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02/16/2017

Jahi McMath – Hearing to Unseal 2013 Records

The Alameda County Superior Court is holding a hearing on Thursday afternoon to determine whether to unseal medical records from the 2013 disputes over whether Jahi McMath was brain dead.   Judge Pulido already issued his tentative ruling&nb...

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

02/16/2017

6th International Conference on Advance Care Planning and End of Life Care (ACPEL)

The Covenant Palliative Institute invites you to the 6th International Conference on Advance Care Planning and End of Life Care (ACPEL) bringing together leading scientists and practitioners from around the world to share the latest research and education.

Taking place in the picturesque alpine town of Banff, Alberta, Canada, the conference will focus on the theme of Conversations Matter – a critical look at the importance of effective, ongoing conversations regarding the quality of Advance Care Planning (ACP) programming and the ethical, economic, and social implications of ACP policies and legislation.

For more information please visit www.acpel2017.org

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

02/16/2017

The 2017 Common Rule and the Clinical Ethics of Prolixity

by Steven H. Miles, MD

Bioethicist Steven Miles suggest that making the new Common Rules regulations easy to read is as important as the content

The new Common Rule to protect human subjects has an extraordinarily large and diverse audience.[i] The new Rules defines the obligations of an enormous number of personnel at the National Institutes of Health as well as virtually any other government agency engaged in research with human subjects. The Rules define the requisite knowledge, training, and work of staff who oversee and conduct clinical research in the United States. The Rules are a template for institutions in other countries, including those that don’t use English as a primary language.…

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02/16/2017

Death By Salad: Two Reasons ‘Healthy’ Food Could Make You Fat

In an effort to lose weight, you pass on the steak sizzler at your favorite family restaurant and settle, instead, for a healthy salad. But you might be in for a dieting double whammy. First off, the salad probably has … Continue reading

The post Death By Salad: Two Reasons ‘Healthy’ Food Could Make You Fat appeared first on PeterUbel.com.

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02/16/2017

Kay Hodges – Practicing Nurse at 97 Years Old

Okay, this has nothing to do with end-of-life liberty or law.  But this is such an inspiring story that I just had to share.  Kay Hodges still works as a nurse in New Jersey at 97 years of age.

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

02/15/2017

Is there a compelling reason for germline genetic editing?

Yesterday the National Academy of Sciences and the National Academy of Medicine release the findings of an expert panel on Human Genome Editing. The most significant of their recommendations relate to human germline genetic editing. They recognize that the techniques for doing this are not yet at the point that they can be considered safe enough to do at the present, but make the assumption... // Read More »

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

02/15/2017

Convict Liz Van Note of Falsification & Forgery of an Advance Directive

A jury acquitted Liz Van Note of murdering her father, because there were some gaps in the evidence.   But the evidence clearly showed that Van Note forged the advance directive she used to withdraw life-sustaining treatment from her father. &nbs...

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

02/15/2017

The National Academy of Sciences Expands its Approval for Gene Editing

by Keisha Ray, Ph.D.

This week the National Academy of Sciences (NAS) released a report giving their support for altering heritable genes when previously the NAS only supported altering uninheritable genes. Although it gave very special conditions in which altering human eggs, sperm, and embryos would be acceptable, giving their seal of approval to any alteration of the human germline is a revolutionary move for the current and future status of genetic engineering for a few reasons:

  1. Expanding Clinical Research

Genetic engineering is already practiced for non-heritable genes. Genes that are known to cause chronic and debilitating diseases are the subject of clinical trials all across the world.…

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02/15/2017

Beyond the Destination LVAD

There are many forms of life sustaining treatment available to patients thanks to advances in medical technology. When a person’s physiology weakens or fails, devices may be attached or implanted to take over for organs that can no longer bear the workload of processing, moving, or taking in the elements needed to keep a body alive. Conceptually, this is appealing to a society that is as averse to death as are those of us here in the US. But we still struggle to accommodate the range of needs that crop up when function is compromised. As an ethicist, the general trend in my work suggests that the more advanced the technology, the more questions it raises when it comes time to talk about halting the mechanical support. Among the more advanced tools for sustaining physiological function is the Left Ventricular Assist Device, or LVAD, which maintains the circulatory function for persons with severe heart failure.

There is little doubt that individuals who are eligible for the device can experience remarkable quality of life gains whether they move on to receive a heart transplant or receive the implant as a destination treatment. Recipients of LVADs can typically return to their daily activities, and enjoy a level of independence not previously possible for persons with otherwise lethal heart conditions. However, these patients are not just like everyone else when complications arise. Decisions about how best to manage long term care for persons who have LVADs can be unexpectedly complex, most notably when the patient lives outside a major metropolitan city center. In particular, securing services when such patients suffer non-cardiac health complications after having the device implanted can be difficult. Consider a patient who is stable with a destination LVAD who develops end stage renal disease and requires hemodialysis. Outpatient dialysis centers can be fearful about safely managing the ongoing dialysis treatment for a patient when they do not have experience with ventricular assist devices. The same may apply to residential care centers when a patient needs a period of rehab for an injury unrelated to the heart failure diagnosis. Perhaps the most challenging circumstance involving resources for LVAD patients who experience age related cognitive decline and need nursing home level care due to confusion, impulsivity, and routine self-care deficits. There are no clear restorative goals, but the need for custodial care can quickly exceed what was once possible at home, but the LVAD is usually unfamiliar to small town nursing homes and can be a barrier to securing long term residential care.

This issue raises an important justice question for LVAD candidates. Should consent for LVADS, when known to be destination devices, include information about the limitations in assuring other types of services? If so, how do we assure that this information is delivered in a way that does not discriminate against patients from more remote areas while favoring those who live near facilities that routinely care for LVAD patients? 

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.

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This entry was posted in Health Care, Informed Consent, Justice and tagged , , . Posted by Bioethics Today. Bookmark the permalink.

02/15/2017

TRIAD VIII: Nationwide Multicenter Evaluation to Determine Whether Patient Video Testimonials Can Safely Help Ensure Appropriate Critical Versus End-of-Life Care

Ann Denny's image on recording healthcare directives
It was a real pleasure to be part of this project on adding video testimonials / messages to advance directives.  This was released today in the Journal of Patient Safety.  This is the 8th in the series of TRIAD articles - The Realistic Interpretation of Advance Directives.



Objective: End-of-life interventions should be predicated on consensus understanding of patient wishes. Written documents are not always understood; adding a video testimonial/message (VM) might improve clarity. Goals of this study were to (1) determine baseline rates of consensus in assigning code status and resuscitation decisions in critically ill scenarios and (2) determine whether adding a VM increases consensus.



Methods: We randomly assigned 2 web-based survey links to 1366 faculty and resident physicians at institutions with graduate medical education programs in emergency medicine, family practice, and internal medicine.  Each survey asked for code status interpretation of stand-alone Physician Orders for Life-Sustaining Treatment (POLST) and living will (LW) documents in 9 scenarios. Respondents assigned code status and resuscitation decisions to each scenario. For 1 of 2 surveys, a VM was included to help clarify patient wishes.



Results: Response rate was 54%, and most were male emergency physicians who lacked formal advanced planning document interpretation training. Consensus was not achievable for stand-alone POLST or LW documents (68%–78%noted “DNR”). Two of 9 scenarios attained consensus for code status (97%–98% responses) and treatment decisions (96%–99%). Adding a VM significantly changed code status responses by 9% to 62% (P ≤ 0.026) in 7 of 9 scenarios with 4 achieving consensus. Resuscitation responses changed by 7%to 57%(P ≤ 0.005) with 4 of 9 achieving consensus with VMs.



Conclusions: For most scenarios, consensus was not attained for code status and resuscitation decisions with stand-alone LW and POLST documents.  Adding VMs produced significant impacts toward achieving interpretive consensus.


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