by Phoebe Friesen, Lisa Kearns, Barbara Redman, and Arthur L. Caplan
Emily Caldes and Jennifer McCormick make several excellent points in their blog post “Rethinking the Belmont Report? Yes!” We appreciate the response to our target article, and generally agree with their comments.
The authors point to an important distinction between the territory covered by the definition of research and the territory covered by research oversight. They rightly observe that, while we tend to conflate the definition of research with where oversight belongs in our article, these two can and perhaps should come apart. As per Caldes and McCormick’s suggestion, we are open to the possibility of retaining the definitions of research and practice offered in the Belmont Report and improving the system of research oversight by other means, although by which other means is a question that remains to be answered.…
The application process for the council is currently open and the Commissioner of Health will be reviewing and appointing 18 members. These members will mostly have experience working with people with serious or chronic conditions, and their families.
Council membership will include:
Two Registered Nurses
One Care coordinator
One Spiritual counselor
Three licensed health professionals who are neither physicians or nurses
One licensed social worker
Four patients or personal caregivers
One health plan company representative
One Physician Assistant
Two members from any of the above categories
For further information, detailed descriptions for each type of member or to apply for a seat on this council, please go to the Board/Commission Palliative Care Advisory Council page on the Secretary of State’s website. Applications will be accepted until positions are filled.
Council membership must include health professionals who have palliative care work experience or expertise in palliative care delivery models. This experience can come from a variety of inpatient, outpatient and community settings including: acute care, long-term care or hospice with a variety of patients, including pediatric, youth and adult.
Members will serve a term of three years and may be reappointed. The council will meet at least twice yearly. There is no per diem or payment for members.
By law, the Council must do the following activities; however, they have the flexibility to decide on other projects. By Feb 15 of each year, the council will submit to the appropriate legislative body:
- An assessment of the availability of palliative care in the State of Minnesota.
- Analysis of barriers to greater access to palliative care.
- Recommendations for legislative action with draft legislation to implement the recommendations.
One of the agenda items is "strengthening patient protections relating to do-not-resuscitate orders." Already four bills have been introduced.
HB 152, like many bills over the past decade, would amend TADA by eliminating the 10 day transfer period. The amendment would require continued treatment until transfer.
The other three bills are identical. Among other things, HB 12, HB 43, and SB 11 would require patient or surrogate consent for DNR orders unless all three of the following are satisfied:
- It is not contrary to the directions of a patient who was competent at the time the patient conveyed the directions.
- The patient ’s death is imminent, regardless of the provision of cardiopulmonary resuscitation.
- The DNR order is medically appropriate.
This is important, because "once the family has expressed a choice, it is much harder to talk them out of it an the process becomes contentious rather than shared." Small tweaks to the words we use can make a big difference.
"Family meetings in the ICU aim to facilitate preference sensitive treatment decisions through shared decision making. To elicit information about patient preferences the Society of Critical Care Medicine endorses questions like 'what would she want?'"
"However use of the word 'want' may be particularly problematic as it encourages surrogates to express desires that are not grounded in the clinical context. Although it is common practice to ask what a patient might want, this question can lead to worse decision making and less exchange of information about patient’s values."
"Attention to word choice is important. To improve surrogate decision making, clinicians should ask family members what their loved one might say or think about the patient’s health state."