Sixth International Symposium on Brain Death

The VI International Symposium on Brain Death and Disorders of Consciousness will be held in Havana, Cuba, on December 1-4, 2015. Details here.

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VSED: Real Alternative to Aid in Dying

Those calling for the legalization of aid-in-dying often highlight the necessity and importance of legalizationthrough denigrating alternative ways to hasten death.  A particularly favorite target is VSED (voluntarily stopping eating and drinking).

In the Telegraph, this week, Bruce Fogle writes about his mother
Aileen and her decision to die in Ontario.  “You won’t give me anything so I have decided to stop eating and drinking. What do you think?”  Since assisted dying was not yet legal, Fogle laments that his mother had no option but to starve herself. 

"Mum was telling me she had decided to die. This time, she was only just
ahead of her time. Thanks to that Canadian Supreme Court ruling, people in her
circumstances will now be able to do so, painlessly, of their own free will,
simply by asking for and taking pills, without putting themselves or their
families through a needlessly protracted and inevitably uncomfortable end of
life. But mum did not have that luxury. Her only option was to refuse food."

Oddly though, Fogle's own description of his mother's VSED is neither "needlessly protracted" nor "inevitably uncomfortable."  Indeed, reported studies of VSED show that it is a safe and comfortable "exit option."

I do not mean to suggest that aid-in-dying is unnecessary.  Some individuals may prefer that exit option.  And AID has a far longer track record of proven safety and effectiveness.  

But even in Oregon, where both options are available, many choose VSED.  It is important to have an option that accord with one's own  preferences and values.  Many may prefer AID over VSED.  But VSED is hardly the abhorrent option that many depict it to be.

  

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Life support wards reviewed to "kick out the bludgers"

The Department of Social Services has launched a
blueprint to "stop hospital patients from bludging on life support."  

Australian satire.  But the column could have almost been a news
story.

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Schizophrenic with Gangrenous Leg Allowed to Refuse Amputation

Even today, two of the best U.S. cases for illustrating the principles of patient decision making capacity are almost 40 years old: Lane v. Candura (Mass. 1978) and DHS v. Northern (Tenn. 1978).  

Both cases concern women with gangrenous feet who refuse life-saving amputation.  The stakes are the same in both cases.  But one only woman really understands her clinical situation.  Her decision was honored.

A recent case from the UK also concerns a woman with gangrenous feet who refused amputation.  The court's reasoning is a good review and application both of decision making capacity and of the right to refuse treatment.

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McMath Family Sues Oakland Children's Hospital; Alleges Jahi is Alive

The case of Jahi McMath is infamous around the world for the remarkable claim that she is no longer dead.  



In December 2013, federal and state courts in California determined that Jahi was legally dead.  While the courts issued temporary restraining orders to preserve the status quo (continued physiological support) pending their rulings on pending motions, both courts ultimately refused to order the hospital or its clinicians to continue administering medical interventions to Jahi.



Since December 2013, the family has twice indicated that it would seek a re-determination of Jahi's status as dead.  In October 2014, it filed a writ of error corum nobis with the Alameda County Court that heard the case in December 2013.  In 2015, the family indicated that it would ask the California Secretary of State to revoke the death certificate.



This week, the family sued Oakland Children's Hospital, alleging that the negligence of its clinicians caused Jahi's injuries.  The family seeks damages for "medical, nursing, and other related expenses in the future." (Complaint para. 36).  These damages presume that Jahi is alive.  Consequently, it seems that the issue of Jahi's life/death status must be litigated and adjudicated in this medical malpractice action.

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Brain Death & Futility at ICCEC

I blogged about the upcoming ICCEC this weekend.  Here are a few sessions that caught my eye.



Panel - Comparing Israeli and American Experiences: Families’ requests for continued physiologic support of patients deemed dead by neurological criteria -- 

Anne Lederman Flamm, Jonathan Cohen



Do Everything!” – New aspects of a never-ending story -- Kurt W Schmidt



Decision-Making for the Unbefriended Patient: A model approach facilitated by the Ethics Consult Service -- Joan Henriksen Hellyer



Physician Attitudes Toward Proactive, Triggered (Unsolicited) Clinical Ethics Consultation for the Unrepresented Patient -- Barrie J. Huberman



Panel - Worse than Futile: Medically non-beneficial treatment in the setting of complicated grief --  Annette Mendola, Vicki Cannington, Lynnette Osterlund, Caroline Vogel



The deployment of law in the clinical setting: Strategies for hospital ethics committees to address concerns surrounding clinician citation of the law -- Anya Prince

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Left Out: Undocumented Immigrants and the American Health Care System

Hamline University is hosting a compelling CLE event on March 25:  "Left Out: Undocumented Immigrants and the American Health Care System."

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