Delaware Governor Signs POLST

Congratulations Delaware on enacting DMOST legislation.I am proud to know many of the people here at the signing.  Among others, right behind the Governor are John Goodill (the head of palliative care and the ethics committee at Christiana Care, Delaware's largest hospital) and Susan Del Pesco (a former judge and Director, Division of Long Term Care Residents Protectio...

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Saying No - Exploring the Ethical Dimensions of Refusals in Healthcare

On September 18, 2015, the Clinical Ethics Network of North Carolina will present "Saying No Exploring the Ethical Dimensions of Refusals in Healthcare."Refusals take place across the spectrum of healthcare The clinician who refuses to offer treatment believed to be futile, non-beneficial or inappropriateThe patient who spurns a proposed discharge planThe family that declines to discuss changes in goals of careThe hospital system that decides not to carry certain drugs on its formularyThe healthcare system that refrains from providing coverage...

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Hospital at 4am [EOL in Art 21]

Douglas Manry "The Hospital at 4 am" as a realistic painting of a hospital interior.  But as he thought of what actually goes on within hospital walls and how many lives are affected there each day, his hand essentially went on "automatic pilot" mode, and this was the resu...

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van Gogh's Ward of Arles Hospital [EOL in Art 20]

In 1889, Vincent van Gogh painted "Ward of Arles Hospital" where he spent some time the year before he died.  Debra Mancoff comments, "the exaggerated length of the corridor and the nervous contours that delineate the figures of the patients express the emotional weight of his isolation and confinemen...

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Euthanasia 2016 in Amsterdam

In cooperation with the World Federation of Right to Die Societies, NVVE, the Dutch Right to Die Society, will be hosting the biennial international conference, Euthanasia 2016 in Amsterdam (May 11-14, 2016).In a world with a growing demand for legalized euthanasia and (physician) assisted dying, this conference intends to inform and inspire a wide range of professionals involved in end-of-life choices. This conference will offer physicians,...

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Sharing the Experience - Honoring Choices Minnesota

Plan now to attend the 6th Annual Honoring Choices Minnesota Conference - on Thursday, July 16, 2015, from 8:15 to 4:30, at the Ramada Plaza Hotel.Featuring Keynote SpeakersKris Maser, JD - "Planning for a Good Life: An Attorney's Personal & Professional Journeyinto Advance Care Planning"Ruth Bachman - "A Narrow Spot in the Hourglass: Lessons in Integrity, Courage & Grace"Concurrent Sessions Where Are They Now? Allina, Fairview,...

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Scary Hospital Room [EOL in Art 19]

Even video game art can prompt reflecti...

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ICU StoryWeb - Sharing Stories about ICU Treatment Decisions

ICU StoryWeb is a new interactive, web-based tool designed to help people share their stories about making decisions related to life-sustaining treatment for family members and friends in the ICU. ICU StoryWeb involves three components: Users can listen to other people's stories. Listening to stories helps normalize feelings. Users can share their own stories. A downloadable storytelling kit guides them to record their story using a cellphone recording or by journaling. Sharing stories about traumatic events is known to reduce post-traumatic...

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Shadow of Death [EOL in Art 18]

The shadow of deathis scarier than death itself in this depiction by Laura Csaja...

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Brain Death Conference - Milwaukee

On Tuesday June 2,  the Medical College of Wisconsin Center for Bioethics and Medical Humanities will host a day-long conference exploring issues surrounding brain death:  "Death by Brain Criteria." &nb...

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Father at Mt. Sinai [EOL in Art 17]

Max Ferguson's "My Father at Mt. Sinai" depicts his dad on a hospital bed, with a tube under his nose. The curtain in the foreground is a tallit (a Jewish prayer shawl).  I like that dad is mid-speech and engaged with the view...

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Death Carts [EOL in Art 16]

The death cart is an object that was used in acts of corporal penance performed by the Hermanos de la Fraternidad Piadosa de Nuestro Padre Jesús Nazareno. The Brotherhoods were secretive, lay-religious fraternal organizations that served the spiritual needs of Hispanic Roman Catholics in northern New Mexico and southern Colorado in the 19th and early 20th centuries. Public processions reenacted the sorrow and suffering of Christ’s final days....

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End-of-Life Care Is Getting Worse

Joan Teno's new report in The Journal of Palliative Medicine confirms that there are still large gaps between the kind of care that patients and families want and the care they actually receive. Teno and her coauthors compared two surveys, one conducted in 2000, and the second carried out between 2011 and 2013. Each of the studies asked individuals about the care received by elderly loved ones at the end of life.  Despite all the effort...

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Louise Vernet on Her Death Bed [EOL in Art 15]

Paul Delaroche created a convincing and transcendent image of his dead wife in "Louise Vernet on her Death Bed" (1845, graphite on slightly textured, moderately thick, cream wove paper).Louise lays blissfully in profile, as both her mouth and right eye remain slightly open. Her elevated head rests on two pillows, as locks of her hair fall vertically to her shoulder and drape diagonally across her bosom. Delaroche carefully defined each curl,...

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Another California Lawsuit for Following the Wrong Surrogate

A few days ago, Bart F. Sullivan filed a lawsuit in Orange County Superior Court (California) against Park Vista at Morningside and Placentia Linda Hospital.  His 92-year-old mother, Clara, died there in May 2014.  Sullivan's legal theories include: abuse of an elder person, negligent wrongful death, medical malpractice, infliction of emotional distress, and fraud.Most interesting is a claim that the nursing home and hospital lacked a good faith belief in the validity of Clara Sullivan's DNR order.  From the complaint: "Clara Sullivan’s...

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Texas Advance Directives Act - House Debate Today

Today, the Texas House is set to consider legislation to re-evaluate the state’s health commission. The Texas Tribune notes that a number of amendments could set the stage for a fiery debate over the futility provisions in the Texas Advance Directives Act.Republican lawmakers have filed amendments to Senate Bill 200 that would limit medical professionals’ abilities to override patients' advance directives or their families’ wishes to continue life-sustaining treatment.The fight over end-of-life care has been a perennial one at the Legislature as...

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Woman Praying at a Deathbed [EOL in Art 14]

Benjamin Vautier's 1864 pencil drawing "Woman Praying at a Deathbed" includes an open Bible on the table and a rosary on the floor.  These suggest a devout life and the promise of salvation after dea...

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European Court of Human Rights Judgment in Vincent Lambert v. France

The European Court of Human Rights will be delivering its Grand Chamber judgment in the case of Lambert and Others v. France (application no. 46043/14) at 11 a.m. on 5 June 2015 in the Human Rights Building, Strasbourg.  A video of the January 2015 hearing is available here.The ECHR is reviewing the June 2014 judgment by the Conseil d’État (the French Supreme Administrative Court) authorizing the withdrawal of the artificial nutrition and hydration...

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Victor Hugo on His Deathbed [EOL in Art 13]

When the poet, playwright, and novelist Victor Hugo died in 1885, Nadar went to his deathbed to make a final image as a memorial. Nadar's sketch of the death chamber showed that black drapery was tied across a window behind the bed and then to one of the bedposts in order to visually isolate Hugo's recumbent figure against a somber background. For the photograph, a mirror reflected light back from the window to provide detail in the shadow ...

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Jahi McMath - Status in May 2015

On Thursday, Paul A. Byrne published a short article titled "Jahi is Alive - Praise the Lord and Pass the Ammunition."  Byrne writes that he recently visited Jahi in her home. "Jahi is beautiful. The day that I visited Jahi she had on lip gloss like many teenagers."  While Byrne rejects the very diagnosis of "brain death," some of his assertions appear to be true.  1.  Byrne writes:  "Jahi's heart has continued to beat...

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Absence of POLST Leads to Criminal Charges

Two New York Fire Department paramedics have been arrested for failing to resuscitate a man on Staten Island.Daniel Ornstein and Joseph Farrell were responding to a "difficulty breathing" call.  The man, who suffered from Lou Gehrig's Disease, was in cardiac arrest.  But the man's wife became upset, stating that he had a DNR, order, and didn't want to be brought back to life.  The paramedics sympathized with the patient's wife, even...

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Dying without Dignity - Investigations by the Parliamentary and Health Service Ombudsman into Complaints about End of Life Care

The UK Parliamentary and Health Service Ombudsman has just published an alarming report on the end of life care, “Dying Without Dignity.”  It is a painful and sad read.The report identifies six key themes, all illustrated with case studiesNot recognising that people are dying, and not responding to their needs – if the needs of those who are close to death are not recognised, their care cannot be planned or co‐ordinated, which means more...

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Marcel Proust on His Deathbed [EOL in Art 12]

In 1922, the photographer Man Ray made a final portrait of Marcel Proust two days after his death.  I love the fact that Proust spent the last night of his life dictating manuscript changes for a section of his famous novel Remembrance of Things Pa...

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Conscience and Proper Medical Treatment

Conscience and Proper Medical Treatment is the topic of several articles in the latest issue of Medical Law Revi...

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Terminally Ill Patients Visit the Museum [EOL in Art 11]

I have posted 10 paintings that portray death.  Today's "end of life in art" post is a little different.  The art itself (Rembrandt's Self-Portrait with Two Circles) is not about death.  But this image is still relevant and compelling.  The charity Stichting Ambulance Wens helped a woman with terminal cancer visit the Rijksmuseum in Amsterdam to see an exhibition on Rembran...

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Aid in Dying: An Important Possibility at the End of Life

End of Life Choices New York and the New York Society for Ethical Culture invite you to the inaugural Barbara Swartz End of Life Choices Lecture: "Aid in Dying: An Important Possibility at the End of Life."The speaker will be the renowned palliative care expert Dr. Timothy Quill. Dr. Quill is the Director of the Center for Palliative Care and Clinical Ethics at the University of Rochester School of Medicine. After helping...

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Grief and Mourning at Death [EOL in Art 10]

Munch painted "Death in the Sickroom" in 1893.  Like many other paintings, it deals with the tuberculosis and death of his sister when he was 14.  Munch directs our focus not to the dying person but to the inner thoughts and grief of the family members.  Sophie sits facing diagonally to the rear, largely invisible both to us and to all the mourners except her father.  She is already absent from their lives. Each of the mourners...

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Physicians Should Not Act Like Judges (video)

I love this scene (among others) from "Whose Life Is It Anyway?"  Sculptor Richard Dreyfus is paralyzed after a car accident.  He decides he wants to die.  But as the film's title suggests, his physician has other ide...

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Aruna Shanbaug Dies after 42 Years in PVS

Aruna Shanbaug has died in Mumbai after spending 42 years in a vegetative state.Shanbaug suffered brain damage from a sexual assault and strangling in 1973 by a cleaner at the hospital where she worked. She remained in a vegetative state in Mumbai’s King Edward Memorial Hospital until her death this week.  (Wall Street Journal)In 2011, the Supreme Court considered Shanbaug’s case after her biographer and friend, Pinki Virani, filed a petition...

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Monet and Camille [EOL in Art 9]

Monet lived to 86.  But his wife Camille Doncieux died at just 32.“Camille Monet sur son lit de mort,” or “Camille on Her Deathbed” (1879) is one of Monet’s most powerful paintings of his wi...

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Whispering of Death [EOL in Art 8]

Arnold Böcklin painted this self-portrait in 1872.  Since there seems to be only one string left on the violin, it seems that death is whispering, "I'm coming for you soo...

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Texas House Votes to Narrow Futility Law

On Friday, the Texas House of Representatives passed H.B. 3074.  As I blogged earlier, this bill would exempt clinically assisted nutrition and hydration from the scope of life-sustaining treatment subject to Tex. Health & Safety Code 166.0...

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History of Cardiac Arrest and Its Effect on Contemporary Medicine (video)

Recently, at the MacLean Center's end-of-life series, Daniel Brauner offered a compelling history of cardiac arrest and its effect on contemporary medicine. &nb...

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Death Will Come for You [EOL in Art 7]

Edvard Munch painted "By the Deathbed in 1895. Here the focus is not so much on the person who has died, but rather on those who have come to grieve him.While the first four mourners from the left are focused on the person who has died, the fifth mourner is facing the viewer of this painting directly. Her face is somewhat skeletal, representing death.  By looking at the viewer, she sends the message that one day, death will come for us as w...

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Minnesota Case: Final Exit Network Found Guilty of a Crime for Mere Speech

A 12-member Minnesota jury found Final Exit Network, Inc. guilty of "assisting" in a suicide and interfering with the scene of a death so as to mislead the coroner.  Judge Christian Wilton set the sentencing hearing to take place on August 24. The convictions carry potential fines of $33,000.  (A corporation cannot be incarcerated.)Oddly, the State's case consisted of proof that the Network's volunteers provided information, education,...

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An Official ATS/AACN/ACCP/ESICM/SCCM Policy Statement: Responding to Requests for Potentially Inappropriate Treatments in Intensive Care Unit

Almost all of the major professional association guidelines on medical futility are more than a decade old.  Finally, a new multi-society policy was published online yesterday.  I was pleased to be a part of it.There is controversy about how to manage requests by patients or surrogates for treatments that clinicians believe should not be administered.  This multi-society statement provides recommendations to prevent and manage intractable...

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Ignoring the Approach of Death [EOL in Art 6]

Gustav Klimt painted "Death and Life" in 1916.  The allegorical figure of death is portrayed as a robed skeleton, holding a stick, approaching a family that is grouped together. The family is filled with life, and they portray the full range of life, from that of a young baby up to older children, to a mother, father, and even a grandmother. In their grouping and position, the family is turning away from death, and seemingly unconcerned...

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Baby Samuel - Court Vacates DNR over Mom's Objections

In January, when Samuel Flaherty Irvin was less than a month old, the Arizona Department of Child Safety took him from his mother Fawn Flaherty due to  "child abuse, neglect."  (KVOA)Samuel was placed in a foster home for the medically fragile.  But later that month he choked when they were feeding him and went without oxygen for a prolonged period.  Samuel's treating clinician recommended that he “not receive resuscitation efforts...

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Last Portrait of Mother [EOL in Art 5]

In 2010, Daphne Todd won the UK's leading prize for portraiture.  She painted her 100-year-old mother Annie after she died. The undertaker allowed her to spend three days in the funeral parlor cool room painting her mother's body, which can be seen emaciated and propped up on pillows, with her white hospital wristband still on.&nb...

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Assisted Suicide: Death with Dignity or Legalized Killing

A debate in Saint Paul, MN on May ...

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Death Leading the Doctor [EOL in Art 4]

It seems that many of today's physicians could learn something from this 15th century print "Death Leading a Doctor Holding a Vial of Urine."  It is from the La Danse Macabre (Dance of Death) series of prints at the Bibliotheque de la Sorbonne, Par...

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EMS SignPost - Medical ID on a Refrigerator Magnet

This simple yellow magnet is embedded with an NFC (near-field communication) chip, that allows EMTs to quickly learn about a patient in an emergency.The NFC technology in the EMS SignPost magnet is the same thing that makes Apple Pay and Google Wallet work. In this case, rather than transmitting payment information when a phone is tapped against it, medical information and documents (like a DNAR order) are transferred.&nb...

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Overtreatment in 1848 [EOL in Art 3]

Edward Lamson Henry portrays his ailing fiancee, Kate White of Philadelphia, who died around the time of the painting.  The flowers, fruit, and cakes, and sunlight make this look like something other than a deathbed scene.But look at all that medicine on the nightstand.  How much of it helped her?  How much of it actually hastened her death?  How much have things failed to change in 170 yea...

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POLST - An Authoritative Summary

The latest issue of BIFOCAL, the journal of the ABA Commission on Law and Aging includes a lucid four-page summary of POLST.  It is written by four of the top experts on POLST:  Amy Vandenbroucke, Susan Nelson, Patricia A. Bomba, and Alvin H. Mo...

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Respice Finem [EOL in Art 2]

Respice Finem means consider the end.  Here is Saint Jerome in his study surrounded by objects symbolizing transience and death (Joos van Cleve, 1521).  Note the skulls, the snuffed out candle, and other symbols.This predates the genre of memento mori, images that compelled contemplation of mortality.&nb...

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Ethical Reflection in End-of-Life Decisions: Dutch Perspective (UMN)

At the University of Minnesota on May 18:  "Ethical Reflection in End-of-Life Decisions: Dutch Perspectiv...

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POLST or Advance Directive? [EOL in Art 1]

This is Antiochus dictating his last wishes (Halle, 1738).  Note the scribe in the lower left.  If this were 2015, Antiochus might be completing a POLST.  He is close to death.  In contrast, he would have completed an advance directive long before getting wounded in battle. &nb...

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Duty to Transfer Brain Dead Individual

The patient has been determined dead by neurological criteria (brain dead).  While this has been explained to the family, they reject the diagnosis.  Even after an independent second opinion, they still reject the diagnosis.  They ask, "Isn't there anything else we can do?"  Do you have any obligation to inform this family of the option to transfer?1.  This question is worth asking because such transfers are apparently actually possible (even if unlikely).  Jahi McMath was transferred to a willing facility.  Jesse...

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New Multi-Society Futility Policy

The ATS International Conference starts next Friday in Denver.  In advance that meeting, the ATS of will release "An Official ATS / AACN / ACCP / ESICM / SCCM Policy Statement: Responding to Requests for Potentially Inappropriate Treatments in Intensive Care Units."  This multi-society statement provides recommendations to prevent and manage intractable disagreements about the use of such treatments in IC...

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Christians and Aggressive End-of-Life Care

I am at a conference on "Law, Religion and Health in America" at Harvard.  So, this caught my eye today.  Vanderbilt surgeon Myrick C. Shinall, Jr. has just published "Christians and Aggressive End-of-Life Care" in Perspectives in Biology and Medicine.  Here is the abstract:Patients or their family members sometimes give religious reasons for requesting life-sustaining technologies that have little hope of restoring health. This poses an ethical challenge for clinicians and a potential strain on limited health-care resources. Among...

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Delaware Passes POLST Bill (DMOST)

Yesterday, the Delaware Senate passed H.B. 64, which the House passed at the end of March. Once signed by the governor, this will add a new title 25A to title 16 of the Delaware Code:  "Delaware Medical Orders for Scope of Treatment Act” (DMOST Act)."Getting a legal status for POLST in Delaware has been a long a bumpy road.  I review some of that here.This summer, I will be assessing this and other new POLST and surrogate decision making statutes for the 2016 supplement to the RIGHT TO DIE legal reference treati...

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22 Week Babies - Viable After All

This week's New England Journal of Medicine reports that in a large and systematic study of thousands of premature births, a tiny minority of babies born at 22 weeks who were medically treated survived with few health problems.  The study also found that hospitals varied widely in their approach to 22-week-olds, ranging from a few that offer no active medical treatment to a handful that assertively treat most cases.   22-week-old babies...

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Christopher Dolan's Other Brain Death Case

From today's San Francisco Examiner."I can tell you, as you will soon hear, that a brain death diagnosis made in the Bay Area recently at a well-known hospital made by four members of the hospital’s medical staff was recently overturned by two independent neurologists who conducted an examination pursuant to a court order.""Like the McMath case, I handled that too albeit in a less public manner than the McMath case. So are people crazy who challenge...

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Minnesota Health Law Section Spring Social

You are invited to join the Health Law Section of the Minnesota State Bar Association for their annual Spring Social.  Come to the River Room at the Aster Cafe on Tuesday, May 19, 2015, from 5:30 to 7:00 PM.  Socialize with your colleagues over drinks and appetizers.  This is a great opportunity to get to know your fellow practitioners and to reconnect with old friends.  We will announce the winner of the Student Writing Competition...

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Another Florida "Terri Schiavo" Court Case

Now playing out in the Florida courts is a case strikingly similar to the Terri Schiavo case that was litigated there more than a decade ago.THE PATIENTTim Mattingly, 67, is a retired DeLand police lieutenant.  He was taken to Halifax Health Medical Center in Daytona Beach, on March 29, after he fell while coming down out of the attic in his home. He hit his head on the concrete floor of the garage, and underwent...

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