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11/13/2014

Patients and Clinicians Discuss Only 2 of 11 Goals of Care Elements

Studies showing lackluster rates of advance care planning are nothing new.  But this new study in the Canadian Medical Association Journal is particularly disturbing.  





















The authors identified 11 recommended elements of goals-of-care discussions that are the most important to older adults patients in hospital with serious illness and their family members.  They found that these elements are VERY infrequently addressed by health care providers in hospital.
  1. Asked the respondent about preferences for care in event of life-threatening illness
  2. Inquired about the respondent’s values
  3. Discussed prognosis 
  4. Gave an opportunity for the respondent to express fears or concerns
  5. Asked the respondent if they had additional questions about goals of care
  6. Provided information about outcomes, risks, benefits of comfort care
  7. Asked about prior discussions or written documents
  8. Offered a time to meet to discuss goals of care
  9. Provided information about outcomes, risks, benefits of life sustaining treatments
  10. Provided information to review about advance care planning before discussions
  11. Helped access legal documents to record advance care plans

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

11/12/2014

Wisdom Does Come with Age

<p style="line-height: 19.0400009155273px;">Reminders of our finitude always lurk close by, like <a href="http://www.theatlantic.com/features/archive/2014/09/why-i-hope-to-die-at-75/379329/">Ezekiel Emanuel's</a> article in last month's Atlantic, "Why I Hope to Die at 75." The head of the <a href="http://bioethics.nih.gov/about/">Clinical Bioethics Department</a> at the National Institutes of Health gives reasons for not living beyond 75: inevitable decline, disability, incapacity, and diminishment of "creativity, originality, and productivity." According to Emanuel, we wish to be remembered for our good years, prior to decline.</p> <p style="line-height: 19.0400009155273px;"><span style="line-height: 19.0400009155273px;">There are grains of truth here. Many of us "die" well before we are officially declared dead. I've seen patients kept alive for far too long in permanent vegetative states, while family dynamics, emotions, finances and scarce medical resources are depleted. We pay a high price for medical "progress." I also know thriving, vibrant elderly, themselves significantly disabled and incapacitated.</span></p> <p style="line-height: 19.0400009155273px;"><strong style="line-height: 19.0400009155273px; color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px;">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="text-decoration: underline; color: #000099;" href="http://www.amc.edu/Academic/bioethics/index.cfm">website</a>.</strong></p>

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This entry was posted in End of Life Care, Health Care and tagged , . Posted by Hayley Dittus-Doria. Bookmark the permalink.

11/12/2014

A Look at How M.D. Anderson Cancer Center Uses Bioethics Educational Materials

The Presidential Commission for the Study of Bioethical Issues (Bioethics Commission) loves hearing from educators who use our pedagogical materials in traditional and nontraditional settings. As a part of its initiative to promote and enhance bioethics education, the Bioethics Commission has produced a library of educational materials to accompany its reports. The Commission aims to […]

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This entry was posted in Health Care and tagged , , , . Posted by Alannah Kittle. Bookmark the permalink.

11/12/2014

Why the right to die movement needed Brittany Maynard

by Keisha Ray, Ph.D.

Brittany Maynard was diagnosed with brain cancer. At the age of 29 she decided to end her own life and “die with dignity” under Oregon’s “Death with Dignity Act.” There have been many articles written in support of Maynard’s choice and many articles written condemning her choice to die. The right to die movement has many hurdles that it must overcome to draw in more supporters and hopefully influence public policy. Some of those hurdles include misconceptions about the kinds of people that want to end their lives and why people who have been diagnosed with terminal illness want to have the choice to take their own lives.…

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This entry was posted in End of Life Care, Featured Posts and tagged , , . Posted by Keisha Ray. Bookmark the permalink.

11/12/2014

Outpatient Spending Is Catching Up To Hospital Expenditures

For decades now, policymakers have been trying to slow down the growth of healthcare costs. For much of this time, a large part of that effort was directed at hospital spending. American hospitals are extremely expensive, and take care of … Continue reading

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11/12/2014

Susan Tolle Wins MacLean Center Prize in Clinical Ethics for Work on POLST

The 2014 MacLean Center Prize in Clinical Ethics, an award of $50,000, will be presented to Susan Tolle, MD, who has pioneered efforts to improve communication between health care providers and patients regarding end-of-life care.

Tolle will receive the MacLean Prize, the largest award in the clinical medical ethics field, during the 26th annual Dorothy J. MacLean Fellows Conference on ethics in medicine. The conference will be held at the University of Chicago Law School, on Friday and Saturday, Nov. 14 and 15.

“Dr. Susan Tolle’s dedication, scholarship and hard work to ensure that patient’s wishes are honored at the end of life has transformed the care of dying patients in the U.S.,” said Mark Siegler, MD, Lindy Bergman Distinguished Service Professor of Medicine and Surgery and director of the MacLean Center. “I’m very proud of how Dr. Tolle continues to improve patient care and advance the field of clinical medical ethics.”

Tolle, a professor of medicine in the Oregon Health & Science University School of Medicine and director of the OHSU Center for Ethics in Health Care, is one of the founders of the Physician Orders for Life-Sustaining Treatment (POLST) movement in Oregon in the early 1990s. In a specific subset of patients — those with advanced illness or frailty — Tolle and others found that advanced directives were insufficient to safeguard patients’ wishes about how they wanted to be treated in life-threatening situations. By contrast, POLST orders work to allow patients to receive the level of care they want in the setting they want.

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

11/12/2014

UK Hospital Places DNR Order without Consent or Consultation

Leon Scoble and his sister Danni say that Basildon University Hospital put a “do not resuscitate” order on their father Paul Scoble without consulting them. (Echo)

On a Facebook page the family states:

"The doctors have twice put a Do Not Resuscitate on our Dad, we managed to get it lifted the first time but doctors refuse to lift it now their reason for this is due to a faulty heart valve." 

"He needs an operation on his heart to fix two faulty valves but the hospital have refused due to his size. We have heard about TAVI Mitral valve surgery by Dr Vinayak Bapat at St Thomas' Hospital in London and men much bigger than Dad have survived this operation."

"All we ask is that our Dad is given a chance at life, if he doesn't get this operation he will die. His situation has become pretty desperate over the last couple of weeks, he has been having panic attacks brought on by hearing doctors discussing switching off the machine. As you can imagine, he's terrified and so are we."

"The doctors have met and decided he is to receive no more treatment, even though the drugs being given are damaging to the kidneys, should a problem arise they have already stated that they will take no action."

"They tell us we cannot move our father to another hospital, as he is from Harlow."

"We want our Dad moved to a hospital that has the capability and desire to save his life (preferably St Thomas') He's a 48 year old father of two, who hasn't yet walked his only daughter down the aisle or held a first grandchild. He isn't a statistic, he's our world, so much more than just a father and we refuse to give up on him because he's never given up on us."

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

11/11/2014

Dying and Dignity

On November 1st, Brittany Maynard, a 29 year-old Oregonian with an incurable brain tumor, took her own life using a medication prescribed by a physician specifically for this purpose. The medication, legal under the Oregon’s Death With Dignity Act, was prescribed weeks earlier. The case is well-known because Brittany became a spokesperson for efforts to expand “assisted suicide” laws to other states. Through her own... // Read More »

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This entry was posted in Health Care and tagged , , , , . Posted by Tom Garigan. Bookmark the permalink.

11/11/2014

A Park Bench That Tells You You’re Fat?

Clearly we in the United States are not taking the obesity epidemic as seriously as the Russian government. We debate whether it is appropriate for the government to require restaurants to inform their customers about how many calories they are … Continue reading

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11/11/2014

Making a Case for Case Studies

<p class="MsoNormal" style="line-height: 19.0400009155273px;"><span style="line-height: 19.0400009155273px;">In Peter D. Kramer’s New York Times piece published in the ‘Couch’ section on October 18, 2014 (</span><a style="line-height: 19.0400009155273px;" href="http://opinionator.blogs.nytimes.com/2014/10/18/why-doctors-need-stories/">Why Doctors Need Stories</a><span style="line-height: 19.0400009155273px;">) he affirms the experience of learners, educators, and researchers in his arguments that a case vignette can provide a kind of instruction that cannot be duplicated by data collection alone. While we do still need evidence based material to assure safety and efficacy of treatments, the case study offers contextual material that makes the evidence come to life.</span></p> <p class="MsoNormal" style="line-height: 19.0400009155273px;">As a Clinical Ethicist each clinical encounter is rich with substantive information that is part of an individual or family story intersecting with the healthcare setting. When invited to provide input, support, or recommendations in any given case, the most informative elements of any case are the story of the patient. What was before, what is now, and what the future may require is different for each patient, and I am often awed by the ‘before.’ The contextual landscape of each story is often where we come to understand the psychosocial factors that weigh heavily in how a patient, family, or community interacts with the healthcare community. Hard data is not as useful as hearing the story that belongs to the patient.</p> <p class="MsoNormal" style="line-height: 19.0400009155273px;"><strong style="line-height: 19.0400009155273px; color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px;">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="text-decoration: underline; color: #000099;" href="/Academic/bioethics/index.cfm">website</a>.</strong></p>

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This entry was posted in Clinical Ethics, Health Care and tagged , . Posted by Hayley Dittus-Doria. Bookmark the permalink.