End-of-Life Matters: Cultural Representations through the Entertainment Arts

The 2012 National Academies of Sciences Rosenthal Lecture will be on December 12.  It will focus on how the language of the entertainment arts informs our cultural understanding of end-of-life care. 

Through the screening of clips from the film Beginners and television medical dramas, and a live theatrical performance reading from Sophocles’ Philoctetes, the Rosenthal Lecture panelists will explore the various ways the entertainment arts can provide a platform for an engaging and compelling conversation about end-of-life. The panel will approach the conversation through the lens of the patient, the family, the provider, and the community.

Moderator

• Neal Baer, M.D., Executive Producer, CBS Television; Clinical Professor of Preventive Medicine, University of Southern California

Panelists

• Jay Clayton, Ph.D., Professor and Director, Curb Center for Art, Enterprise and Public Policy, Vanderbilt University


• Bryan Doerries, Artistic Director, Outside the Wire


• Kathy Foley, M.D., Professor of Neurology, Weill Medical College of Cornell University; Medical Director, International Palliative Care Initiative, Open Society Foundation

Closing Remarks

• Harvey V. Fineberg, M.D., Ph.D., President, Institute of Medicine

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Minnesota v. Smith: Does Advance Directive Break Chain of Causation?

The Minnesota Supreme Court has agreed to hear a drunken driver's claim that he was not responsible for the death of a
93-year-old woman killed in a 2010 crash because her
"do-not-resuscitate" order kept her from potentially life-saving medical
care.



Eddie Cortez Smith, 34, was convicted by a Ramsey County District
Court jury in June 2011 of criminal vehicular homicide in the death of
Edith Schouveller of St. Paul on March 28, 2010. He was sentenced to 10
years in prison, the maximum term allowed by state law.  His conviction was affirmed by the Minnesota Court of Appeals in
September.



The case turns on the argument that Schouveller's advance directive with the do-not-resuscitate order was a "superseding event." When she developed pneumonia, doctors determined she needed a small tube inserted into her lungs to
aid her breathing. But court documents show she only wanted antibiotics,
and no breathing tube if it did not restore her to her preferred
quality of life.  She died 13 days after the crash. At trial, one of her doctors said
Shouveller might have lived with a breathing tube.  (Star Tribune)



Things do not look good for Smith.  Criminal defendants regularly make this causation argument.  And they regularly lose.

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Role of Minnesota Guardians in End of Life Decision-Making

Join us for breakfast and CLE on Friday, December 21 for "The Role of Guardians in End of Life Decision-Making: Reflections on the Tschumy Decision and its Implications for Guardians and Health Care Providers."  The expert panel will be

• The Honorable Jay Quam, Hennepin County District Court


• Rebecca Egge Moos, Bassford Remele


• Robert McLeod, Lindquist & Vennum PLLP


• Charles W. Singer, Attorney at Law  

Guardians play extremely important roles within our legal system, and are granted wide ranging authority under Minnesota law, including the legal authority to provide or withhold consent for medical care for an individual under guardianship. How far should this authority extend? 



The important question of whether a guardian’s authority extends to end-of-life decisions was recently considered in In re the Guardianship of Tschumy, where the court held that a guardian does not have the power to make a decision to terminate life support. The decision, which is now on appeal, presents important and difficult questions for attorneys, guardians and health care providers alike. 

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Physician Sanctioned for Not Completing End-of-Life Care CME

West Virginia, like New Jersey and many other states, requires that physicians complete a certain number of CME credits in end-of-life care.  The West Virginia Board of Medicine recently sanctioned Michael W. Brown for falsely representing, in 2002, that he had completed this CME requirement.  



Late last month, the Kanawha County Circuit Court reversed and vacated the Board's order.  The Court found that Dr. Brown believed in good faith that his coursework satisfied the then-existing requirements.  Still, it is nice to see this CME requirement is being enforced.

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POLST - DNAR without Consent

I strongly support POLST.  I have been actively engaged with its implementation in both Delaware and Minnesota.  And I am presently preparing a lengthy report to aid the continuing nationwide roll-out.  

But I was surprised to see that some POLST programs and forms explicitly permit unilateral clinician orders.  This form from Vermont, for example, permits the clinician to complete a DNAR order on a patient's POLST without either patient or surrogate consent, in the case of "futility."  

I am not saying that I am necessarily opposed to this development.  Many states have taken the opportunity, when introducing new statutes and regulations authorizing POLST, to fix some other limitations and problems in health care decisions law.  I was simply surprised, because so much of the defense of POLST, in response to attacks from certain Catholic officials, focuses so heavily on its voluntary nature.          

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KCET Show on End-of-Life Medicine

Los Angeles KCET will post a video, today, from last night's broadcast of SoCal Connected.  Three segments are of interest:

• UpFront: One woman makes an end-of-life decision many people dread.


• Your Turn to Care: L.A. Times columnist Steve Lopez reflects with his readers on the hardships of having a parent in decline.


• In the Studio: Dr. Ken Murray, a retired family
  physician, talks to Val about how doctors choose to approach the end of
  life differently than most people.

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Another New Review of Liverpool Care Pathway

The Liverpool Care Pathway has come under intense scrutiny.  Several lawsuits have already been filed over
patients put on the pathway without a proper explanation or their
families being involved.  (BBC News)



Care and Support Minister Norman Lamb said he would appoint an independent chair to report back in the new year.  The new review will pool together data gathered from existing
reviews which are being undertaken by the Association Palliative
Medicine, Dying Matters and the national End of Life Care Strategy.

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