Delighted to see this article title in the Guardian: "Increase in Number of People Dying in the Place of their Choice."
A report released, today, from Public Health England, shows that about 24,000 more people died at home or in care homes rather than hospital in England in 2012 than they did four years before, reflecting the wishes of more people in their last year of life.
As the Dartmouth Atlas has repeatedly demonstrated in the United States, there are large variations in the proportion of deaths in hospital. People are least likely to be in hospital at the end of their lives in Cambridge – 37.9% – and most likely to die in hospital in Waltham Forest, north-east London, where the figure is 69.1%.
"I have often thought it would be important to instruct physicians how to behave in cases of incurable disease: not so much to tell them what to do; rather what not to do."
Letter from Johann Stieglitz to Karl F.H. Marx (15 December 1826).
"Call for Taking Brain Dead off Life Support" - This provocatively titled article appeared in the Saudi Gazette.
Fortunately, there is no need for such a "call" in the United States. However, there is a louder and louder U.S. "call" for taking the permanently unconscious off life support. Across the United States, many institutional and regional policies now define interventions for the permanently unconscious as "non-beneficial" treatment than may be unilaterally refused after some internal due process.
The Saudis are concerned with the cost of taking care of over 1000 brain dead patients each year. And they are concerned with depriving other patients in need of intensive care of beds. Those concerns are driving U.S. healthcare providers to "call" for taking the permanently unconscious off life support irrespective of those patients' preferences to have life support.
Southern California Kaiser Permanente bioethicists Craig Nelson and Blanca Nazareth published a nice review of three years of experience with their futility policy.
Consistent with other published studies (e.g. Predergast; Garros), the rate of intractability is just 5% (5 of 92 cases).
"Your Care, Your Choice - Liberty at the End of Life" is an education forum presented by a broad legal, medical, social service, and faith-based leadership group who has come together to implement a new Delaware Medical Orders for Scope of Treatment (DMOST) plan for Delawareans to use at the end of life.
10:30 -10:50 am
Welcome, Program Overview
Susan DelPesco, JD (Superior Court Judge (retired), Wilmington, DE)
10:50 am - 11:45 am
Developing a Successful State MOST Program: Advice from the Field
David Barile, MD (Executive Director of New Jersey goals of Care, and Medical Director of Acute Care for the Elderly and of Palliative Medicine Services at the University of Princeton Princeton, NJ)
11:45 am- 12:30 pm
Evolution of Advance Directives up to POLST (Physician Orders for Life Sustaining Treatment, and the Need for DMOST
Charles Sabatino, JD (Director, ABA Commission on Law and Aging, Washington, DC)
12:30 -1:15 pm
LUNCH (provided)
1:15 - 2:00 pm
Ethical Considerations, the Key Elements of an End-of-Life Medical Order, Explaining the need for DMOST in Delaware, including stories from Christiana Care and SNF's.
John Goodill, MD (Chief of Christiana Care Health System's Pain and Palliative Care Section, Newark, DE)
2:00 -2:10 pm
BREAK
2:15 -3:00 pm
The Progress of POLST Programs Across the Nation, Litigation Arising From Failure to Respect Patients' Rights
Thaddeus Pope, JD, PhD (Director of the Health Law Institute at Hamline University Minneapolis, MN)
3:00—4:00 pm
DMOST - the Proposed Statute
Susan DelPesco, JD, (Superior Court Judge (retired), Wilmington, DE)
What are the final weeks, days and very moments of life really like? A new Showtime documentary, TIME OF DEATH, offers an unflinching, intimate look at remarkable people facing their own mortality. Cameras follow these brave, terminally ill individuals as they live out the end of their lives, supported by family, friends, and dedicated healthcare and hospice workers who gently guide the process.
A patient in a seemingly vegetative state, unable to move or speak, showed signs of attentive awareness. The patient was able to focus on words signaled by the experimenters as auditory targets just as successfully as healthy individuals.
The lead author explained that the team found both the patient had the ability to pay attention as well as independent evidence of their ability to follow commands. "In order to try and assess the true level of brain function and awareness that survives in the vegetative and minimally conscious states, we are progressively building up a fuller picture of the sensory, perceptual and cognitive abilities in patients. This study has added a key piece to that puzzle, and provided a tremendous amount of insight into the ability of these patients to pay attention."
Delighted to see this article title in the Guardian: "Increase in Number of People Dying in the Place of their Choice." 
