Where the World Finds Bioethics Thu, 27 Nov 2014 21:28:25 +0000 en-US hourly 1 An All-Too-Brief Review of Being Mortal Thu, 27 Nov 2014 17:19:05 +0000 Read More »]]> 0 As You Wish – Virginia Advance Care Planning Website Thu, 27 Nov 2014 09:00:00 +0000 0 Striking the Balance Between Population Guidelines and Patient Primacy Wed, 26 Nov 2014 13:34:06 +0000 ]]> 0 Scientific Research: Critiquing the Critics Wed, 26 Nov 2014 10:11:04 +0000 0 The Lack of Consensus about Futility (Video) Wed, 26 Nov 2014 09:00:00 +0000 0 What Jonathan Gruber Didn’t Say About Obamacare Tue, 25 Nov 2014 16:49:05 +0000 Continue reading ]]> 0 Bad Blood Author James H. Jones Visits the Bioethics Commission Tue, 25 Nov 2014 16:21:45 +0000 0 New Advance Care Planning Videos Show How to Avoid Premature Dying Tue, 25 Nov 2014 15:03:00 +0000 Did Robin Williams commit suicide due to fear of Advanced Dementia? Did Brittany Maynard hasten her dying based on her fear of future unbearable pain? Did they pay the high price of premature dying—losing some remaining enjoyable life—to act while they still had capacity to control WHEN they died? Might they have lived longer had they been aware of an effective plan to die AFTER losing capacity?

Psychiatrist/bioethicist Stanley Terman, PhD, MD, Medical Director and CEO of the non-profit organization, Caring Advocates, has created ​three ​new videos from live presentations in Oct. and Nov. 2014​.

​1) The BEST WAY to Say Goodbye—if living with pain or dementia.​

Th​is video portrays poignant stories of patients that illustrate the need for diligent, strategic Advance Care Planning:

Robin Williams: Was a “key factor” in his decision to commit suicide experiencing hallucinations or other symptoms of early Lewy Body Dementia? Might he have suffered from the “Dementia Fear”?

Brittany Maynard: She admitted this “did not seem like the right time” but then died a few days later. She feared cancer would take away her autonomy: “The worst thing that could happen to me is that I wait too long.” Where there issues she could have worked on to reduce her current suffering, so she could decide to live longer?

Meryl Comer: As her husband’s caregiver, she considers herself a “POA” (Prisoner of Alzheimer’s). Dr. Gralnick was diagnosed 20 years ago. Yet no professional has ever advised Ms Comer about the ethically accepted method of “Substituted Judgment” to make end-of-life decisions. The new “Consensus of Substituted Judgment” method strives to be more accurate, less stressful, and its protocol has built-in, a way to deal with family conflicts.

Margaret Bentley: Neither the administrators of her residential care facility nor the court would HONOR the instructions she made in her Living Will, even though they were consistent with the requests made by her husband and daughter—her proxies/agents. Her sad story shows why DILIGENCE is necessary when completing a written Living Will.

Casey Kasem: His final weeks were plagued with pain and family conflict. The misery of his last chapter of life might have been avoided had he used his (famous) voice to make a strategic audio or video recording on which he stated what he wanted and explained why.

Gillian Bennett: Was her suicide premature and motivated by the “Dementia Fear”? Would she have decided to live longer if she had known about, and had confidence in a strategic plan to implement Natural Dying—AFTER she reached the stage of Advanced Dementia?

Sadly, many people are led to believe they have ONLY two options: premature dying (so they lose some joyful life) OR prolonged dying (so they are forced to endure more suffering longer). A third option makes premature dying unnecessary, sad, and tragic: Diligent, strategic Advance Care Planning.

This one-hour video can be viewed in two parts. Part 2 begins at minute 36. It includes:

  • What is Natural Dying and why is it a peaceful and moral way to die?
  • How can you complete a clear, specific Living Will by making “one decision at a time”? 
  • How can you set up a strategy to feel confident you will get relief from end-of-life pain?
  • What can you do to relieve the prolonged suffering of a loved one who now lives with Advanced Dementia—if he never completed a clear and specific Living Will?

​2) ​Lost, NOT found in Alzheimer’s—important, timely & relevant lessons in Meryl Comer’s revealing book:

“Slow Dancing with a Stranger—Lost and Found in the Age of Alzheimer’s” is inspiring, informative, and above all, honest. It shines a bright light on the dark side, to allow readers to learn what is important, timely, and relevant. It can motivate readers to complete their own diligent Advance Care Planning, if they ever reach the stage of Advanced Dementia. It also demonstrates the urgent need for broader education so that people are informed about end-of-life options that are legal and moral—if their loved one did not previously complete a clear and specific Living Will.

Three events had potential to dramatically change the lives of two people in their prime. Emmy-award winning journalist, Meryl Comer as the "POA"--"Prisoner of Alzheimer's" and her afflicted with dementia husband, Harvey Gralnick, the former head of oncology and hematology at the National Institutes of Health. These events were:  
(1) Not receiving an accurate diagnosis promptly;
(2) Not receiving a realistic potential prognosis; and,
(3) Not receiving information and advice so the POA would know how to implement the ethically accepted standard of “Substituted Judgment method” that she needed, to make a difficult end-of-life decision.

WITHDRAWING hand-feeding/drinking but still offering (that is, NEVER WITHHOLDING) the vital substances of food and fluid can be clinically and ethically appropriate to reduce prolonged and intense suffering of Advanced Dementia patients. Such actions can also be considered consistent with the Principle of Proportionality.

​3) ​Must we all die with forced hand-feeding in Advanced Dementia? Will others honor our Living Will?” 
​Initially, this PowerPoint ​presentation was given to the American Society for Bioethics and Humanities annual meeting in October, 2014​. This video has a revised​, updated audio.

Dementia (Alzheimer's) presents huge challenges. In the advanced stage, the goal to sustain life may conflict with the goal to relieve suffering.

Margot Bentley completed a strongly worded Living Will because she was adamant: She did NOT want to suffer a long time in Advanced Dementia. She also appointed her warriors: her husband and daughter —to make sure her wishes would be honored.

Sadly, her plan did not work. She has now been forced-fed for three years.
What can we learn about from her experience?

]]> 0
Where Social Justice Fits in Medical Decision-Making Mon, 24 Nov 2014 14:23:24 +0000 ]]> 0 Stop Unwanted Medical Treatment Mon, 24 Nov 2014 13:18:00 +0000 0 The Importance of the Collective Afterlife for Human Values: The Collective Afterlife and the “Afterlife Conjecture” Mon, 24 Nov 2014 13:00:21 +0000 by J.S. Blumenthal-Barby, Ph.D.

In his new book, Death and the Afterlife (comprised of his two Tanner Lectures on Human Values), philosopher Samuel Scheffler argues that the assumption of a “collective afterlife” (i.e., the assumption that humanity lives on here on earth after our own individual deaths) plays an essential role in us valuing much of what we do. He argues, provocatively, that if a collective afterlife did not exist we would cease to value much of what we do (his “afterlife conjecture”).…

]]> 0
Deregulation and Free Markets for Stem Cell Products Mon, 24 Nov 2014 03:11:14 +0000 0 Mary Welch Charged with Medical Child Abuse for Obtaining Unnecessary Treatment Sat, 22 Nov 2014 23:17:00 +0000 0 Brain in a Jar – Sufficient Reason to Keep Me Alive Sat, 22 Nov 2014 00:00:00 +0000 0 Bioethics Exam Fri, 21 Nov 2014 21:20:28 +0000 Read More »]]> 0 The Bioethics Commission’s Neuro Double-Header Fri, 21 Nov 2014 16:14:51 +0000 0 Time To Stop Paying For Pepsi With Food Stamps Fri, 21 Nov 2014 13:51:23 +0000 Continue reading ]]> 0 Doused Counties: Banning Tobacco Sales in Massachusetts Fri, 21 Nov 2014 08:09:18 +0000 by Craig Klugman, Ph.D.

The small city of Westminster, Massachusetts is voting on whether to become the first town in the nation to ban sales of tobacco products, e-cigarettes, and bubblegum-shaped smoking implements within its limits. Many cities already have bans on selling tobacco to minors, smoking bars, businesses, offices, and even in public. The drugstore giant CVS has banned sales of tobacco products from its stores. But this is the first time that a city is making the sale of tobacco and e-cigarettes illegal.…

]]> 0
Resident physicians as the key to Do Not Resuscitate orders Fri, 21 Nov 2014 05:24:00 +0000 Read More »]]> 0 Resolving Medical Futility Disputes – Alberta follows Ontario in Chalifoux v. Alberta Health Services Thu, 20 Nov 2014 09:00:00 +0000 0 The Ethics of Uterus Transplantation Thu, 20 Nov 2014 03:11:10 +0000 0 Martha Perez – Texas Family Charges Organs Procured BEFORE Death Wed, 19 Nov 2014 08:30:00 +0000 I recently summarized a few cases in which a patient was either negligently or intentionally declared dead prematurely.  

But this recent case reported by Fox News in Dallas Fort Worth indicates misunderstanding by the family rather than error by the clinicians.  

26-year-old Martha Perez dies from injuries sustained in an car wreck involving a suspected drunk driver.  Perez was a registered organ donor and doctors told the family they were prepared to harvest the organs for donations.

The family objected: “But she still has heart and lung functions,” said family member Juan Martinez.  Unfortunately, this statement indicates that the family does not understand that these cardiopulmonary functions are compatible with legal death in Texas.  They can be artificially sustained even after death is determined (on neurological criteria).   

On the other hand, the family also alleges: “They took her off the life support and she was still breathing.”  If that is true, then the determination of death must have been wrong.  A person breathing on their own (without ventilation support) cannot be dead under either cardiopulmonary or neurological criteria.

]]> 0
Found: Billions of Wasted Medicare Dollars Tue, 18 Nov 2014 13:48:39 +0000 Continue reading ]]> 0 Texas Legislature to Address Marlise Munoz Dead Pregnant Situation Tue, 18 Nov 2014 10:30:00 +0000 0 Elderspeak: Words Can Hurt Tue, 18 Nov 2014 07:04:33 +0000 by Craig Klugman, Ph.D.

During the season premiere of the HBO comedy, Getting On, I noticed the excessive use of toddler-speak toward patients portrayed as being elderly. The show takes place in a senior rehab/hospice unit in a community hospital. Whenever one of the health care providers (physician or nurse) was speaking to one of the patients, they tended to use baby talk—higher pitch, lilting tone, longer spaces between words, elongated space around vowels, and using simple, shortened words.…

]]> 0
Genetic Testing Can’t Do Our Behavioral Dirty Work Mon, 17 Nov 2014 18:04:36 +0000 Continue reading ]]> 0 Janina Kolkiewicz Wakes Up in Morgue after Pronounced Dead Mon, 17 Nov 2014 09:30:00 +0000 0 The New Abortion Issue: The Moral Status of Women Mon, 17 Nov 2014 03:11:17 +0000 0 Oregon Death with Dignity Act – 20th Anniversary Mon, 17 Nov 2014 00:14:00 +0000 0 The Importance of Ethical Standards Sun, 16 Nov 2014 15:22:21 +0000 Read More »]]> 0 Top 30 Bioethics Journals on Earth Sun, 16 Nov 2014 10:00:00 +0000 0 First Execution under Obamacare Death Panels? Sat, 15 Nov 2014 08:30:00 +0000 0 Is it right to compel hospital staff to care for patients with Ebola? Fri, 14 Nov 2014 23:46:22 +0000 Read More »]]> 0 Patient Modesty: Volume 70 Fri, 14 Nov 2014 21:44:00 +0000 0 My Burrito Has How Many Calories?!? Fri, 14 Nov 2014 19:49:25 +0000 Continue reading ]]> 0 Finding a Voice Fri, 14 Nov 2014 16:42:41 +0000 0 Dhaka Hospital Withdraws Life Support without Consent or Consultation Fri, 14 Nov 2014 12:57:00 +0000 0 Three Items About Human Research Ethics Fri, 14 Nov 2014 01:27:33 +0000 Read More »]]> 0 Patients and Clinicians Discuss Only 2 of 11 Goals of Care Elements Thu, 13 Nov 2014 09:30:00 +0000 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

]]> 0
Wisdom Does Come with Age Thu, 13 Nov 2014 03:11:09 +0000 0 A Look at How M.D. Anderson Cancer Center Uses Bioethics Educational Materials Wed, 12 Nov 2014 17:39:41 +0000 0 Why the right to die movement needed Brittany Maynard Wed, 12 Nov 2014 16:56:29 +0000 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.…

]]> 0
Outpatient Spending Is Catching Up To Hospital Expenditures Wed, 12 Nov 2014 13:50:14 +0000 Continue reading ]]> 0 Susan Tolle Wins MacLean Center Prize in Clinical Ethics for Work on POLST Wed, 12 Nov 2014 10:00:00 +0000 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.

]]> 0
UK Hospital Places DNR Order without Consent or Consultation Wed, 12 Nov 2014 10:00:00 +0000 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."

]]> 0
Dying and Dignity Wed, 12 Nov 2014 02:06:06 +0000 Read More »]]> 0 A Park Bench That Tells You You’re Fat? Tue, 11 Nov 2014 14:23:30 +0000 Continue reading ]]> 0 Making a Case for Case Studies Tue, 11 Nov 2014 10:11:43 +0000 0 Taiwan End-of-Life Policies Inflict Unwanted Pain & Torture Tue, 11 Nov 2014 09:00:00 +0000 0 Ruby Graupera-Cassimiro Survives 45 Minutes without Pulse Tue, 11 Nov 2014 01:36:00 +0000 0