Family Seeks Injunction against OPO Removing Life Support

I am just pulling a copy of the complaint in this case just
filed in Sacramento Superior Court.  Gloria Woods was in an auto accident on April 30 and is in critical
condition at the UC-Davis Medical Center.  The family was soon "contacted by Sierra Donor Services and advised that
Department of Motor Vehicle records indicated that Gloria Woods was an organ
donor." At that time Sierra Donor Services inquired of plaintiffs when
they would be able to harvest Gloria Woods' organs. Plaintiffs responded that
Gloria Woods was still alive. 

"Thereafter, Sierra Donor Services contacted plaintiff again and
advised that it had the right to make the decision to remove Gloria Woods from
life support and then to harvest the organs of Gloria
Woods in light of the Department of Motor Vehicle records."

The family seeks a restraining order and
injunction against Sierra and the UC-Davis Hospital, preventing them from
removing Gloria from life support and from harvesting her organs.  They
claim, quite reasonably, that "irreparable injury would result" if
her organs are harvested.

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Professor Pope to Meet with White House about Judicial Vacancy Crisis

Tomorrow, I will travel
to Washington, DC, to meet with White House officials about the vacancy crisis.
 Nearly one out of every ten federal judgeships remains vacant, and more
than 250 million Americans live in a community with a courtroom vacancy.  

The Minnesotans
traveling to Washington with me are:

•  Thao
  Mee Xiong, Public Policy Specialist, Minnesota Coalition for Battered
  Women


• See Vang Thao, Attorney

We will join 150
advocates (including many other law professors from Penn, Georgia State, FIU, and
other law schools) from 27 states in a day of discussions with White House
staff. A deal between Senate Republicans and Democrats to allow judicial
nominations to proceed in the Senate expires May 7th, and we are urging the
Senate to hold final up-or-down votes on all pending nominees.

After the White House meeting, we will visit the offices of key
senators, including Senators Klobuchar and Franken, to urge them to work to end
the delays that have plagued the Senate confirmation process since the
beginning of the Obama presidency.

Despite the delays, the overwhelming majority of Obama’s nominees
have garnered tremendous bipartisan support, such as Susan Nelson who was
confirmed to the U.S. District Court for the District of Minnesota by unanimous
voice vote in December 2010.  We hope our
conversations in Washington will help national leaders understand how harmful
the confirmation delays have been to Americans who are seeking justice.

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The Texas Advance Directives Act: A Threat to Catholic Identity?

In the just-released issue (20(2): Spring 2012) of CHA's Health Care Ethics USA, Elliott Louis Bedford has a feature article titled "The Texas Advance Directives Act: A Threat to Catholic Identity?"  Here is his conclusion:




In conclusion, it seems that, with certain qualifications, Catholic hospitals should support laws that use the TADA as a model because, in the rare case that the process is actually implemented, it allows physicians to practice according to professional conscience and seeks the good of the patient by preventing the harmful prolongation of the dying process while avoiding euthanasia. Furthermore, evidence from those who have reviewed experiences of cases that invoked the process indicates that, in general, the law tends to improve the quality of the end-of-life care in the most difficult circumstances because it increases communication between staff and families. Specifically, it often provides relief to families struggling with the weight of the decision to remove LST from their loved one.




The general concern regarding the law’s compatibility with the ERDs highlights another important point: the TADA establishes minimums. Catholic hospitals can make internal policies regarding the implementation of the TADA that go beyond the minimums that the law establishes. For instance, a hospital might adopt a policy extending the waiting period or requiring a second opinion before the physician can submit the case to the review committee. Additionally, it could even revise the policy for the implementation of the TADA process to specify that it cannot be applied to a case in which the patient is merely receiving MANH. In fact, the law encourages developing just such a policy. While other means of resolving conflicts over medically inappropriate treatment are highly successful, used comparatively often, and should be explored before turning to legal means for resolution, laws like the TADA are, and should be, a last option that is nonetheless worthy of qualified support by Catholic hospitals.

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Cat Hospice

The CAT PRACTICE has offered care for elderly or terminally ill felines for years.  But, this week, they announced a home-based hospice program.  It costs $75 dollars per week, which includes the cost of office visits and gives patients access to veterinarians at all times. Medications can cost a great deal more, although the clinic has partnered with a pharmaceutical firm to provide discounts.  The clinic is also partnering with a psychologist, to help owners come to terms with loss. 




Hospice may not be the proper choice in all situations and sometimes euthanasia is a better option for extremely ill pets.  But advancement in medications and treatments can give owners more choices while still doing what's best for the animal.   (Detroit News)

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Supreme Court Should Rule in Rasouli Case

In Wednesday's Globe & Mail, Law professor Hilary Young rightly calls on the Supreme Court of Canada to decide the Rasouli case even if, because of the patient's cognitive improvement, the case has become moot.  She writes that "given the importance of the issues at stake and the uncertainty in the law, the Supreme Court should take this opportunity to clarify the law."



I agree.  This was a key point of a recent JAMA article that I published with critical care physician Doug White.  Two of the reasons that we called on courts to resolve these cases are:



(1) To Shine a Spotlight on an Unresolved Social Issue. Because the public debate on futility has largely stagnated without achieving satisfactory clarity for patients and physicians, renewed public debate may be an important step toward better policy.



(2) To Cast a Shadow that Allows Extrajudicial Solutions.  Because less than 6% of all serious lawsuits are tried, the most important thing that Courts do is to cast a shadow of legal rules within which litigants can craft their own custom-made settlements.”  Roberts v. Stevens Clinic Hosp., Inc., 345 S.E.2d 791 (W.Va.,1986).



Some may argue that state legislatures are better positioned (than courts) to deliberate about how to balance the competing interests at stake in such cases.  Indeed it is true that legislatures can conduct more extensive, resource-intensive hearings.  But the lack of legislative movement on this topic suggests that the futility debate is “too hot” for the political branch of government, especially in the wake of the highly-charged public rhetoric regarding “death panels”.  A Pennsylvania court hearing a right-to-die case summarized this sentiment as follows:  “Legislatures are often slow to act, and where the legislature has failed to act, the Courts must respond to protect individual rights.”  In re Jane Doe, 45 Pa. D. & C.3d 371 (1987).

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Revising CPR Default Status

Craig Blinderman and colleagues have, in a recent issue of JAMA, a persuasive and succinct three-part approach to offering CPR based on the likelihood and degree of potential benefits and harms.

1. Where relative benefits and harms are uncertain, consider CPR as a plausible option.


2. Where there is a low likelihood of benefit and a high likelihood of harm, recommend against CPR.  They note that despite such a recommendation, some patients or surrogates may request that CPR be attempted.  Blinderman and colleagues conclude that it is ethically acceptable to acquiesce "so long as it is grounded in the patient's wishes and goals and there is a potential for a modicum of benefit."


3. Where the patient will die imminently or has no chance of surviving CPR to the point of leaving the hospital, physicians should not offer CPR.  If a patient or surrogate continues to insist, request an ethics consult.  If the consult concurs, then the patient/surrogate should be informed that CPR will not be attempted and psychological/emotional/spiritual support should be made available.  Blinderman and colleagues do note that even here CPR might be attempted if the patient has "highly unusual values or goals."  

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Critical Care Physicians Getting Surrogate Consent through Lying

Last July, I wrote about how some range of the high  (90%+) consensual resolution rate of end-of-life conflicts is illusory because the surrogates may consent based on incomplete information and understanding.  




A new study by David Brush and colleagues in Critical Care Medicine lends support to concern that some physicians deliberately misrepresent information in order to obtain surrogate consent to their proposed treatment plan.  This seems like a serious informed consent violation, especially in Wisconsin where physicians must often disclose options even if they think they are inappropriate.

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