Blog RSS Blog.

06/30/2015

Professionalism in Medicine: I Know it When I See it

by Jennifer Chevinsky, BS

A medical student comes into the hospital wearing his favorite pair of old, ripped, dirty jeans.

A physician ‘pimps’ a medical student and publicly shames her when she doesn’t know the answer.

A nurse tells the patient that he really does not like working with the case manager on the medical service.

A resident presents her patient to the attending, including a complete physical exam that she did not perform.

In recent years, increased focus has been placed on the concept of professionalism in medicine by the Association of American Medical Colleges (AAMC), Liaison Committee for Medical Education (LCME), Accreditation Council of Graduate Medical Education (ACGME), and Accreditation Council of Continuing Medical Education (ACCME).…

Full Article

This entry was posted in Featured Posts and tagged , , . Posted by Jennifer Chevinsky. Bookmark the permalink.

06/30/2015

Vanitas [EOL in Art 51]

Vanitas (by Peter Claesz) means "emptiness" - the meaninglessness of earthly life and the transient nature of vanity.

Full Article

This entry was posted in Health Care and tagged , . Posted by Thaddeus Mason Pope. Bookmark the permalink.

06/30/2015

Estate Planning In the 21st Century: Seismic Shifts and Predictions for the Future – CFP

Estate Planning in the 21st Century:  Seismic Shifts and Predictions for the Future The American College of Trust and Estate Counsel (ACTEC Law Journal) announces a Call For Papers on the following topics:   Estate planning has radical...

Full Article

This entry was posted in Health Care and tagged , . Posted by Thaddeus Mason Pope. Bookmark the permalink.

06/30/2015

Ethical Issues at the End of Life – CFP

The Journal of Social Work in End-of-Life & Palliative Care has a CFP for a special thematic issue on ethical issues at the end of life.

Full Article

This entry was posted in Health Care and tagged , . Posted by Thaddeus Mason Pope. Bookmark the permalink.

06/29/2015

Jahi McMath – Children’s Hospital Demurrer

Following last week's demurrer by Defendant Rosen, this week, Children's Hospital Oakland filed its own demurrer in the medical malpractice action filed by the family of Jahi McMath.   Almost the entire brief is devoted to the question of her sta...

Full Article

This entry was posted in Health Care and tagged , . Posted by Thaddeus Mason Pope. Bookmark the permalink.

06/29/2015

Judge Strikes California Law that Allowed Nursing Homes to Make Medical Decisions for Unbefriended Residents

I just updated my prior articles on decision making for adult orphans, unbefriended, unrepresented patients without surrogates (forthcoming 26(2) J Clinical Ethics).  And then this.

A California law allowing nursing homes to make medical decisions on behalf of certain mentally incompetent residents is unconstitutional, a state court ruled this week.

The law, which has been in effect more than 20 years, gave nursing homes authority to decide residents’ medical treatment if a doctor determined they were unable to do so and they had no one to represent them.

Alameda County Superior Court Judge Evelio M. Grillo wrote in the June 24 decision that the law violates patients’ due process rights because it doesn’t require nursing homes to notify patients they have been deemed incapacitated or to give them the chance to object.

Grillo acknowledged the decision is likely to “create problems” in how nursing home operate but wrote that patients’ rights are more compelling.

“The stakes are simply too high to hold otherwise,” the judge wrote. Any error could deprive patients of their rights to make medical decisions that “may result in significant consequences, including death.”

The medical decisions on incapacitated residents without representatives are made by a team that includes a physician and a nurse.

The fact that nursing homes are making end-of-life decisions without patient input is a big concern, according to the ruling. The decision cited one nursing home resident who was found to be mentally incapacitated and who had no representative. The facility staff made a decision to take him off life-sustaining treatment and he passed away in 2013.

The ruling came after the California Advocates for Nursing Home Reform, an advocacy group, filed a lawsuit in 2013 against the state Department of Public Health. The suit alleged that nursing homes used the law to administer anti-psychotic drugs, place residents in physical restraints and deny patients life-sustaining treatment.

Tony Chicotel, a staff attorney for the group, said the ruling will dramatically impact the lives of the most vulnerable nursing home residents.

“What [nursing homes] used to do was routinely make decisions big and small for their residents without really any regard to due process,” Chicotel said. “Now the residents are finally going to have their rights acknowledged and honored.”

Even patients who are compromised should still have a say in their medical care, he added.

“They have been ignored,” he said. “Unrepresented residents and the way they are treated in nursing homes has never been a priority of the Department of Public Health.”

The department is reviewing the decision, a spokesman said. Department officials declined to comment further or say whether they planned to appeal.

The law was enacted in 1992 because nursing facilities needed a way to give medical treatment to their incapacitated residents without having to wait up to six months for state approval, according to the ruling.

But the decision could make it challenging for nursing homes to provide routine medical care or to offer hospice care to residents who lack the mental capacity to make their own decisions and have no designated representatives, said Mark Reagan, an attorney representing the trade group, California Association of Health Facilities, which is not part of the lawsuit.

“If the person objects, then what?” Reagan said. “That can put patients and facilities in a difficult place.”

And seeking court approval to provide anti-psychotic medication to residents who truly need it would be costly and time-consuming for nursing facilities, he said. “How do you keep that person safe and how do you keep the other residents of the skilled nursing facility safe?” he said.

Reagan believes the ruling could have an unanticipated outcome: Patients without decision-makers could have a hard time finding a nursing facility willing to take them.

“If this decision makes it more difficult to supply necessary care at the bedside, this population is going to be less served,” he said.

The judge, however, wrote that informing patients and allowing them to object is not likely to result in any significant burdens on nursing homes.

Golden Gate University Law School Professor Mort Cohen, who filed the case, said the next step is for the judge to issue an order directing the state Department of Public Health, which oversees nursing homes statewide. The state could ask the court for a stay or could appeal the decision, but Cohen said he expects the decision to stick.

[From Kaiser Health News (KHN), a nonprofit national health policy news service.]

Full Article

This entry was posted in Health Care and tagged , . Posted by Thaddeus Mason Pope. Bookmark the permalink.

06/29/2015

iPhone App Will Track Sexual Activity and Reproduction

<div style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">Apple recently announced that they will update their health app, HealthKit, to include reproductive health. Many were critical of the original app because although it can track a wide range of health indicators, such as BMI, sleep, sodium intake, number of falls, etc., it neglected reproductive health. Specifically, <a href="http://fusion.net/story/100781/apple-ios-update-new-version-of-healthkit-still-doesnt-track-periods/">it is problematic</a> that the app includes some obscure health indicators, like selenium intake, but not menstrual cycle, which affects half of the population. While there are other apps that are specifically geared toward women's reproductive health, it is troubling that an iPhone app that comes standard with the phone would exclude something so central to women's health as menstruation. Some believe that the omission of reproductive health from HealthKit is due to the fact that the tech world, including Apple, is dominated by men.  </div> <div style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;"><br /></div> <div style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">The new the updated app is a huge improvement because it includes a variety of reproductive health indicators like menstruation, basal body temperature, and spotting. The broad range of reproductive health indicators helps women keep track of their reproductive health in general and specifically for women looking to prevent pregnancy and for women looking to achieve pregnancy. This is an important addition because too often reproductive health is overlooked or not considered part of "real" healthcare. The addition of the reproductive health category in HealthKit technology not only acknowledges the reproductive health issues specific to many women, but also normalizes them.</div> <p><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 19.0400009155273px;">The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our <a style="color: #000099; text-decoration: underline;" href="http://www.amc.edu/Academic/bioethics/index.cfm">website</a>.</strong></p>

Full Article

06/29/2015

Relics – Film on Assisted Death [EOL in Art 50]

Relics is a 15-minute film about a salesman who tries to sell his miraculous cleaning machine to a sick woman and her skeptical daughter, on the day that the woman asked her daughter to help her end her own life. It's a comedy! Sort of... Relics scree...

Full Article

This entry was posted in Health Care and tagged , . Posted by Thaddeus Mason Pope. Bookmark the permalink.

06/29/2015

Support Informing Bioethics Policy

This week, I added a Paypal donation button to my website to help cover cost, such as obtaining court documents from PACER and state court websites.  I want to thank the first four individuals (L.I., S.D., S.C., and T.P.) who donated.

Full Article

This entry was posted in Health Care and tagged , . Posted by Thaddeus Mason Pope. Bookmark the permalink.

06/28/2015

Heartfelt – Photography of Troubled Births [EOL in Art 49]

Heartfelt is a volunteer organisation of professional photographers from all over Australia dedicated to giving the gift of photographic memories to families that have experienced stillbirths, premature births, or have children with serious and termina...

Full Article

This entry was posted in Health Care and tagged , . Posted by Thaddeus Mason Pope. Bookmark the permalink.