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Author Archive: Thaddeus Mason Pope

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British Medical Association Issues Report – "End of Life Care and Physician Assisted Dying"

The British Medical  Association has just published a two volume report on end-of-life care.  

BMA calls for UK Governments to prioritize end-of-life care.  New research finds the current provision does not consistently match either the public or doctor's expectations.

The research found that while there were pockets of excellence in end-of-life care across the country, the current system has led to a variation in the level of care between regions, within hospital authority areas, and based on a patient’s condition.  Four areas of concern were raised:

1. Communication

End-of-life care and dying were seen to be a topic which many people found uncomfortable, even to discuss between family and loved ones. Doctors recognised that communication between them, the patient and the family could be critical in making end-of-life easier to understand and accept, but many doctors felt uncomfortable about the prospect of having to give uncertain answers particularly on the timescale of life expectancy. 

During the study, very few doctors claimed to have had adequate training in discussing death and the dying process with patients, with many doctors having to develop these skills ‘on the job’. One doctor said: ‘We should say, ‘You are coming to the end of your life’. I think that is where we are failing patients. We are not preparing them. We are not even mentioning the word… So it all comes as a huge surprise… We should be far more frank.’ 

2. Medical services

Doctors were concerned that the quality of end-of-life care is varied. There was a generally held view that patients dying from cancer received better medical care because of the way cancer services were organised. Doctors also considered that due to a lack of coordination of care, the planning of end-of-life care often comes too late. 

On the whole, the public had low expectations and little knowledge of end-of-life care with one member of the public stating, ‘Reading between the lines, [end-of-life care] is the basic minimum to keep you ticking over until you fall off the great life conveyor belt and you pop your clogs…’ while another commented that there are ‘short staffed services so you’re not going to get what you need.’ 

3,  Location

Concerns were raised about the considerable variation in the quality of end-of-life care in the community, and felt this was reflective of the lack of hospice beds in some areas, alongside poorly resourced and coordinated community services including district nursing. 

One doctor told the researchers: ‘If a person is alone… it’s our experience that they don’t die at home. There isn’t the care to look after them… and tragically, they end up spending the rest of their short life [in hospital].’

4. Coordination

Doctors agreed that for end of life care to meet patient needs, it must be well coordinated, irrespective of whether the patient was in hospital or living in the community. However, co-ordination of care was said to be variable across the country and where it worked less well was where co-ordination was often ‘assumed’ to have taken place. 

One doctor said: ‘Some patients seem to have a very good outcome. If they’ve got into the right sort of system – they have the right cancer, the right specialist nurse that they’ve dealt with, the right access points then they seem to be fast-tracked into the hospice and so on. Other people haven’t had so much good experience, really.’

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CMS Clarifies Deductible and Coinsurance Obligations for Advance Care Planning

CMS has clarified that providers should waive the deductible and the coinsurance for advance care planning only when ACP is furnished as an optional element of an annual wellness visit.  ACP services furnished on the same day and by the same provi...

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Connecticut Nursing Home Fined for Administering Unwanted CPR

The Connecticut Department of Public Health fined Miller Memorial Community’s Edward Pavilion-Caroline Hall for administering unwanted CPR.  (New Haven Register)

The 93-year-old resident and family members had requested a “do not resuscitate” order.  But the order was not entered into the home’s computer system. On June 5, the resident was found without a heartbeat. CPR was performed and the resident was intubated by paramedics and hospitalized on advanced life support, but then died.

I collect other such cases and assess clinician legal duties here.

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Nine to Ninety – Dying with Dignity and Grace

Nine To Ninety (also here) is the love story of Phyllis and Joe Sabatini, who at age 89 and 90 live in the home of their daughter and son-in-law, where they relish time with their young granddaughter Jacqueline.  

Every morning after taking a long list of medications, Phyllis does her calisthenics and goes on a long walk around the Palm Desert neighborhood where she lives with her husband, daughter, and granddaughter. “Grandmom” may only be 4’ 7,’’ but she still stands tall as the head of a close-knit Italian American family struggling to come to terms with the declining health of its aging parents.

Phyllis is facing her last chapter with courage and determination, but her 90-year-old husband Joe seems to have given up; he’s detached and prefers to sleep most of the day. Phyllis loves her family. She especially relishes the time she spends with her granddaughter, Jacqueline. But she sees how much strain taking care of her and Joe is putting on their family.

As she watches her daughter struggle to care for everyone from nine to 90, Phyllis makes a radical decision to move into assisted living. Phyllis Sabatini realizes that leaving home is difficult at any age, but she learns that sometimes, the best way to say “I love you” is to say “goodbye.”

Nine To Ninety Trailer from VERACITY PRODUCTIONS on Vimeo.

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New Jersey Senate Resolution Urging Hospitals to Notify Next of Kin When Patients Lack Capacity

Yesterday, the New Jersey Senate passed Resolution 126.  It urges hospitals to establish protocols for notifying next of kin when treating patients who lack decision-making capacity.

While certainly uncontroversial, it is surprising that such a resolution was thought to be necessary or useful.  Were families not being notified when incapacitated patients were in the hospital?

BE IT RESOLVED by the Senate of the State of New Jersey:

1.    Each general hospital licensed in this State is respectfully urged to establish and implement standards, protocols, and procedures for identifying a patient’s next of kin and notifying them, when appropriate, that the patient has been admitted to the hospital.

2.    Copies of this resolution, as filed with the Secretary of State, shall be transmitted to the Department of Health and to the chief administrator of each general hospital licensed in New Jersey.

Here is the legislative purpose from the Resolution:

WHEREAS, Patients have a fundamental right to make their own determinations as to health care and treatment, including the right to have their preferences respected if they are unable to make their own decisions because they are unconscious, unable to communicate, or have a mental impairment or disability; and

WHEREAS, Although health care providers must respect a patient’s fundamental right to privacy, patients can derive great benefit from the companionship, comfort, and support of their friends and family as they undergo treatment for illness or injury; and

WHEREAS, Accidental injury or sudden illness which leaves a person unable to communicate can cause great anxiety for their loved ones when they do not know what has happened to the person or they find themselves unable to contact the person; and

WHEREAS, Safe and effective treatment depends on obtaining the best possible information as to a patient’s health condition, whether the patient is taking any medications, and whether there are other facts which could impact the provision of health care, particularly in an emergency.  When a patient is incapacitated, the patient’s family may be in the best position to provide this essential information; and

WHEREAS, New Jersey has recognized the importance of carrying out a patient’s fundamental right to control decisions about the patient’s own health care through the enactment of the “New Jersey Advance Directives for Health Care Act” in 1991, the “New Jersey Advance Directives for Mental Health Care Act” in 2005, and the “Physician Orders for Life-Sustaining Treatment Act” in 2011; and

WHEREAS, When a patient is incapacitated or unresponsive, a family member may be in the best position to know whether the patient has executed an advance directive or a Physician Order for Life-Sustaining Treatment (POLST) form, or the details of the patient’s health care preferences in the absence of such documents; and

WHEREAS, Ensuring that hospitals, and emergency departments in particular, establish standards and protocols for contacting an incapacitated patient’s next of kin is an essential step in protecting the rights of patients to make their own health care decisions, ensuring that a patient’s loved ones are informed as expeditiously as possible when an incapacitated patient is admitted for treatment, and providing patients with safe and effective treatment appropriate to their health condition; now, therefore,

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New Texas Case Alleges Hospital Noncompliance with TADA

The Dunn case challenges the very constitutionality of the Texas Advance Directives Act.   Another Texas case, filed last month (Agoucha-Ohakweh v. Baylor College of Medicine), alleges that the hospital failed to even comply with the statutory pr...

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Focus on Technology Distracts from Impending Death [EOL in Art 195]

This 1932 work by Peter Blume is called "Light of the World."  It is an allegorical critique of modernity and the unquestioning embrace of progress.  The four figures are transfixed by the bright light of a fantastical lamp whose brilliance c...

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Medically Inappropriate or Futile Treatment: Deliberation and Justification

New in the Journal of Medicine & Philosophy:  "Medically Inappropriate or Futile Treatment: Deliberation and Justification."  

Cheryl J. Misak, Douglas B. White and Robert D. Truog reframe the futility debate.  They move away from the question: “Who decides when to end what is considered to be a medically inappropriate or futile treatment?”  

Instead, they move toward the question:  “How can society make policy that will best account for the multitude of values and conflicts involved in such decision-making?” 

The authors offer a pragmatist moral epistemology that provides us with 
(1) a clear justification of why it is important to take best standards, norms, and physician judgment seriously and 
(2) a clear justification of why ample opportunity must be made for patients, families, and society to challenge those standards and norms.

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Jahi McMath Family Can Prove She Is Now Alive

Today was the hearing on the defendants' demurrer to the McMath family's first amended complaint.  Judge Freedman issued a tentative ruling about an hour before the hearing.   This tentative ruling like Judge Freedman's ruling on the de...

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Surgeons Refuse to Treat Addicts

Cardiac surgeons are seeing a 50 percent increase in ineffective valvular heart disorders attributed to the use of dirty needles. The cost is staggering: more than $500,000 for the procedure and hospital stay for an uninsured addict, many of whom are b...

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