7:00 Registration opens – complimentary Continental Breakfast & Exhibits
9:00 Welcome and Introduction: keynote speaker – Thaddeus Pope, JD, PhD.
Voluntary Stopping Eating and Drinking (VSED) – it’s special place in our American culture, ethics, and law as regards End-of-Life Decision-Making.
10:00 Survey of end-of-life choices: North America versus Western Europe.
10:40 Breakout Presentations: in-depth exploration, discussion & Q&A
Morning Theme: For the Hospice-eligible patient seeking VSED nursing support: the ethical, legal, clinical issues for the patient & family caregiver
10:40-11:50 John Moskop, PhD – Medical Bioethicist
Ethical issues– in simpler case – alternative strategies: How might the patient and family approach the ethical issues about early onset of death with the choice of VSED?
10:40-11:50 Mark Corbett, MD – Hospice Physician
Clinical issues– in simpler case – is it generally expected with Hospice nurse support that a family caregiver can manage pain, discomforts, hygiene with VSED?
10:40-11:50 Kevin Diaz, JD – Legal Advocate
Legal issues – various EOL legal and medical documents (ACD, HCPOA, MOST, competency exam) to perfectly or usually avoid legal controversy with VSED?
10:40-11:50 Office of the Medical Examiner
Law enforcement issues – VSED: competence, coercion, elder abuse? How and when these issues come into focus for the Medical Examiner?
Noon – complimentary Lunch served on the mezzanine
1:00-4:00 Plenary session – 3 presenters – then moderated panel discussion & Q&A
Afternoon Theme: For the UNCERTAIN case and the COMPLICATED case
Case 2: with clinically uncertain “imminent-death” – what are the obstacles to a patient choosing to start VSED? The practical alternatives to provide medical/nursing support.
Case 3: with complicated questions of patient consent, mental capacity, possible coercive influence – what are the obstacles to surrogate decision-making for VSED?
1:40-2:10 Mark Corbett, MD – case 2: challenges and clinical alternatives when a competent patient chooses VSED before imminent-death.
2:10-2:40 John Moskop, PhD – case 2/3: ethical challenges in decision-making situations such as before imminent-death or absent cognitive competence.
2:40-3:10 Thaddeus Pope, JD, PhD – case 2/3: without imminent-death or without competence – what is the surrogate decision-maker to do? how compelling is the patient’s earlier ACD affirmation, other forms/media to show intention – now that years later they can not decide? Can their surrogate rely upon it? Would the court be persuaded by it?
3:25 Panel Discussion and Audience Q&A – Moderator Rosemarie Tong, PhD
4:00 Conference closing Thanks – sponsors! evaluations & feedback.
Davidson College campus – public is invited free-of-charge – Davidson NC
6:30-8:00 Thaddeus Pope, JD, PhD
Withholding Food & Fluids in Advanced Dementia – is it ethical and legal?
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In a quest for health news which might spark some meaningful topic worth sharing with the Bioethics community, I was repeatedly dismayed at the number of articles offering relatively little useful information at all. In fact, there seemed to be a surprising number of articles that offer scientific support for topics that might be tempting for a superficial glance, but do not add meaningfully to the much broader well-being of individuals and communities. I strongly support using any tools necessary to disseminate health information to persons who may benefit from evidence based health information, but the focus of this effort ought to address more meaningful goals of medicine and human welfare.
An article published in Substance Use and Misuse points out that of the over 15,000 individuals there was no significant relationship between alcohol consumption and physical activity (PA) study link. This article offers common sense health advice for future efforts: “Prevention programs to increase PA levels from low to moderate combined with a reduction of alcohol intake in men who regularly drink alcohol should be considered.” This conclusion is based on the finding that persons who drink heavily also have lower physical activity levels. Hardly seems groundbreaking. Yet, if there had been a correlation suggesting that heavy drinkers are also quite physically active, what would this offer as a useful nugget of health information? Don’t worry about heavy alcohol consumption?
Studying the long term effect of wearing high heel shoes has also gained attention in the media and academic literature. Though, in fairness, I suppose someone has to study it so we can provide evidence based practice considerations to persons who develop foot or ankle problems, or are required to wear high heels as part of a work uniform. “One condition known to compound the difficulty of walking is the use of high heeled shoes.” study link #2. I believe all who have worn high heels are likely to agree on this point. The piece does offer some considerations about blood flow to the lower extremities, which could be helpful to physicians treating patients with high heeled related ambulatory difficulties, so a relevant factor in advising patients. Nonetheless, it seems a bit startling that such research is surfacing in the media to answer this question for consumers. A recent New York Times blog (blogs.nytimes.com/2015/06/17) titled “Reducing the frequency of wearing high-heeled shoes and increasing ankle strength can prevent ankle injury in women” leads off with a critique of having a character run from Jurassic dinosaurs while she is wearing high heels, and offers evidence for negative effects of long term high heeled shoe wearing. Just in case there was any doubt, the article concludes with sound advice for not wearing high heels as the footwear of choice if escaping a fast moving deadly animal.
Media is a powerful too, and so is scientific inquiry. I believe the public can digest more meaningful discussions of health related matters than those which confirm common sense.
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 website.