I have posted, here, an MP4 video of my May 2012 presentation at the ATS 2012 Conference in San Francisco: "What Are the Boundaries of Acceptable Medical Practice Near the End of Life In ICUs? Legal Mechanisms to Resolve Futility Disputes." This is not a video of me but of my slides with me speaking.
Angelo Volandes has spearheaded a body of research (e.g. here and more to come in 2012-2013) persuasively demonstrating that compared with participants who only heard a verbal description, participants who viewed a goals-of-care video were more likely to prefer comfort care and avoid CPR, and were more certain of their end-of-life decision making.
I was delighted to hear, this morning, that version 2.0 of Volandes' research will move from using videos to inform patient decision making to using videos to document that decision making. Having a video of the patient describing her preferences will surly help ED physicians, family members, and others accept and honor the patient's choices.
While I missed his presentation at the 2012 Healthcare Law and Ethics Institute at Samford University, I thoroughly enjoyed John Lantos’ slides on medical futility and moral distress. Lantos powerfully uses literature and film-- from Huckleberry Finn to ET -- to illustrate relevant themes and issues.
I am heading, this morning, to hot, hot Tempe, Arizona to attend and speak at the 35th Annual Health Law Professors Conference. This is probably the largest U.S. gathering of academic lawyers teaching and researching health law and bioethics.
Last year, I also attended the Australasian Association of Bioethics and Health Law (AABHL) conference. AABHL is Australia and New Zealand’s leading organisation concerned with issues of bioethics and health law. In contrast to ASLME, AABHL is a little more diverse. Its members come not only from law but also from nursing, ethics, philosophy, healthcare administration, allied health and complementary healthcare. I am pleased to see that ASLME is similarly including, this year, presenters and attendees from other disciplines. The agenda is here.
For all those patients who have left no evidence of their treatment preferences at the end-of-life, hospice should be the default argues this physician (in the clip below).
I agree. It is time to revisit, as Justice Rehnquist put in in Cruzan, the "societal judgment about how the risk of error should be distributed." Empirical evidence over the past twenty years about patient preferences and the reversibility of certain medical states supports Justice Brennan's observation that "an erroneous decision in either direction is irrevocable." We would commit far, far less error by having hospice as a default option for certain populations of the chronically critically ill.
Take a look at the cover of this week's Time Magazine. "How to Die" appears in large white letters on a red background. This is great sign that our society is having much needed discussion and dialogue about these issues. The author explains how the high-quality end-of-life care that his parents received from the Geisinger Health System was due largely to its salaried physician structure that avoids problematic fee-for-service incentives. Here is a video accompanying the print story.
The UK National Confidential Enquiry into Patient Outcome and Death (NCEPOD) has released a new report that highlights the process of care for adult patients who received cardiopulmonary resuscitation in an in-hospital setting.
The report takes a critical look at areas where the care of patients might have been improved, and factors which may have affected the decision to initiate a resuscitation attempt. Notably, the report found that even when a DNACPR decision had been made it was not always followed, and 52 patients underwent CPR despite their explicit DNACPR decision.
NCEPOD Chairman Bertie Leigh said that he hoped this report would prompt a rethink on the limits of what is possible, and act as a wake up call to the NHS: “In nearly half of all the cases we reviewed there was a failure to formulate an appropriate care plan on admission, and a failure, often over several days, to find out what the patient’s wishes were – and to carry them out.” “We are at a crossroads. All of us need to recognise and accept the limits of what can be achieved in medicine to the benefit of the patient, and a ‘ceiling of treatment’ described and agreed with the patient wherever possible. Doctors should only administer CPR where a patient has consented, or if the doctor is satisfied it is in the patient’s best interests.”
