British End-of-Life Quality Survey

The British Office for National Statistics (ONS) has released the National Bereavement Survey 2011.  Among other things, the data show:

• Only 50 per cent of hospital nurses showed dignity and respect towards patients at the end of their lives, compared to 80 per cent of hospice nurses 


• And just 30 per cent of people who died in hospital were given a choice about where they died, whereas the figure was double that for those in a hospice

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Michigan Peace of Mind Registry

Joanna Lax at Dykema has a great
post about the new Michigan Peace of Mind Registry.  I have excerpted a bit of her excellent post
below.

What is the new database?

On June 18, 2012, Michigan
Governor, Rick Snyder, signed legislation establishing the “Peace of Mind
Registry”—a cutting-edge, statewide electronic database for storing
individuals’ health care advance directives and organ donation documents.
Individuals in Michigan will be among the first in the nation  to be able
to electronically upload or send via snail mail, their signed advance directive
and organ donation documents to an accessible  centralized Registry.
Database registration is free and voluntary. To those who do register, the
Peace of Mind Registry will send a receipt and a wallet-sized card documenting
the registration. If an individual should change his/her mind about either the
advance directive or the organ donation, the Peace of Mind Registry will also
include forms to revoke a previous registration.

What is the significance of the Peace of Mind
Registry for health care providers?

The Peace of Mind Registry will
enable hospitals, nursing homes, physicians and other health care providers to
search for advance directives in a centralized location no matter where the
patient lives in Michigan. It will also allow providers to download advance
directives directly into their own electronic medical record system. Curiously,
health care providers are not mandated by the new legislation to check the
Peace of Mind Registry when a new patient is admitted. However, since the early
1990s health care providers have had an obligation under their Medicare
provider agreements to ask all newly admitted inpatients whether they have an
advance directive, and to take reasonable steps to obtain a copy if one exists.

What best practices can providers adopt now?

Once the Peace of Mind Registry
is operational in Michigan, health care providers should search the database for
all new admits, and to obtain copies of filed advance directives. Note that
providers will still need to confirm that the filed registered directive is the
individual’s most current expression of wishes. It is certainly possible for an
individual to write a second—or third or fourth—advance directive, or to
totally revoke all prior documents, but fail to register these later documents
or actions. Once the Peace of Mind Registry is operational, hospitals, nursing
homes and other health care providers should also update their policies and
procedures regarding advance directives to incorporate the anticipated benefits
of the new data repository.

For those outside Michigan, consider using a private (non-governmental) registry.  The largest one in the United States is DocuBank, based in Philadelphia.

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Foundational works of scholarship in health law

The American Society of Law, Medicine & Ethics, the AALS Section of Law, Medicine & Health Care, and the American Health Lawyers Association are seeking nominations of foundational works of scholarship in health law, very broadly defined, published in English before December 31, 2010.



They intend to publish an edited volume in an academic press.  The first round of nominations will close on December 31, 2012.  Nominations must be accompanied by a brief description, not to exceed 300 words, of the importance of the scholarly work, addressed to:

Ted Hutchinson, Executive Director, American Society of Law, Medicine & Ethics, 765 Commonwealth Avenue, Boston, MA  02445  thutchinson@aslme.org

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Cervantes v. Rady Children's Hospital

On Friday, I blogged about the case of Cervantes
v. Rady Children's Hospital.  Two-year-old
Zody Cervantes had meningitis and suffered a seizure in an emergency room
nearly two months ago. He was then transferred to Rady Children’s
Hospital where he’s being treated for a severe brain injury.  

Last week,
Zody's mom Laura Nieves said doctors visited her twice and told her they
planned to take the boy off life support. Both times Nieves told the doctors
that she didn’t approve of the decision:  "I'm just letting you know
right now that I don't give you permission, I don't give you consent to take my
son off life support."  She has even
posted signs near her son's bed stating the family's position.  Nieves said a hospital staff member told her:  "We don't need your consent."

NBC News reports that Nieves says her son has been making progress,
responding to touch and voices speaking to him.  Hospital administration denied
planning to remove Zody.  

Ted Mazer, M.D. of the San Diego County
Medical Society said there's no legal precedent requiring consent from parents
to take children off of life support.  As I have written, this is not entirely accurate.

 

View more videos at: http://nbcsandiego.com.

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Duluth, MN End-of-Life Talk on July 8

Speaker Janet Conn, President of Compassion and Choices ofMinnesota will speak on the broad picture of public policy, the future
direction of advocacy and the current public discussion regarding care for the
elderly, family decision-making for health care, hospice services and decisions
about end of life. A question and answer period will follow. 

Admission
Information: Free

Time:
 July 8th at 2:00 pm

Location:

Duluth-Superior Friends Meeting House

1802 East First Street

Duluth, MN 55801

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Health Law at SEALS

The final agenda for the SEALS conference in Amelia Island, Florida, later this month, is now available here.  There are, especially relative to all the other areas of law that could be included, quite a few sessions on health law topics.  I look forward to seeing you there.  I will be coming to SEALS straight off two weeks in Colorado at the Economics Institute for Law Professors.

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Legality of U.S. Physician Aid-in-Dying

It struck
me, yesterday, that much of the legal work of Compassion
& Choices is not about changing
the law but more about clarifying that
the existing law (already) does not prohibit physician aid-in-dying.  Here
are four examples:

1.    
In Hawaii and New Mexico, (as earlier in Connecticut) the argument
is basically that any criminal prohibition on "assisted suicide" does
not extend to a physician's lethal prescription for a competent terminally ill
patient.  That conduct does not constitute "assisted suicide" as
that term is defined under the criminal code.

2.    
In Montana, Baxter already clarified, in 2009,
that PAD does not violate public policy and would not constitute a crime if the
patient consents.  But clinicians want more clarity: guidelines, explicit
safe harbor immunity.  Current statutory efforts are aimed at elucidating
what is already legal (but arguably not yet very practically effective).

3.    
The California Right to Know End of Life Options Act merely
codifies what was already a legal informed consent duty.
 A California physician must disclose all information that a reasonable
patient in the patient's situation would find material.  A terminally ill
patient's end-of-life options surely constitute significant information for
that patient.  Yet, again, that does not mean the law is useless.  It
serves an important clarifying and highlighting function.

    

4.    
VSED is legal in all U.S. jurisdictions, at
least for a contemporaneous request from a capacitated patient.  But the
widespread perception (especially among long term care providers) is that
assisting VSED may trigger criminal and regulatory sanctions.  So, again,
the focus is on clarifying that the law does not actually prohibit (and even
requires) assisting VSED.

Poisoning
or dehydrating another person is normally a crime.  But when (1) a
clinician does this (2) for a terminally ill patient (3) with that patient's consent,
then it is not a crime.  This reminds me of a powerful scene in Frost/Nixon when
Nixon says "when the President does it, that means it's not illegal."

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