or a transfer to another facility. A brief waiting period is a standard part of the dispute resolution procedures in hospital policies, in model medical society policies, and in state laws.
Lisa Avila Family Now Accepts Death Diagnosis, Agrees to Stop Physiological Support
It looks like the brain death dispute between the family of Lisa Avila and Anaheim Regional Medical Center is coming to a consensual conclusion.After obtaining a TRO, the family was able to bring in their own neurologist. Like the ARMC physicians, the independent neurologist did not detect any brain activity. The family now plans to take Avila off of life support around 5 p.m. Friday. (ABC News)
The family reported on its fundraising website: "So now the family does have a little more piece of mind in regards to trusting a third party Dr, that is not affiliated with the hospital. We are currently now working with the staff of the hospital in trying to agree to terms of a time frame of the disconnection of the plug from Lisa's Life support. This is not something that is very easy for the family still to accept, although the fact of the reality is just setting in."
Thứ Năm, 26 tháng 3, 2015
Biosecurity in a Globalised World: The Adoption of the Revised International Health Regulations – 10 Years On
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Dissecting the Ethics of Organ Donation - 2nd Annual Islamic Bioethics Workshop
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Thứ Tư, 25 tháng 3, 2015
Court Orders Hospital to "Treat" Dead Woman - Avila v. ARMC
Following the procedural path set by the Jahi McMath case in 2013, the family of Lisa Avila has obtained a TRO "precluding" Anaheim Regional Medical Center from "removing Lisa Avila from the ventilator or ending any of the current treatment." The family is going to get an "independent" exam to confirm the diagnosis of death by neurological criteria.
Thứ Ba, 24 tháng 3, 2015
Medical Futility Lawsuit Proceeds against Yale - Marsala v. Yale New Haven Hospital
In 2008, I reviewed all the medical futility lawsuits that I could find. I looked at both ex ante cases (for injunctions) and ex post cases (for damages). With respect to the ex post cases, I concluded that the single most successful theory has been for emotional distress (IIED or NIED).
Consistent with my findings, in late 2013, the Connecticut Superior Court denied Yale New Haven Hospital's motion to dismiss an intentional infliction of emotional distress (IIED) claim brought by the family of Helen Marsala. (I blogged about this case almost exactly a year ago, when I spoke at Yale.)
In Marsala v. Yale, the family alleges that clinicians removed Helen's ventilator without consent and over their objections. The court ruled that a jury could find that "terminating a patient's life support with an awareness of her contrary wishes constitutes unacceptable behavior and would readily be considered extreme and outrageous."
But while the family defeated Yale's motion to dismiss, it could not defeat Yale's motion for summary judgment. Connecticut law apparently does not support "bystander" IIED claims. This week, Yale successfully moved for summary judgment' on the IIED claim. The case is still proceeding on a number of other counts.
Consistent with my findings, in late 2013, the Connecticut Superior Court denied Yale New Haven Hospital's motion to dismiss an intentional infliction of emotional distress (IIED) claim brought by the family of Helen Marsala. (I blogged about this case almost exactly a year ago, when I spoke at Yale.)
In Marsala v. Yale, the family alleges that clinicians removed Helen's ventilator without consent and over their objections. The court ruled that a jury could find that "terminating a patient's life support with an awareness of her contrary wishes constitutes unacceptable behavior and would readily be considered extreme and outrageous."
But while the family defeated Yale's motion to dismiss, it could not defeat Yale's motion for summary judgment. Connecticut law apparently does not support "bystander" IIED claims. This week, Yale successfully moved for summary judgment' on the IIED claim. The case is still proceeding on a number of other counts.
California Lawsuit for Not Honoring POLST
The family of Mary Virginia Schuller has just filed a lawsuit in Los Angeles Superior Court against a long term care facility for, among other things, failing to honor her June 2014 POLST.
Administratively, CMS has already concluded that the facility violated Ms. Schuller's rigths under Medicare/Medicaid Conditions of Participation. The civil damages claims are for:
Administratively, CMS has already concluded that the facility violated Ms. Schuller's rigths under Medicare/Medicaid Conditions of Participation. The civil damages claims are for:
- ELDER ABUSE & NEGLECT
- NEGLIGENCE
- NEGLIGENT HIRING, SUPERVISION, & RETENTION
- VIOLATION OF RESIDENTS RIGHTS
- NEGLIGENT INFLICTION OF EMOTIONAL DISTRESS
- WRONGFUL DEATH
AALS Section on Disability Law Call for Papers/Presentations for 2016 Annual Meeting
The AALS Section on Disability Law issued the following call for papers and presentations for the 2016 AALS Annual Meeting to be held in New York, New York, January 6-9, 2016. Selected papers will be published in the Journal of Legal Medicine.
Program title
The Wounded Warrior Comes Home: Exploring the Impact of Disabled Veterans on Disability, Health, and Other Law and Policy.
Program Description
About a century ago, returning war veterans with disabilities had a profound impact on both cultural and legal attitudes toward disability, shifting us from the charitable model to the rehabilitation model. Today’s soldiers often survive injuries that would have been fatal in prior combat engagements, leaving them with even more significant physical impairments. There is also a growing understanding of the scope of mental impairments associated with military service.
At the same time, disability has shifted from something personal to the individual that she or he must work to overcome, to something largely attributable to choices made by society, and we now recognize equal opportunity for individuals with disabilities is a matter of civil rights. Veterans with disabilities may once again play a significant role in shaping the future of disability rights law. In addition, in an era of changing norms regarding health care, veterans with disabilities may play a significant role in that context. Beyond those topics, veterans with disabilities may affect issues of criminal law, employee benefits law, and tax law, to name a few.
This panel will explore the contemporary impact of veterans with disabilities on our law, including ways in which law and policy can be more responsive to the needs of these veterans and those with whom they interact, and how their unique status may help inform various normative conversations.
Paper/Presentation Requirements and Submission Instructions
Presentations and papers may address a wide spectrum of issues associated with the program topic, from macro or micro perspectives, and further may focus on historical foundations, present conditions, assessment of past or current corrective measures, and/or the analysis of necessary corrections or changes in law or public policy.
Selected papers will be published in the Journal of Legal Medicine, the legal journal of the American College of Legal Medicine. Papers must not have been published or accepted for publication elsewhere. Preference will be given to papers of 25,000 words or fewer.
Abstracts of proposed papers/presentations should be submitted to Cheryl L. Anderson, AALS Disability Law Section Chair, at cheryla@siu.edu no later than Monday, August 3, 2015. The officers of the Section on Disability Law will select two abstracts for presentations. Authors will be notified no later than August 24, 2015.
Program title
The Wounded Warrior Comes Home: Exploring the Impact of Disabled Veterans on Disability, Health, and Other Law and Policy.
Program Description
About a century ago, returning war veterans with disabilities had a profound impact on both cultural and legal attitudes toward disability, shifting us from the charitable model to the rehabilitation model. Today’s soldiers often survive injuries that would have been fatal in prior combat engagements, leaving them with even more significant physical impairments. There is also a growing understanding of the scope of mental impairments associated with military service.
At the same time, disability has shifted from something personal to the individual that she or he must work to overcome, to something largely attributable to choices made by society, and we now recognize equal opportunity for individuals with disabilities is a matter of civil rights. Veterans with disabilities may once again play a significant role in shaping the future of disability rights law. In addition, in an era of changing norms regarding health care, veterans with disabilities may play a significant role in that context. Beyond those topics, veterans with disabilities may affect issues of criminal law, employee benefits law, and tax law, to name a few.
This panel will explore the contemporary impact of veterans with disabilities on our law, including ways in which law and policy can be more responsive to the needs of these veterans and those with whom they interact, and how their unique status may help inform various normative conversations.
Paper/Presentation Requirements and Submission Instructions
Presentations and papers may address a wide spectrum of issues associated with the program topic, from macro or micro perspectives, and further may focus on historical foundations, present conditions, assessment of past or current corrective measures, and/or the analysis of necessary corrections or changes in law or public policy.
Selected papers will be published in the Journal of Legal Medicine, the legal journal of the American College of Legal Medicine. Papers must not have been published or accepted for publication elsewhere. Preference will be given to papers of 25,000 words or fewer.
Abstracts of proposed papers/presentations should be submitted to Cheryl L. Anderson, AALS Disability Law Section Chair, at cheryla@siu.edu no later than Monday, August 3, 2015. The officers of the Section on Disability Law will select two abstracts for presentations. Authors will be notified no later than August 24, 2015.
Very Sick Children: Treatment at Any Cost?
The Royal College of Paediatrics and Child Health (RCPCH) has just published a new framework to help doctors make tough decisions on end of life care for children and young people. The new framework sets out an ethical and legal framework for when it can be considered no longer in the best interests of the child to give life sustaining treatment. Specifically, the framework provides three sets of circumstances when limiting treatment can be considered because it is no longer in the child’s best interests to continue:
- When life is limited in quantity: If treatment is unable or unlikely to prolong life significantly it may not be in the child’s best interests to provide it
- When life is limited in quality: This includes situations where treatment may be able to prolong life significantly but will not alleviate the burdens associated with illness or treatment itself
- Informed competent refusal of treatment: An older child with extensive experience of illness may repeatedly and competently consent to the withdrawal or withholding of LST. In these circumstances, and where the child is supported by his or her parents and by the clinical team, there is no ethical obligation to provide LST.
Thứ Hai, 23 tháng 3, 2015
Schiavo 10 Years Later (conference)
Coming up next month in Miami: "Schiavo: 10 Years Later" - at the Florida Bioethics Network and University of Miami 23rd Annual Bioethics Conference on April 17, 2015.Other sessions address
- The Future of Hospital Ethics Committees
- Ethics, Child Safety and Gender Identity Dysphoria
- Incapacitated and Alone: Social Workers as Proxies
- Nursing in the Indian Health Service: Managing Ethical Challenges
Chủ Nhật, 22 tháng 3, 2015
Utah Bill Assures Coverage for Terminally Ill
Utah S.B. 271 has passed both houses of the state legislature. It prohibits denial of coverage under a health benefit plan because of life expectancy or a terminal condition.The bill mandates that a health benefit plan may not deny coverage for medically necessary treatment if: (1) it is prescribed by a physician; (2) it is agreed to by the patient/surrogate, and (3) the patient/surrogate is fully informed regarding life expectancy or diagnosis with a terminal condition.
Specifically, the health plan may not deny coverage solely because: (1) of the life expectancy of the patient, or (2) the patient has been diagnosed with a terminal condition.
The bill clarifies that it does not require an insurer to offer any particular benefit or service as part of a health benefit. The plan just cannot deny already covered services based on the beneficiary's terminal status.
Thứ Bảy, 21 tháng 3, 2015
Hospital Agrees to 4 More Days of Physiologic Support for Dead Woman
Earlier this week, Anaheim Regional Medical Center diagnosed Lisa Avila, 37, and the mother of seven, as dead (by neurological criteria). Accordingly, consistent with California law and the medical standard of care, the hospital told the family that it would remove physiologic support at 4 p.m. on Friday.
But Avila's family objected, insisting that she is alive and does not want to give up. The hospital has now agreed to further accommodate the family until noon Tuesday. (CBS News)
But Avila's family objected, insisting that she is alive and does not want to give up. The hospital has now agreed to further accommodate the family until noon Tuesday. (CBS News)
Living the Best Life Possible: Doctor and Patient Conversations About Serious Illness and Mortality (Video)
This week, Public Radio International "The World," WGBH, and Harvard T.H. Chan School of Public Health presented "Living the Best Life Possible: Doctor and Patient Conversations About Serious Illness and Mortality." The panel in this one hour video includes Atul Gawande and Susan Block.
Many Americans may confront illnesses so serious that they are life threatening. These diagnoses may come with treatment attempts and hospital stays. What they may not include are honest and open conversations about the final stages of life. How might the patient want to live during these stages? What choices are most likely to bring a sense of peace and empowerment? How might family members be included in these discussions? A growing palliative care movement is encompassing these questions, bringing together doctors, patients and their families in a new and compassionate way.
This Forum event examined this movement, taking a look at the Serious Illness Care Program system developed at Ariadne Labs, as well as the upcoming launch of a national collaborative to test the use of this program in multiple healthcare systems in the U.S. This event also reviewed issues within healthcare systems, including utilization of end-of-life services and the debate around the role of payment for value.
Many Americans may confront illnesses so serious that they are life threatening. These diagnoses may come with treatment attempts and hospital stays. What they may not include are honest and open conversations about the final stages of life. How might the patient want to live during these stages? What choices are most likely to bring a sense of peace and empowerment? How might family members be included in these discussions? A growing palliative care movement is encompassing these questions, bringing together doctors, patients and their families in a new and compassionate way.
This Forum event examined this movement, taking a look at the Serious Illness Care Program system developed at Ariadne Labs, as well as the upcoming launch of a national collaborative to test the use of this program in multiple healthcare systems in the U.S. This event also reviewed issues within healthcare systems, including utilization of end-of-life services and the debate around the role of payment for value.
Thứ Sáu, 20 tháng 3, 2015
Legal Briefing: Coerced Treatment and Involuntary Confinement for Contagious Disease
My latest “Legal Briefing” column is now up over at the Journal of Clinical Ethics. "Legal Briefing: Coerced Treatment and Involuntary Confinement for Contagious Disease" covers recent legal developments involving coerced treatment and involuntary confinement for contagious disease. Recent high profile court cases involving measles, tuberculosis, human immunodeficiency virus, and especially Ebola, have thrust this topic back into the bioethics and public spotlights. This has reignited debates over how best to balance individual liberty and public health. For example, the Presidential Commission for the Study of Bioethical Issues has officially requested public comments, held open hearings, and published a 90-page report on “ethical considerations and implications” raised by “U.S. public policies that restrict association or movement (such as quarantine).” Broadly related articles have been published in previous issues of JCE. We categorize recent legal developments on coerced treatment and involuntary confinement into the following six categories:
1. Most Public Health Confinement Is Voluntary
2. Legal Requirements for Involuntary Confinement
3. New State Laws Authorizing Involuntary Confinement
4. Quarantine Must Be as Least Restrictive as Necessary
5. Isolation Is Justified Only as a Last Resort
6. Coerced Treatment after Persistent Noncompliance
Thứ Năm, 19 tháng 3, 2015
Another California Brain Death Dispute - Lisa Avila
Last month, Lisa Avila went to Anaheim Regional Medical Center while pregnant with her eighth child. Her family says that the hospital sent her home. A day later, Avila slipped into a coma due to an undiagnosed ectopic (tubal) pregnancy. (Family website)In the past few days, hospital clinicians have determined that Avila is now brain dead. Consequently, they have told the family that they are planning to remove Avila's physiologic support on Friday afternoon.
But like the December 2013 Jahi McMath case, the family is resisting the hospital's plan. After all, this is the very same hospital that (the family claims) botched her treatment and put her on life support in the first place. “They shouldn’t be pressuring us, because the reason we’re here, is because of their mistake.” “Pretty much they’re trying to kill her to reduce them from having to pay the bill that it would cost to keep her alive.” (CBS
News)
The hospital has limited obligation to accommodate family objections. I reviewed those obligations in Los Angeles just a few weeks ago. It need not continue to provide physiological support after 24-48 hours. But it might have an obligation to facilitate a transfer which is what the family is looking for. (CBS News)
Higher Brain Death - Gravestones of Schiavo and Cruzan
I just finished the second edition of Veatch and Ross's excellent Transplantation Ethics (Georgetown 2015). The first several chapters review competing definitions of death. Among other arguments, the authors defend a higher brain standard, an argument that has not had much currency the past decade.
This reminded me of the gravestones of Nancy Cruzan and Theresa Schiavo. Both indicate that the women "died" as of the point they permanently lost consciousness, not the later point in time that they has complete cessation of cardiopulmonary function.
This reminded me of the gravestones of Nancy Cruzan and Theresa Schiavo. Both indicate that the women "died" as of the point they permanently lost consciousness, not the later point in time that they has complete cessation of cardiopulmonary function.
Thứ Tư, 18 tháng 3, 2015
The Art of Dying (NYC April 24-26, 2015)
The Art of Dying is the 5th installment of a conference that brings together important innovators, researchers and authors in the fields of death and dying, including practitioners in the areas of palliative and hospice care. Many are trained in modern medicine and work directly with the dying or bereaved. Others speak from the wisdom of traditional teachings, while still others share with us their own deeply personal accounts.
This conference presents a unique opportunity for all those seeking to better understand, acknowledge and ultimately embrace their own mortality, their fears of non-existence, and their relationship to their own death.
This conference presents a unique opportunity for all those seeking to better understand, acknowledge and ultimately embrace their own mortality, their fears of non-existence, and their relationship to their own death.
Thứ Ba, 17 tháng 3, 2015
Minnesota Compassionate Care Act of 2015 Will Legalize Aid in Dying
Minnesota Senators Eaton, Pappas, Dibble, and Marty have just introduced the Minnesota Compassionate Care Act of 2015 (SF 1880).
Like
legislation now under consideration in more than 20 states, this bill would
legalize physician aid in dying.
Anatomy Bequest Program
I just submitted my donation authorization to the Anatomy Bequest Program at the University of Minnesota. The bequest program is a whole body donation program whose purpose is to support medical research and education for health professionals by facilitating the donation process. Anatomical donation supports high quality education for future health professionals and continued advancements in medical care through research. The program has collected a lot of positive media coverage here.
Thứ Hai, 16 tháng 3, 2015
Texas Futility Law - Stakeholder Talks
Over the past few days, I have summarized a number of new Texas bills aimed either at improving or at eliminating the dispute resolution provisions in the Texas Advance Directives Act.
It was encouraging to see that there have been some efforts to discuss these issues among relevant stakeholders - as there was back in the early years of TADA. But it is unclear (here too) whether those efforts are going to be successful.
It was encouraging to see that there have been some efforts to discuss these issues among relevant stakeholders - as there was back in the early years of TADA. But it is unclear (here too) whether those efforts are going to be successful.
Thứ Bảy, 14 tháng 3, 2015
Texas Advance Directives Act - More 2015 Amendments
A few days ago, I blogged about S.B. 1163. This week, Texas legislators introduced a number of other bills directed at amending the dispute resolution provisions of the Texas Advance Directives Act. Here is a quick run down:
H.B. 2351 (Harless) requires review committees to adopt two types of policies: (1) "to prevent financial and health care professional conflicts of interest" and (2) "to prohibit consideration of a patient ’s permanent physical or mental disability during a review . . . unless the disability is relevant in determining whether a medical or surgical intervention is medically appropriate."
H.B. 2984 (Hughes) would, as many of Hughes' prior bills, require treatment until transfer.
H.B. 3074 (Springer) would exempt CANH from the scope of life-sustaining treatment subject to 166.046.
H.B. 3414 (Frank) is the mirror companion to S.B. 1163.
H.B. 4100 (Coleman) would, like S.B. 1163 and H.B. 3414, narrow the scope of the review committee. It can deny requested treatment only if it would (1) threaten the patient's life; (2) seriously exacerbate other major medical problems not outweighed by the benefit of the provision of the treatment; or (3) result in substantial irremediable physical pain or
discomfort not outweighed by the benefit of the provision of the treatment. And CANH is exempted from the scope of life-sustaining treatment that can be refused.
Coleman's bill also require the review committee to not determine medically appropriateness on the basis of "permanent disability, advanced age, gender, religious or cultural differences, or financial circumstances." It extends the notice period from 48 hours to 7 days and the transfer period from 10 to 21 days. It requires a patient liaison, quick access to the medical record, and an advisory consultation.
H.B. 2351 (Harless) requires review committees to adopt two types of policies: (1) "to prevent financial and health care professional conflicts of interest" and (2) "to prohibit consideration of a patient ’s permanent physical or mental disability during a review . . . unless the disability is relevant in determining whether a medical or surgical intervention is medically appropriate."
H.B. 2984 (Hughes) would, as many of Hughes' prior bills, require treatment until transfer.
H.B. 3074 (Springer) would exempt CANH from the scope of life-sustaining treatment subject to 166.046.
H.B. 3414 (Frank) is the mirror companion to S.B. 1163.
H.B. 4100 (Coleman) would, like S.B. 1163 and H.B. 3414, narrow the scope of the review committee. It can deny requested treatment only if it would (1) threaten the patient's life; (2) seriously exacerbate other major medical problems not outweighed by the benefit of the provision of the treatment; or (3) result in substantial irremediable physical pain or
discomfort not outweighed by the benefit of the provision of the treatment. And CANH is exempted from the scope of life-sustaining treatment that can be refused.
Coleman's bill also require the review committee to not determine medically appropriateness on the basis of "permanent disability, advanced age, gender, religious or cultural differences, or financial circumstances." It extends the notice period from 48 hours to 7 days and the transfer period from 10 to 21 days. It requires a patient liaison, quick access to the medical record, and an advisory consultation.
Thứ Năm, 12 tháng 3, 2015
Texas Advance Directives Act - 2015 Amendments
House and Senate bills both to improve and to eliminate the dispute resolution provisions in the Texas Advance Directives Act have been introduced in every Texas legislative session since 2003. The first such bill in the 2015 session was introduced this week. Senator Kelly Hancock has introduced S.B. 1163. Senator Hancock is described as pro-life and defending core conservative values. Consequently, it is no surprise that his bill aims not to improve the fairness of TADA (like Senator Deuell's bills over the past sessions) but instead to wholly eliminate its dispute resolution provisions.
S.B. 1163 adds a new section (Tex. H&S Code 166.0455) that specifies two reasons on which a review committee may not base a determination of medical inappropriateness.
"A physician or other health care professional, a health care facility, or an ethics or medical committee shall not override or refuse to honor and comply with a patient ’s advance directive or a health care or treatment decision made by or on behalf of a patient that directs the provision of life-sustaining treatment and shall not consider life-sustaining treatment to be inappropriate treatment under Section 166.046 based on:
(1) the lesser value the physician or professional, facility, or committee places on sustaining the life of an elderly, disabled, or terminally ill patient compared to the value of sustaining the life of a patient who is younger, not disabled, or not terminally ill; or
(2) a disagreement between the physician or professional, facility, or committee and the patient, or the person authorized to make a treatment decision for the patient under Section 166.039, over the greater weight the patient or person places on sustaining the patient ’s life than the risk of disability."
S.B. 1163 also specifies (in a new a-1 subsection of 166.046) the only bases on which a review committee may determine life-sustaining treatment inappropriate: (1) physiological futility and (2) when "providing the treatment to the patient would clearly create a substantially greater risk of causing or hastening the death of the patient than would withholding or withdrawing the treatment."
Thứ Tư, 11 tháng 3, 2015
"We Know How This Ends: Living While Dying" - Book Launch Event
On Wednesday, March 25, from 7:00 to 8:30 PM, Minnesota Public Radio is holding a live and free event at the University of St. Thomas to celebrate the publication of We Know How This Ends: Living while Dying.We Know How This Ends details discoveries by authors Bruce H. Kramer and Cathy Wurzer as they embarked on a journalistic project to document Kramer's struggle with ALS.
What began as a series of interviews on the subject of a debilitating and terminal illness became a deep mutual understanding and friendship as both authors came to terms with loss and new beginnings. For Kramer, progressive illness brought the loss of his professional life as a dean at the University of St. Thomas, as well as his physical health and autonomy. During the same period, MPR Morning Edition host Cathy Wurzer lost her father to a debilitating battle with dementia. For both, the experiences were life changing and transformative.
Join Kramer and Wurzer with the host of MPR's Daily Circuit, Kerri Miller, for a conversation about the making of the book, their work together over the years, and the life lessons found in living fully through loss.
Thứ Ba, 10 tháng 3, 2015
2016 US News & World Report - Best Health Law
This morning, US News & World Report issued its 2016 rankings of all law schools and law school programs. Here is the list of health law. This is the third year in a row, that Hamline has moved up, now to No. 13.#1 St. Louis University
#2 University of Maryland (Carey)
#3 Georgia State University
#4 Georgetown University
#5 Boston University
#6 Loyola University Chicago
#7 Seton Hall University
#8 University of Houston
#9 Case Western Reserve University
#10 Harvard University
#11 Indiana University—Indianapolis (McKinney)
#12 Arizona State University (O'Connor)
#13 Hamline University
#14Tie University of Minnesota—Twin Cities
#14Tie University of Pittsburgh
#14Tie Wake Forest University
#17Tie Drexel University (Kline)
#17Tie Northeastern University
#17Tie Stanford University
#20Tie DePaul University
#20Tie University of California (Hastings)
#20Tie University of Pennsylvania
#23Tie Quinnipiac University
#23Tie Yale University
#25Tie Duke University
#25Tie Emory University
Thứ Hai, 9 tháng 3, 2015
Healthcare for Undocumented Immigrants
The esteemed bioethics think tank, the Hastings Center, recently identified "eight news stories to watch in 2015." These are topics that the staff determined are developing and therefore "certain or likely to have impact in the year ahead."Right near the top of the list, the Hastings Center encourages its readers to "look for increased attention to solutions to closing gaps in access to health care for undocumented immigrants on grounds of fairness and cost-effectiveness."
This is precisely the topic of the next CLE at the Hamline University Health Law Institute. At 6:00 on Wednesday, March 25, Wendy Parmet will present "Left Out: Undocumented Immigrants and the American Health Care System."
Chủ Nhật, 8 tháng 3, 2015
Sixth International Symposium on Brain Death
The VI International Symposium on Brain Death and Disorders of Consciousness will be held in Havana, Cuba, on December 1-4, 2015. Details here.
Thứ Bảy, 7 tháng 3, 2015
VSED: Real Alternative to Aid in Dying
Those calling for the legalization of aid-in-dying often highlight the necessity and importance of legalizationthrough denigrating alternative ways to hasten death. A particularly favorite target is VSED (voluntarily stopping eating and drinking).In the Telegraph, this week, Bruce Fogle writes about his mother
Aileen and her decision to die in Ontario. “You won’t give me anything so I have decided to stop eating and drinking. What do you think?” Since assisted dying was not yet legal, Fogle laments that his mother had no option but to starve herself.
"Mum was telling me she had decided to die. This time, she was only just
ahead of her time. Thanks to that Canadian Supreme Court ruling, people in her
circumstances will now be able to do so, painlessly, of their own free will,
simply by asking for and taking pills, without putting themselves or their
families through a needlessly protracted and inevitably uncomfortable end of
life. But mum did not have that luxury. Her only option was to refuse food."
Oddly though, Fogle's own description of his mother's VSED is neither "needlessly protracted" nor "inevitably uncomfortable." Indeed, reported studies of VSED show that it is a safe and comfortable "exit option."
I do not mean to suggest that aid-in-dying is unnecessary. Some individuals may prefer that exit option. And AID has a far longer track record of proven safety and effectiveness.
But even in Oregon, where both options are available, many choose VSED. It is important to have an option that accord with one's own preferences and values. Many may prefer AID over VSED. But VSED is hardly the abhorrent option that many depict it to be.
Thứ Sáu, 6 tháng 3, 2015
Life support wards reviewed to "kick out the bludgers"
The Department of Social Services has launched a
blueprint to "stop hospital patients from bludging on life support."
Thứ Năm, 5 tháng 3, 2015
Schizophrenic with Gangrenous Leg Allowed to Refuse Amputation
Even today, two of the best U.S. cases for illustrating the principles of patient decision making capacity are almost 40 years old: Lane v. Candura (Mass. 1978) and DHS v. Northern (Tenn. 1978). Both cases concern women with gangrenous feet who refuse life-saving amputation. The stakes are the same in both cases. But one only woman really understands her clinical situation. Her decision was honored.
A recent case from the UK also concerns a woman with gangrenous feet who refused amputation. The court's reasoning is a good review and application both of decision making capacity and of the right to refuse treatment.
Thứ Ba, 3 tháng 3, 2015
McMath Family Sues Oakland Children's Hospital; Alleges Jahi is Alive
The case of Jahi McMath is infamous around the world for the remarkable claim that she is no longer dead.
In December 2013, federal and state courts in California determined that Jahi was legally dead. While the courts issued temporary restraining orders to preserve the status quo (continued physiological support) pending their rulings on pending motions, both courts ultimately refused to order the hospital or its clinicians to continue administering medical interventions to Jahi.
Since December 2013, the family has twice indicated that it would seek a re-determination of Jahi's status as dead. In October 2014, it filed a writ of error corum nobis with the Alameda County Court that heard the case in December 2013. In 2015, the family indicated that it would ask the California Secretary of State to revoke the death certificate.
This week, the family sued Oakland Children's Hospital, alleging that the negligence of its clinicians caused Jahi's injuries. The family seeks damages for "medical, nursing, and other related expenses in the future." (Complaint para. 36). These damages presume that Jahi is alive. Consequently, it seems that the issue of Jahi's life/death status must be litigated and adjudicated in this medical malpractice action.
In December 2013, federal and state courts in California determined that Jahi was legally dead. While the courts issued temporary restraining orders to preserve the status quo (continued physiological support) pending their rulings on pending motions, both courts ultimately refused to order the hospital or its clinicians to continue administering medical interventions to Jahi.
Since December 2013, the family has twice indicated that it would seek a re-determination of Jahi's status as dead. In October 2014, it filed a writ of error corum nobis with the Alameda County Court that heard the case in December 2013. In 2015, the family indicated that it would ask the California Secretary of State to revoke the death certificate.
This week, the family sued Oakland Children's Hospital, alleging that the negligence of its clinicians caused Jahi's injuries. The family seeks damages for "medical, nursing, and other related expenses in the future." (Complaint para. 36). These damages presume that Jahi is alive. Consequently, it seems that the issue of Jahi's life/death status must be litigated and adjudicated in this medical malpractice action.
Brain Death & Futility at ICCEC
I blogged about the upcoming ICCEC this weekend. Here are a few sessions that caught my eye.
Panel - Comparing Israeli and American Experiences: Families’ requests for continued physiologic support of patients deemed dead by neurological criteria --
Anne Lederman Flamm, Jonathan Cohen
Do Everything!” – New aspects of a never-ending story -- Kurt W Schmidt
Decision-Making for the Unbefriended Patient: A model approach facilitated by the Ethics Consult Service -- Joan Henriksen Hellyer
Physician Attitudes Toward Proactive, Triggered (Unsolicited) Clinical Ethics Consultation for the Unrepresented Patient -- Barrie J. Huberman
Panel - Worse than Futile: Medically non-beneficial treatment in the setting of complicated grief -- Annette Mendola, Vicki Cannington, Lynnette Osterlund, Caroline Vogel
The deployment of law in the clinical setting: Strategies for hospital ethics committees to address concerns surrounding clinician citation of the law -- Anya Prince
Panel - Comparing Israeli and American Experiences: Families’ requests for continued physiologic support of patients deemed dead by neurological criteria --
Anne Lederman Flamm, Jonathan Cohen
Do Everything!” – New aspects of a never-ending story -- Kurt W Schmidt
Decision-Making for the Unbefriended Patient: A model approach facilitated by the Ethics Consult Service -- Joan Henriksen Hellyer
Physician Attitudes Toward Proactive, Triggered (Unsolicited) Clinical Ethics Consultation for the Unrepresented Patient -- Barrie J. Huberman
Panel - Worse than Futile: Medically non-beneficial treatment in the setting of complicated grief -- Annette Mendola, Vicki Cannington, Lynnette Osterlund, Caroline Vogel
The deployment of law in the clinical setting: Strategies for hospital ethics committees to address concerns surrounding clinician citation of the law -- Anya Prince
Thứ Hai, 2 tháng 3, 2015
Left Out: Undocumented Immigrants and the American Health Care System
Hamline University is hosting a compelling CLE event on March 25: "Left Out: Undocumented Immigrants and the American Health Care System."
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