Free End-of-Life Counseling

Compassion & Choices offers End-of-Life Counseling.  This is free, confidential, professional support anywhere in the country.  Compassion & Choices counselors will listen to your unique situation and answer your questions whether you want to improve the quality of life you have left, achieve a peaceful death or simply plan ahead.



Over 100 expert staff and volunteers stand ready to serve in every state. We help with advance directives, local referrals, information and support on end-of-life care and decision making.  Call 800.247.7421 or email.  Here are some of their general FAQs.



Q: What should I expect when I talk to a counselor?

• Our 800 number connects you with a confidential voicemail system, and we check messages at least twice daily. A trained professional counselor will then call back to answer all your questions, find out more about you and allow you to talk openly.

Q: How do I discuss my end-of-life wishes with my doctor or family members?

• Plainly, simply and honestly. Speaking with one of our end-of-life counselors often helps people clarify their goals so they can more easily communicate them to others.

Q: Where can I find information about advance directives?

• You can find information and advance directive forms for every state on our advance planning information page. If you have difficulty completing them, one of our end-of-life counselors will gladly assist you.

Q: If I live in a state with no law protecting aid in dying, should I move to Oregon or Washington?

• No; there are many options available to people across the nation, which an end-of-life counselor can explain to you. Compassion & Choices wants everyone with a terminal illness to have a peaceful death no matter which state they live in.

Q: Where can I get the pill to end my life?

• This is the question we hear most often, and people ask it with many different things in mind. In certain cases a lethal dose of medication, prescribed by a physician and self-ingested, can be the best path to a gentle death. After a thorough conversation with you and perhaps your family, our counselors may provide information regarding medication and how to obtain it.

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Tylenol Can Facilitate Advance Care Planning

Significant amounts of over-treatment in the United States are due to a persistent widespread failure to do advance care planning.  Most people do not want aggressive curative directed treatment at the end of life.  But most leave no instructions or informed surrogates to implement such wishes.  One reason for the lack of advance care planning is anxiety about discussing death.




University of British Columbia researchers may have found an inexpensive and easy solution:  the over-the-counter pain drug Tylenol. Typically known to relieve physical pain, the study suggests that Tylenol may also reduce the psychological effects of fear and anxiety over the human condition, or existential dread.



“Pain exists in many forms, including the distress that people feel when exposed to thoughts of existential uncertainty and death,” says lead author Daniel Randles, UBC Dept. of Psychology. “Our study suggests these anxieties may be processed as ‘pain’ by the brain – but Tylenol seems to inhibit the signal telling the brain that something is wrong.”



"The Common Pain of Surrealism and Death: Acetaminophen Reduces Compensatory Affirmation Following Meaning Threats" is in the Association for Psychological Science journal Psychological Science.



Perhaps, next year, community organizers at National Healthcare Decisions Day events across the country will include a bottle of Tylenol next to the Five Wishes forms and cookies.

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Legal Issues Concerning Withholding and Withdrawal of Dialysis

The dynamic Australian health law professor Cameron Stewart and a physician colleague have published "Legal issues concerning withholding and withdrawal of dialysis" in Nephrology.  The in-press article is available as a free download.  



The article is a general overview of legal principles concerning healthcare decision making.  Among these, is some good analysis of medical futility.  For example:  "The law does not obligate a nephrologist to provide treatment that they believe is of no benefit to the patient or that any benefit is outweighed by the burdens of the treatment . . . ." 

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Medical Futility Policy Transparency

I have a new post on "Medical Futility Policy Transparency" at bioethics.net.

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Minnesota Court of Appeals to Decide Guardian Power to Stop Life Support

On October 18, 2012, the Hennepin County (MN) District Court issued a written opinion in In re Tschumy, holding that guardians under the court’s jurisdiction must ask the court for authorization to terminate life support.  



That decision was appealed.  After some preliminary briefing on jurisdiction, the Court of Appeals has agreed to hear the case on the merits on May 15, 2013 at 10:40 a.m.

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Daughter Sues Florida Hospital for Failing to Implement DNAR Order

A lawsuit (docket here) filed in Polk County, Florida, earlier this
month, alleges that Lakeland
Regional Medical Center failed to send a copy of Marjorie
Mangiaruca's DNAR order with her when it transferred her to Oakbridge
Healthcare Center.  LRMC didn't tell the people transporting her to the nursing home that she
had a DNAR order and didn't alert the nursing home she was a DNAR patient.

A few days after the transfer, Oakbridge nurses found Mangiaruca not
breathing and unresponsive.  What happened next should not have happened
to a DNAR patient:

• Oakbridge called 911.  


• When Mangiaruca's heart stopped en route to the hospital EMTs did CPR.  


• When that did not work, EMTs put a hole in her neck and
  inserted an airway tube.  They injected drugs to restart her heart and
  paralyze her so she couldn't resist intervention.


• At the hospital, clinicians removed the tube inserted
  by the EMTs and put in another tube that was connected to a ventilator.  


• A feeding tube also was installed.


• Mangiaruca wwas transferred to a medical ICU.

Only days later were these interventions deescalated.  Hospital staff followed the daughter's direction to remove the breathing tube and
disconnect Mangiaruca from the ventilator.  She died five days later in a
palliative care unit.  In short, Mangiaruca's wishes were ignored and
her death was prolonged.  

It is worth noting that one of the most significant cases concerning unwanted
life-sustaining treatment was also a Florida
case.  I have collected
many similar cases here.  I have analyzed the law concerning the
administration of unwanted treatment here.

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New Medical Futility Cases

I have updated my collection of court and agency cases concerning medical futility disputes.  I have collected all the PDF documents together here.  

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