Vanitas (by Peter Claesz) means "emptiness" - the meaninglessness of earthly life and the transient nature of vanity.
Thứ Ba, 30 tháng 6, 2015
Estate Planning In the 21st Century: Seismic Shifts and Predictions for the Future - CFP
Estate Planning in the 21st Century: Seismic Shifts and Predictions for the Future
The American College of Trust and Estate Counsel (ACTEC Law Journal) announces a Call For Papers on the following topics:
Estate planning has radically changed in the last several decades. Statutes such as the Uniform Probate Code and the Uniform Parentage Act altered the presumptive definitions of such terms as "children" and "descendants" to include a much broader range of beneficiaries, including adoptees, out-of-wedlock children, and in some cases foster children and stepchildren. Some children may now inherit from more than two parents. Very recent changes have broadened those allowed to marry and thus inherit in intestacy from each other. The assets dealt with by estate planners have transformed dramatically, with the rise in the acceptance of non-probate forms of title, digital assets, etc. Perpetual trusts, once allowed only for charities, now exist for families, with attendant issues such as decanting, virtual representation, and non-judicial trust modification. Advance health care directives have become a common tool in the estate planner's box, and in a few states estate planners may deal with clients opting for physician aid in dying. Papers will address ways in which estate planning has transformed in the last 20, 30 or 40 years, and how it may continue to change over a comparable time in the future.
We encourage submissions by co-authors, especially those teaming an experienced estate planning with novices or students. Articles that delve into one or two changes deeply are preferred over those which skim multiple changes. Accepted articles will be published in the ACTEC Law Journal, Volume 41 Issue 2.
Deadline for submissions: December 1, 2015 to Professor Kris Knaplund, Editor, ACTEC Law Journal, kris.knaplund at pepperdine.edu. Footnotes should use conventional Bluebook form. Early submissions are encouraged and will be reviewed on a rolling basis.
The American College of Trust and Estate Counsel (ACTEC Law Journal) announces a Call For Papers on the following topics:
Estate planning has radically changed in the last several decades. Statutes such as the Uniform Probate Code and the Uniform Parentage Act altered the presumptive definitions of such terms as "children" and "descendants" to include a much broader range of beneficiaries, including adoptees, out-of-wedlock children, and in some cases foster children and stepchildren. Some children may now inherit from more than two parents. Very recent changes have broadened those allowed to marry and thus inherit in intestacy from each other. The assets dealt with by estate planners have transformed dramatically, with the rise in the acceptance of non-probate forms of title, digital assets, etc. Perpetual trusts, once allowed only for charities, now exist for families, with attendant issues such as decanting, virtual representation, and non-judicial trust modification. Advance health care directives have become a common tool in the estate planner's box, and in a few states estate planners may deal with clients opting for physician aid in dying. Papers will address ways in which estate planning has transformed in the last 20, 30 or 40 years, and how it may continue to change over a comparable time in the future.
We encourage submissions by co-authors, especially those teaming an experienced estate planning with novices or students. Articles that delve into one or two changes deeply are preferred over those which skim multiple changes. Accepted articles will be published in the ACTEC Law Journal, Volume 41 Issue 2.
Deadline for submissions: December 1, 2015 to Professor Kris Knaplund, Editor, ACTEC Law Journal, kris.knaplund at pepperdine.edu. Footnotes should use conventional Bluebook form. Early submissions are encouraged and will be reviewed on a rolling basis.
Ethical Issues at the End of Life - CFP
The Journal of Social Work in End-of-Life & Palliative Care has a CFP for a special thematic issue on ethical issues at the end of life.
Thứ Hai, 29 tháng 6, 2015
Jahi McMath - Children's Hospital Demurrer
Following last week's demurrer by Defendant Rosen, this week, Children's Hospital Oakland filed its own demurrer in the medical malpractice action filed by the family of Jahi McMath.
Almost the entire brief is devoted to the question of her status as alive or dead.
Almost the entire brief is devoted to the question of her status as alive or dead.
Judge Strikes California Law that Allowed Nursing Homes to Make Medical Decisions for Unbefriended Residents
I just updated my prior articles on decision making for adult orphans, unbefriended, unrepresented patients without surrogates (forthcoming 26(2) J Clinical Ethics). And then this.
A California law allowing nursing homes to make medical decisions on behalf of certain mentally incompetent residents is unconstitutional, a state court ruled this week.
The law, which has been in effect more than 20 years, gave nursing homes authority to decide residents’ medical treatment if a doctor determined they were unable to do so and they had no one to represent them.
Alameda County Superior Court Judge Evelio M. Grillo wrote in the June 24 decision that the law violates patients’ due process rights because it doesn’t require nursing homes to notify patients they have been deemed incapacitated or to give them the chance to object.
Grillo acknowledged the decision is likely to “create problems” in how nursing home operate but wrote that patients’ rights are more compelling.
“The stakes are simply too high to hold otherwise,” the judge wrote. Any error could deprive patients of their rights to make medical decisions that “may result in significant consequences, including death.”
The medical decisions on incapacitated residents without representatives are made by a team that includes a physician and a nurse.
The fact that nursing homes are making end-of-life decisions without patient input is a big concern, according to the ruling. The decision cited one nursing home resident who was found to be mentally incapacitated and who had no representative. The facility staff made a decision to take him off life-sustaining treatment and he passed away in 2013.
The ruling came after the California Advocates for Nursing Home Reform, an advocacy group, filed a lawsuit in 2013 against the state Department of Public Health. The suit alleged that nursing homes used the law to administer anti-psychotic drugs, place residents in physical restraints and deny patients life-sustaining treatment.
Tony Chicotel, a staff attorney for the group, said the ruling will dramatically impact the lives of the most vulnerable nursing home residents.
“What [nursing homes] used to do was routinely make decisions big and small for their residents without really any regard to due process,” Chicotel said. “Now the residents are finally going to have their rights acknowledged and honored.”
Even patients who are compromised should still have a say in their medical care, he added.
“They have been ignored,” he said. “Unrepresented residents and the way they are treated in nursing homes has never been a priority of the Department of Public Health.”
The department is reviewing the decision, a spokesman said. Department officials declined to comment further or say whether they planned to appeal.
The law was enacted in 1992 because nursing facilities needed a way to give medical treatment to their incapacitated residents without having to wait up to six months for state approval, according to the ruling.
But the decision could make it challenging for nursing homes to provide routine medical care or to offer hospice care to residents who lack the mental capacity to make their own decisions and have no designated representatives, said Mark Reagan, an attorney representing the trade group, California Association of Health Facilities, which is not part of the lawsuit.
“If the person objects, then what?” Reagan said. “That can put patients and facilities in a difficult place.”
And seeking court approval to provide anti-psychotic medication to residents who truly need it would be costly and time-consuming for nursing facilities, he said. “How do you keep that person safe and how do you keep the other residents of the skilled nursing facility safe?” he said.
Reagan believes the ruling could have an unanticipated outcome: Patients without decision-makers could have a hard time finding a nursing facility willing to take them.
“If this decision makes it more difficult to supply necessary care at the bedside, this population is going to be less served,” he said.
The judge, however, wrote that informing patients and allowing them to object is not likely to result in any significant burdens on nursing homes.
Golden Gate University Law School Professor Mort Cohen, who filed the case, said the next step is for the judge to issue an order directing the state Department of Public Health, which oversees nursing homes statewide. The state could ask the court for a stay or could appeal the decision, but Cohen said he expects the decision to stick.
[From Kaiser Health News (KHN), a nonprofit national health policy news service.]
A California law allowing nursing homes to make medical decisions on behalf of certain mentally incompetent residents is unconstitutional, a state court ruled this week.
The law, which has been in effect more than 20 years, gave nursing homes authority to decide residents’ medical treatment if a doctor determined they were unable to do so and they had no one to represent them.
Alameda County Superior Court Judge Evelio M. Grillo wrote in the June 24 decision that the law violates patients’ due process rights because it doesn’t require nursing homes to notify patients they have been deemed incapacitated or to give them the chance to object.
Grillo acknowledged the decision is likely to “create problems” in how nursing home operate but wrote that patients’ rights are more compelling.
“The stakes are simply too high to hold otherwise,” the judge wrote. Any error could deprive patients of their rights to make medical decisions that “may result in significant consequences, including death.”
The medical decisions on incapacitated residents without representatives are made by a team that includes a physician and a nurse.
The fact that nursing homes are making end-of-life decisions without patient input is a big concern, according to the ruling. The decision cited one nursing home resident who was found to be mentally incapacitated and who had no representative. The facility staff made a decision to take him off life-sustaining treatment and he passed away in 2013.
The ruling came after the California Advocates for Nursing Home Reform, an advocacy group, filed a lawsuit in 2013 against the state Department of Public Health. The suit alleged that nursing homes used the law to administer anti-psychotic drugs, place residents in physical restraints and deny patients life-sustaining treatment.
Tony Chicotel, a staff attorney for the group, said the ruling will dramatically impact the lives of the most vulnerable nursing home residents.
“What [nursing homes] used to do was routinely make decisions big and small for their residents without really any regard to due process,” Chicotel said. “Now the residents are finally going to have their rights acknowledged and honored.”
Even patients who are compromised should still have a say in their medical care, he added.
“They have been ignored,” he said. “Unrepresented residents and the way they are treated in nursing homes has never been a priority of the Department of Public Health.”
The department is reviewing the decision, a spokesman said. Department officials declined to comment further or say whether they planned to appeal.
The law was enacted in 1992 because nursing facilities needed a way to give medical treatment to their incapacitated residents without having to wait up to six months for state approval, according to the ruling.
But the decision could make it challenging for nursing homes to provide routine medical care or to offer hospice care to residents who lack the mental capacity to make their own decisions and have no designated representatives, said Mark Reagan, an attorney representing the trade group, California Association of Health Facilities, which is not part of the lawsuit.
“If the person objects, then what?” Reagan said. “That can put patients and facilities in a difficult place.”
And seeking court approval to provide anti-psychotic medication to residents who truly need it would be costly and time-consuming for nursing facilities, he said. “How do you keep that person safe and how do you keep the other residents of the skilled nursing facility safe?” he said.
Reagan believes the ruling could have an unanticipated outcome: Patients without decision-makers could have a hard time finding a nursing facility willing to take them.
“If this decision makes it more difficult to supply necessary care at the bedside, this population is going to be less served,” he said.
The judge, however, wrote that informing patients and allowing them to object is not likely to result in any significant burdens on nursing homes.
Golden Gate University Law School Professor Mort Cohen, who filed the case, said the next step is for the judge to issue an order directing the state Department of Public Health, which oversees nursing homes statewide. The state could ask the court for a stay or could appeal the decision, but Cohen said he expects the decision to stick.
[From Kaiser Health News (KHN), a nonprofit national health policy news service.]
Relics - Film on Assisted Death [EOL in Art 50]
Relics is a 15-minute film about a salesman who tries to sell his miraculous cleaning machine to a sick woman and her skeptical daughter, on the day that the woman asked her daughter to help her end her own life. It's a comedy! Sort of...
Relics screened at numerous film festivals in 2014 and won several awards along the way, including an Adrienne Shelly Foundation Award for Best Female Director, second place at Palm Springs International ShortFest, and Finalist at the USA Film Festival. It has now been released online.
Relics screened at numerous film festivals in 2014 and won several awards along the way, including an Adrienne Shelly Foundation Award for Best Female Director, second place at Palm Springs International ShortFest, and Finalist at the USA Film Festival. It has now been released online.
Support Informing Bioethics Policy
This week, I added a Paypal donation button to my website to help cover cost, such as obtaining court documents from PACER and state court websites.
Chủ Nhật, 28 tháng 6, 2015
Heartfelt - Photography of Troubled Births [EOL in Art 49]
Heartfelt is a volunteer organisation of professional photographers from all over Australia dedicated to giving the gift of photographic memories to families that have experienced stillbirths, premature births, or have children with serious and terminal illnesses.
Thứ Bảy, 27 tháng 6, 2015
Art of Hospice [EOL in Art 48]
Last summer, the Louisiana-Mississippi Hospice and Palliative Care Organization held an Art of Hospice competition. The works help make people more aware of hospice and better understand its benefits.
Thứ Sáu, 26 tháng 6, 2015
No Immunity for Providers Who Treated Patient Contrary to Her Advance Directive
In March 2012, clinicians at Doctors Hospital of
Augusta intubated terminally ill 91-year-old Bucilla Stephenson and placed her own mechanical ventilation. This was contrary to Stephenson's advance directive and contrary to the specific directions of her designated healthcare agent (her granddaughter).
In May 2013, Stephenson's agent filed a lawsuit alleging that the defendant clinicians caused her grandmother "pain, suffering, and emotional distress by subjecting her to unnecessary procedures." The agent seeks both compensatory and punitive damages. She asserts claims for (1) breach of contract, (2) informed consent, (3) ordinary negligence, (4) battery, (5) IIED, and (6) breach of fiduciary duty.
A few days ago, the Georgia Court of Appeals affirmed the trial court's denial of summary judgment to the defendants, because genuine issues of material fact exist regarding whether defendants made a good faith effort to rely on the agent's directions (and were thus entitled to statutory immunity).
The court also affirmed the trial court's denial of summary judgment on the battery claim. But it reversed the denial of summary judgment on the informed consent claim, because there was no evidence of injury caused by this breach.
Augusta intubated terminally ill 91-year-old Bucilla Stephenson and placed her own mechanical ventilation. This was contrary to Stephenson's advance directive and contrary to the specific directions of her designated healthcare agent (her granddaughter).
In May 2013, Stephenson's agent filed a lawsuit alleging that the defendant clinicians caused her grandmother "pain, suffering, and emotional distress by subjecting her to unnecessary procedures." The agent seeks both compensatory and punitive damages. She asserts claims for (1) breach of contract, (2) informed consent, (3) ordinary negligence, (4) battery, (5) IIED, and (6) breach of fiduciary duty.
A few days ago, the Georgia Court of Appeals affirmed the trial court's denial of summary judgment to the defendants, because genuine issues of material fact exist regarding whether defendants made a good faith effort to rely on the agent's directions (and were thus entitled to statutory immunity).
The court also affirmed the trial court's denial of summary judgment on the battery claim. But it reversed the denial of summary judgment on the informed consent claim, because there was no evidence of injury caused by this breach.
Pluralism, Futility, and Thresholds for Treatment in Intensive Care
The annual meeting of the Australasian Association of Bioethics and Health
Law starts today with a keynote plenary by Dominic Wilkinson: "Pluralism,
Futility, and Thresholds for Treatment in Intensive Care."
Thứ Năm, 25 tháng 6, 2015
Hospice Stamp [EOL in Art 46]
In 1999, the U.S. Postal Service issued the Hospice Care Commerative Stamp to help raise awareness about hospice.
The stamp was designed by veteran stamp designer Phil Jordan to symbolize life’s journey to its final stage, the stage where Hospice lends its vision for end-of-life care. The Hospice stamp features a large green field in front and a tree beside a while house, with a large yellow and red butterfly flying above.
The stamp was designed by veteran stamp designer Phil Jordan to symbolize life’s journey to its final stage, the stage where Hospice lends its vision for end-of-life care. The Hospice stamp features a large green field in front and a tree beside a while house, with a large yellow and red butterfly flying above.
SNF Fined $400,000 for Blindly Following the Surrogate
Earlier this week, I wrote about a recent CMS investigation in which a hospital wrongly looked to a surrogate even though the patient still had capacity to make her own healthcare decisions. Today, I summarize a similar case from the DHHS Departmental Appeals Board in which the facility was fine nearly $400,000.
NMS Healthcare of Hagerstown is a skilled nursing facility. It confined one of its residents and restricted her access to members of her family and others. NMS did this at the request of the resident's daughter even though there was no medical or other basis for doing so.
The ALJ observed: "A skilled nursing facility is not excused of its obligations to provide care by the
fact that a resident or someone on the resident’s behalf demands that the facility
provide a certain type or level of care. The regulations governing skilled nursing
facilities do not allow facilities to abdicate their responsibilities to residents in
order to cater to the whims of residents’ family members, whether or not they have
POAs."
"Moreover, a facility is not inherently a neutral arbiter. There can be a conflict of interest between a facility and its resident. . . . Resident # 4 generated a steady stream of revenue to Petitioner . . . . Given that potential conflict of interest it was incumbent on Petitioner to be scrupulously neutral in dealing with the resident. Simply going along with JF’s wishes in this case – without independently assessing the resident to determine whether confining her and restricting her access to visitors was appropriate – was anything but neutral."
NMS Healthcare of Hagerstown is a skilled nursing facility. It confined one of its residents and restricted her access to members of her family and others. NMS did this at the request of the resident's daughter even though there was no medical or other basis for doing so.The ALJ observed: "A skilled nursing facility is not excused of its obligations to provide care by the
fact that a resident or someone on the resident’s behalf demands that the facility
provide a certain type or level of care. The regulations governing skilled nursing
facilities do not allow facilities to abdicate their responsibilities to residents in
order to cater to the whims of residents’ family members, whether or not they have
POAs."
"Moreover, a facility is not inherently a neutral arbiter. There can be a conflict of interest between a facility and its resident. . . . Resident # 4 generated a steady stream of revenue to Petitioner . . . . Given that potential conflict of interest it was incumbent on Petitioner to be scrupulously neutral in dealing with the resident. Simply going along with JF’s wishes in this case – without independently assessing the resident to determine whether confining her and restricting her access to visitors was appropriate – was anything but neutral."
Thứ Tư, 24 tháng 6, 2015
Aid in Dying - Minnesota
To follow-up on yesterday's Minnesota Public Radio show on
aid-in-dying, I collect some relevant resources below.
Minnesota is one of nearly 30 states, this year, to consider legislation legalizing aid in dying. Here is a link to the bill, SF 1880, "The Minnesota Compassionate Care Act." Here is some press coverage.
The leading organization in the country defending AID is Compassion & Choices. There is a Minnesota chapter. Here is its Facebook page.
 |
| MN Senator Chris Eaton |
aid-in-dying, I collect some relevant resources below.
Minnesota is one of nearly 30 states, this year, to consider legislation legalizing aid in dying. Here is a link to the bill, SF 1880, "The Minnesota Compassionate Care Act." Here is some press coverage.
The leading organization in the country defending AID is Compassion & Choices. There is a Minnesota chapter. Here is its Facebook page.
Process of Dying in 6 Paintings [EOL in Art 45]
A Swiss Oncologist shares six paintings by the Swiss painter Ferdinand Hodler (1853-1918) in the Journal of Clinical Oncology (2002; 20:7: 1948-50).
Hodler painted his wife before, during, and after her illness. He documented her wasting and eventual extinction without mercy and yet with intense sympathy. He created a series of paintings that force the viewer to face the process of dying.
Hodler painted his wife before, during, and after her illness. He documented her wasting and eventual extinction without mercy and yet with intense sympathy. He created a series of paintings that force the viewer to face the process of dying.
- Figure 1, the youth. This portrait in shades of red shows her as a beautiful, healthy young woman.
- Figure 2, the illness. His wife is a bedridden patient.
- Figure 3, the exhaustion. Now, the eyes have closed. The head is hanging loose off the neck. The patient is sleeping. Her traits are becoming sharper, angular, bony.
- Figure 4, the pain. The dying patient is in the last days of her life. This
- gruesome sketch shows her tormented face; her head has fallen deep into the pillow.
- Figure 5, the agony. One day before her death, the patient has lost consciousness. The mouth is wide open; one imagines hearing a loud rattle.
- Figure 6, 1 day after death.
Thứ Ba, 23 tháng 6, 2015
Jahi McMath Malpractice Lawsuit - June 2015 Update
As I blogged here in March 2015, the family of Jahi McMath filed a medical malpractice action against Oakland Children's Hospital and several individual clinicians. Last week, the lead defendant, otolaryngologist Frederick Rosen, filed a demurrer (76-page PDF). Not surprisingly, the demurrer starts by arguing that Jahi "is deceased" and therefore does "not have standing to allege a personal injury claim."
Furthermore, anticipating that this is a fact the plaintiffs contest, the defendant contends that "Judge Grillo's [January 17, 2014] Judgment and finding of'death is not subject to reversal, reconsideration, re-opening or collateral attack. Jahi's brain death is, tragically, final and irreversible. . . . This court must give conclusive effect to Judge Grillo's final Judgment and should not entertain plaintiffs' claim that Jahi is no longer dead."
Time and Death [EOL in Art 44]
In this terracotta model, Gianlorenzo Bernini (1598-1680) shows Time dominating the skeletal figure of Death.
The Victoria & Albert Museum notes that this conveys the message that the passage of time confirms the immortality of the deceased's reputation through fame (or of their soul through redemption).
Time raises the coffin out of Death's reach, thus cheating him of his prize. Death appears to emerge from the ground itself, his skeletal form half decomposed and otherworldly. He effectively meet's Time's gaze, signalling a silent communication in which he must admit defeat. Nevertheless, he retains a tight grip on the shroud, with muscles tensed - a last desperate attempt to seize the coffin.
The Victoria & Albert Museum notes that this conveys the message that the passage of time confirms the immortality of the deceased's reputation through fame (or of their soul through redemption).
Time raises the coffin out of Death's reach, thus cheating him of his prize. Death appears to emerge from the ground itself, his skeletal form half decomposed and otherworldly. He effectively meet's Time's gaze, signalling a silent communication in which he must admit defeat. Nevertheless, he retains a tight grip on the shroud, with muscles tensed - a last desperate attempt to seize the coffin.
Thứ Hai, 22 tháng 6, 2015
Aid in Dying - Minnesota Public Radio
Join me tomorrow, Tuesday, June 23rd at 9:00, on Minnesota Public Radio. From the producer's notes:Earlier this month, the California Senate approved a physician-assisted suicide bill, allowing some terminally ill patients to receive help in ending their lives. The bill had been stalled for years, in part because the California Medical Association - a group representing California physicians - had always opposed physician-assisted suicide. But the CMA has changed its position from opposing the practice to taking a neutral stance - the first state medical group to do so. We'll look at how professional and public opinion is shifting on this issue.
Guests:
- Thaddeus Pope is a bioethicist and is the director of the Health Law Institute at Hamline University in St. Paul, Minnesota.
- Dr. Joanne Lynn is the director of the Altarum Center for Elder Care and Advanced Illness.
- Dr. Theodore Mazer is an otolaryngologist and the speaker of the California Medical Association House of Delegates
Death Listens [EOL in Art 43]
In "Death Listens," Hugo Simberg (1873-1917) depicts Death, personified as a skeleton wearing a black coat, listening with a bowed head as a young man plays the violin.
In the background, there is an old woman lying on a bed, pale and apparently sickly. There is a suggestion that Death is there for the old woman, but that he is pausing so the young man, possibly the dying woman's son, can have time to finish his violin playing.
In the background, there is an old woman lying on a bed, pale and apparently sickly. There is a suggestion that Death is there for the old woman, but that he is pausing so the young man, possibly the dying woman's son, can have time to finish his violin playing.
Do Not Look to the Surrogate If the Patient Still Has Capacity
Washington Adventist Hospital in Takoma Park, Maryland was recently sanctioned by CMS for looking to a surrogate rather than to the patient herself when the patient still had capacity."According to her medical record patient #1 was alert and oriented x4 with a period of delirium for several days while in ICU. There was no documentation in the medical record that patient #1 lacked capacity."
"Patient #1's granddaughter in Florida expressed concerns over the fact that patient #1 had MRSA in the nares and that she was on Xeralto. The note read in part 'she (granddaughter) wants the Xeralto discontinued' . . . The physician stated she was aware of the concerns and will discontinue Xeralto . . . ."
"This progress note as well as others reveal the hospital making changes in the patient's treatment based on Patient #1's granddaughter's wishes rather than those of the patient who was not identified at the time as lacking capacity to make her decisions nor was there documentation that the patient had agreed to her granddaughter making her decisions."
Chủ Nhật, 21 tháng 6, 2015
Letter Remained Unfinished [EOL in Art 42]
Vasily Vereshchagin has a series of these cards. The prior one has the nurse writing a letter for the patient but that is "interrupted" by an emergent medical need. Apparently, the patient never got to finish the letter.
Ontario Medical Board Cautions Physicians for Writing Unilateral DNR Order (Wawrzyniak v. Chapman & Livingstone)
Various Ontario tribunals have issued quite a few decisions (example) arising out of the civil and administrative complaints filed by Elizabeth Wawrzyniak against several clinicians at Sunnybrook Health Sciences Center involved in the death of her father on September 22, 2008. The latest one (23 single-spaced pages) was delivered just a few days ago by the College of Physicians and Surgeons of Ontario.This is the third time that the College has considered the same conduct by the same physicians, but this time with a different result. Basically, the physicians wrote a DNR order for Douglas DeGuerre without the consent of his substitute decision maker, his daughter.
The College held
- The physicians "demonstrated good clinical judgment in determining that extreme measures to preserve life would be futile and would only further exacerbate Mr. DeGuerre's suffering. . . . Mr. DeGuerre's death was inevitable . . . and the actions of [the physicians] . . . did not decrease Mr. DeGuerre's life span in any meaningful way."
- But the College held that the physicians "did not take adequate steps to discuss the proposed change [in code status]. They failed to make "reasonable or sufficient efforts to have a proper discussion with Ms. Wawrzyniak."
- Accordingly, the College issued a "written caution" to the physicians "on failing to ensure proper communication with the patient's SDM."
- The College ordered the physicians to "carefully and fully review the HCCA and provide the Committee with a written report, approximately 2-4 pages in length . . . about what they have learned . . . on how their practices will change in the future."
Thứ Bảy, 20 tháng 6, 2015
ASBH Annual Meeting (October 2015)
Register here for the 17th annual meeting of the American Society for Bioethics & Humanities (ASBH) in Houston, October 22-25, 2015.
I will be presenting in two panels:
The rest of the program looks great too, from art, to anthropology, to philosophy, to medicine, and more.
I will be presenting in two panels:
- Legal Update 2015: Top 10 Legal Developments in Bioethics
- The Unbefriended Must Not Be Unprotected: Organizational and Clinical Management of Patients Without Surrogates
The rest of the program looks great too, from art, to anthropology, to philosophy, to medicine, and more.
Hospital Sanctioned for Patients Lacking POLST
Northwest Hospital Center in Randallstown, Maryland received this statement of deficiencies compiled by health inspectors for the Centers for Medicare and Medicaid Services."Based on observation, medical record review, and interview of the licensed nursing and risk management staff, it was determined that not all patients consistently had . . . MOLST . . . ."
3.) Patient #8 . . . Review of the medical record on 11/12/14 revealed that there was no Maryland Order
for Life Sustaining Treatment (MOLST) form to indicate the patient's wishes. . . ."
"Failure to ensure in advance that patients and their representatives receive patient right's information potentially places patients at risk for having care not wanted or care wanted but not provided."
Thứ Sáu, 19 tháng 6, 2015
Savulescu on Rationing in the NICU
The Australian Centre for Health Law Research has just posted Julian Savulescu's lecture, last month: "Rationing: The Case of NICU."
It is far more defensible to justify treatment refusals on the basis of utilitarian allocation than on the basis of futility or benefit/harm trade-offs.
Does your hospital have a policy on resource allocation, so that you have principled grounds for denying treatment on the basis of scarcity?
It is far more defensible to justify treatment refusals on the basis of utilitarian allocation than on the basis of futility or benefit/harm trade-offs.
Does your hospital have a policy on resource allocation, so that you have principled grounds for denying treatment on the basis of scarcity?
Thứ Năm, 18 tháng 6, 2015
Critically Impaired Infants and End of Life Decision Making: Resource Allocation and Difficult Decisions
Neera Bhatia is a Lecturer at Deakin University School of Law, Australia. She has just published Critically Impaired Infants and End of Life Decision Making: Resource Allocation and Difficult Decisions (Routledge June 2015).Bhatia explores the legal and ethical issues surrounding decisions to withdraw or withhold life-sustaining treatment for babies born on the edge of viability (23 weeks) and addresses the controversial question, are some lives too expensive to treat?
"In western developed countries such as the UK and Australia medical practitioners are now able to keep extremely premature babies alive, but unfortunately cannot protect them from disability and lifelong poor health outcomes and the ongoing costs and impact on the families caring for these children,"
"The main premise of my book is that the allocation of finite healthcare resources should be a serious consideration in end of life decision making for this select group of patients. With an ageing population and limited healthcare funds these difficult questions need to be asked and answered.
"I am not saying exclusively that these babies should be not kept alive, rather I am asking if we are doing the right thing by saving babies that are going to require a lifetime of ongoing health care given the fact that we have many competing priorities putting pressure on limited health care budgets."
The book has seven chapters:
- Introduction
- The effectiveness of the best interests principle
- Non-uniformity in clinical guidelines
- The role, impact and importance of key care givers and decision makers
- Theories of distributive justice: Healthcare and extremely premature and critically impaired infants
- Resource allocation: An objective approach in end of life decision making for extremely premature and critically impaired infants
- Other observations and concluding remarks
Thứ Tư, 17 tháng 6, 2015
VSED - Is It Neglect?
The British Columbia Supreme Court determined that respecting a patient's non-contemporaneous decision to VSED would constitute elder neglect. The Mary Hildreth Winston case going to trial, this month, in Florida also raises the question whether honoring a patient's choice to hasten her death constitutes criminal neglect.
Alan Watts - Acceptance of Death [EOL in Art 38]
Here is a very well done four minute clip on the importance
of accepting death. It correlates film clips with portions of a lecture by British philosopher Alan Watts.
Thứ Ba, 16 tháng 6, 2015
In the Presence of a Spoon - VSED & Margot Bentley
This past Sunday, CBC aired a 30-minute
documentary on the Margot Bentley case.
The description reads: "Margot Bentley was a nurse in BC who made her end of life wishes crystal clear and on paper. Now, 17 years into dementia and many court cases later, she is being kept alive - all because she opens her mouth in the presence of a spoon."
I disagree that her wishes were "crystal clear." But I agree with the family that opening her mouth is not consent. And I agree that she is living in "extreme degradation . . . a horrible place she would never want to be."
Perhaps worst of all, the case may chill others from ding advance care planning. When families read about this case and the failure of planning instruments completed by a nurse whose father was a judge, they may conclude: "What's the point?"
documentary on the Margot Bentley case.
The description reads: "Margot Bentley was a nurse in BC who made her end of life wishes crystal clear and on paper. Now, 17 years into dementia and many court cases later, she is being kept alive - all because she opens her mouth in the presence of a spoon."I disagree that her wishes were "crystal clear." But I agree with the family that opening her mouth is not consent. And I agree that she is living in "extreme degradation . . . a horrible place she would never want to be."
Perhaps worst of all, the case may chill others from ding advance care planning. When families read about this case and the failure of planning instruments completed by a nurse whose father was a judge, they may conclude: "What's the point?"
Thứ Hai, 15 tháng 6, 2015
Youth in Oregon (film)
Look out for the 2016 release of "Youth in Oregon." 
This is a comedic drama about a man who must drive his 80-year-old father-in-law cross country for aid in dying. The cast includes Frank Langella and Christina Applegate.
Death the Friend [EOL in Art 36]
Alfred Rethel (1816–1859) was best known for painting images based upon German history of stories from the Old Testament, but from about 1848 he did a series of drawings with Death as a central character.
Here, death is tolling the bell for this old man.
Here, death is tolling the bell for this old man.
Chủ Nhật, 14 tháng 6, 2015
Thứ Bảy, 13 tháng 6, 2015
"I Am Dying" - National Geographic
Tonight, the National Geographic Channel has a one-hour special "I'm Dying." The show follows 32-year-old Renee Heidtman during the last months of her life capturing intimate moments through photos, camera work and Heidtman's personal video diary of her experience that she started when she was diagnosed in 2009.
The filmmakers had a goal of documenting death in an intimate way. Film crews hung out with the Heidtmans for nearly two months. They witnessed Renee Heidtman weakening daily, they saw family members helping her get in and out of bed, they watched as Rita Heidtman fed her sister, helped her bathe and dressed her.
Limits of Medicine [EOL in Art 34]
Daumier's satirical work is legendary. Here, he has two doctors arguing and pointing to their books. Meanwhile death is dancing by the patient.
Calculate Your Risk of Dying in the Next 5 Years
Determine your chance of surviving the next five years - with 80% accuracy. The Ubble website launched here a few days ago.
Baby Boomers for Balanced Health Care - Goldilocks Healthcare
Baby Boomers for Balanced Health
Care is a group of concerned citizens looking for "balanced" health care.
They want "Goldilocks health care" - not too much, not too little.
Care is a group of concerned citizens looking for "balanced" health care.
They want "Goldilocks health care" - not too much, not too little.
Thứ Sáu, 12 tháng 6, 2015
Samadhi 4D Death Simulator
Last summer in Shenzhen, China, an amusement park opened the Samadhi 4D death simulator. Participants can experience what it’s like to get cremated and reborn in a uterus. (CNN; Motherboard)
Players compete in a series of challenges in which everyone is trying to avoid the ultimate penalty—death. Players who "die" in the game (and in the end, all the players die) are placed in a coffin, then carried to a large furnace via conveyor belt. The coffin is heated to 40 C (105 F), and a combination of hot air and light produce an “authentic experience of burning.”
After the cremation, players see a womb projected on the ceiling and hear a heartbeat. Soon, they see a bright light which they must crawl toward so that they might emerge in a are white, padded area, which is supposed to represent their rebirth.
More Doctors Going to Jail for Gross Negligence
In a recent issue of the Medico-Legal Journal Alec Samuels observes: "A finding of civil negligence is bad enough; a verdict of criminal negligence is truly tragic.""There are not many prosecutions . . . however, prosecutions are now more common than before." He reviews several recent cases. I will be collecting the U.S. cases later this year.
POLST or Advance Directive [EOL in Art 33]
I started this series with a photo that I took while at the Harvard Art Museums.
Like that painting, the main character in this painting ("Last Will" by Nikolay Bogdanov-Belsky ) would be dictating a POLST, not an advance directive.
Like that painting, the main character in this painting ("Last Will" by Nikolay Bogdanov-Belsky ) would be dictating a POLST, not an advance directive.
Thứ Năm, 11 tháng 6, 2015
New Jersey Again Worst in ICU Use at End of Life
A few days ago, the United Health Foundation released the 2015 edition of America's Health Rankings: Senior Report. ICU use is one core measure. "Overusing the critical care system is costly and often goes against the wishes of dying patients. While not correlated with better outcomes or longer life, intensive care unit (ICU) use is correlated with
availability of ICU beds; this could indicate a supply-induced
demand. Areas with higher ICU use are high-use areas in other aspects as well, including physician visits and hospitalizations. Because such a high volume of Medicare spending is for care of chronic illness in the last years of life, it is possible to increase both cost savings and patient-preference satisfaction by decreasing ICU use."
In New Jersey, 23.5 percent of seniors spent seven or more days in the ICU during their last six months of life, the highest rate in the nation. In contrast, the rates in Vermont, Maine, Idaho, Oregon, and Vermont are all under 6%.
Palliative Care Is the Path Alongside the River of Curative Treatment
Dominic Wilkinson is a Consultant Neonatologist and Director of Medical Ethics at the University of Oxford. A recent short article on prognostication includes a great metaphor for palliative care.
"Conventional medical treatment is more akin to a river, while palliative care is the path running alongside. Sometimes it is appropriate to climb out of the water, and to walk more slowly along the towpath. Often, once people have left it, they have no desire to return to the river. But others will find, after some time, that they are ready to plunge back in. This may be for a short dip, or for a long swim. But the palliative path will be there at the side when they need it."
"Conventional medical treatment is more akin to a river, while palliative care is the path running alongside. Sometimes it is appropriate to climb out of the water, and to walk more slowly along the towpath. Often, once people have left it, they have no desire to return to the river. But others will find, after some time, that they are ready to plunge back in. This may be for a short dip, or for a long swim. But the palliative path will be there at the side when they need it."
Sky Light - A Cemetery that Glows [EOL in Art 32]
Sky Light transforms the idea of dark and gloomy cemetery in a natural experience, simple and happy through a series of natural elements like water, flora and light.
Each of the remains are introduced into an urn, sealed, and placed in an urn light containing an LED system. Each urn can be placed in a family tree, or hung on a constellation.
Each of the remains are introduced into an urn, sealed, and placed in an urn light containing an LED system. Each urn can be placed in a family tree, or hung on a constellation.
Thứ Tư, 10 tháng 6, 2015
Wild Variations in Hospice Use across USA
These data has long been published in the Dartmouth Atlas. But seeing it in the 2015 America's Health Rankings Senior Report is a reminder. Hospice use varies from 65% in Arizona and Utah to just around 30% in New York, Alaska, and North Dakota.
Modern Tomb [EOL in Art 31]
Pedro Dias designed "Family Tomb in the Açor Mountains" to have the interior as an open space, accessible to all, equipped with a bench, which serves both as such as well as a surface for placing the coffin during the mentioned funeral ritual. The contemplative “spatial void” fulfills the “emotional void” caused by a feeling of loss.
New Award Recognizing Health Law-Related Service to the Community
Nominate a Colleague for New Award Recognizing Health Law-Related Service to the Community
The AALS Section on Law, Medicine and Health Care created a new award in 2014 to recognize outstanding contributions of law teachers in the service of health law.
The award is designed to recognize a wide variety of community service activities, including: pro bono litigation, legislative advocacy, leading or consulting on public initiatives, and other public or private projects. The service may be local, regional, national or international in scope. It is not the purpose of the award to recognize teaching, scholarship or service other than community service (such as service to the AALS, academic institutions, or to academia).
Nominators and nominees must be Section members. Please nominate a colleague (or yourself) for this award by September 15 using this Nomination Form.
The award winner will be selected by the 2015 Section Executive Committee, listed here, and acknowledged at the 2016 AALS Annual Meeting. Please contact Elizabeth Pendo,ependo@slu.edu, if you have any questions.
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