Blog Posts (54)
January 29, 2015
Last Saturday, the Wall Street Journal carried an excellent op-ed piece, “Dr. Death Makes a Comeback” (subscription required), by Dr. Paul McHugh, former chief psychiatrist at Johns Hopkins Hospital. In it, Dr. McHugh opposes physician-assisted suicide (PAS), making three key points: The practice will tend to spread beyond terminally ill people to those who are “treatable but mentally troubled.” He appeals to the experience in... // Read More »
January 28, 2015
Having conversations with patients about death are difficult. Sometimes I think we need to talk, but the patient or family does not seem to be ready. I suspect that sometimes the patient wants to talk, but I am not sensitive to that. Sometimes a patient clearly has a terminal illness, but the patient or the family is in denial. Sometimes different physicians approach the patient... // Read More »
January 23, 2015
Today California Senate Bill SB 128 was introduced. It is described in the press as being comparable to Oregon’s law. Its status can be followed here. Apparently (I am betraying my weak knowledge of the civics of my home state here) it is first referred to the California Senate Rules Committee for committee assignment. I have just downloaded the text and have not studied... // Read More »
January 17, 2015
by Susan Mathews, Bioethics Program Alumna (2014) In a recent op-ed article, Dr. Ezekiel Emanuel, former Special Advisor for Health Policy to the Obama Administration, stated that he did not want to live beyond the age of 75. At that point, his productive life would be over and he become a burden rather than a benefit to […]
January 15, 2015
Among the publications I can’t keep up with is the ASCO post, a tabloid-size, 100+ page newspaper that arrives in my mailbox monthly. But I do peruse it. December’s offering included a brief summary of a November 2014 debate regarding whether to “Legalize Assisted Suicide,” by the nonpartisan group Intelligence Squared US Debates. That is the phrase the group used. It is commonly pointed out... // Read More »
January 8, 2015
Just reporting this week…I will leave it to readers to comment beyond my brief comments here… Just before Christmas, my email inbox included a link (registration may be needed to access) from Medscape to a slideshow describing some results of a survey of 21,000 physicians, 17,000 in the US and 4,000 in Europe. There was a comparison of 2014 results with prior results from 2010. ... // Read More »
January 2, 2015
My local newspaper carried this Page 1 story this morning: there is a national campaign encouraging people to discuss end of life matters with their loved ones by holding a Death Over Dinner gathering between now and January 7. Well. Happy New Year. The content sounds on-target: discuss how one wants to live the end of one’s life—how does one feel about aggressive treatment, elder... // Read More »
December 17, 2014
The case of Jahi McMath has been back in the news. She was declared brain dead Dec. 12, 2013 after she went into cardiac arrest following a tonsillectomy surgery in California. Her mother did not accept the diagnosis of brain death and moved her to New Jersey where state law allows the continuation of medical treatment for a person who has been declared brain dead... // Read More »
November 27, 2014
Being Mortal, which is subtitled “Medicine and What Matters in the End,” is about aging and frailty, decline and death, and dealing with those as well as possible. It’s not really a book about medical ethics or even about medicine as much as about our latter days. It’s full of stories about the loss of independence, assisted living, nursing homes, intensive care at the end... // Read More »
November 21, 2014
In keeping with the evaluation-obsessed spirit of the time, here is a little bioethics test. No multiple-choice fill-in-the-bubbles here, no simple true/false; but bioethics usually isn’t so simple, is it? So it’s OK if you don’t have a No. 2 pencil, you can still take today’s exam! _______________________ 1. The patient-physician relationship depends on trust, and close observation, and appreciating subtleties, and giving one’s full attention... // Read More »
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October 23, 2012 6:01 pm
[I]n South Australia last week, a bill has been proposed to clarify the legal status of advance directives. One very small part of that bill involves a modification to an older palliative care act. The modification corrects an ambiguity in wording in the earlier act. The ambiguity is subtle. However, that choice of words has had major consequences for seriously ill children and adults in South Australia and for health practitioners. It is a salutary reminder of how hard it is to enact good laws in the area of end of life, and how easily such laws can make things worse rather than better.
September 21, 2012 8:12 pm
EDINA, Minn. — Just down the hallway, in Room 356, Curtis Kelly’s body lay covered to the chest by a white blanket, his torso rising and falling with the help of a ventilator. A neurologist at Fairview Southdale Hospital had declared him brain-dead nearly six hours earlier. Mr. Kelly’s far-flung family — a son, three siblings, a sister-in-law, his girlfriend and the daughter of a former girlfriend — had gathered in a narrow conference room in the intensive care unit so that John P. LeMay could ask permission to recover his tissue and organs.
August 14, 2012 7:47 pm
Healthcare providers should have rapid access to legal remedies for end-of-life disputes involving children whose parents resist withdrawal of aggressive therapy on the basis of religious beliefs, authors of a review concluded. Over a 3-year period, 17 of 203 cases could not be resolved after lengthy discussions with parents. Subsequently, most of the cases were resolved, but five remained undecided, each because of the parents’ belief in a miracle for their children, according to an article published online in the Journal of Medical Ethics.
August 14, 2012 7:45 pm
Arthur Caplan, the head of the division of medical ethics at NYU Langone Medical Center, recalls a case of a man who had beaten his six-month-old child to death. It was a horror the mother simply could not accept. A deeply religious woman, she pushed the doctors to do more, telling them that God would intervene and allow her daughter to make a miraculous recovery. For several hours there was a tense standoff between caregivers and parent.
August 7, 2012 9:35 pm
Living or dying is not at issue. The question this family confronts is how the patient will die: a little sooner, with adequate morphine, surrounded by loved ones in the hospice unit, or a little later, in a never dark or quiet patch of the I.C.U., ribs broken by failed, if well-intentioned, CPR. Add to this the following: The patient and family are black. And while race should not be relevant at this moment, research tells us otherwise.
July 27, 2012 5:57 pm
Are doctors more likely to refuse revival in the event of cardiac arrest? In the Hopkins study, 90 percent of doctors said they’d rather die by cardiac arrest than be resuscitated. Only a quarter of the public feels the same way. Do doctors know something we don’t about the miracles of CPR? In one Japanese study of 95,000 CPR cases, just eight percent of patients survived for longer than a month after being revived.
July 26, 2012 4:25 pm
Another challenge for the U.S. with respect to overall health care costs is our cultural approach to end of life care. Medicare now estimates that 27 percent of its budget goes for care provided in the last year of life, and a big chunk of that is spent in the last few weeks of a person’s life. The Lien Foundation did a study on end of life care in 40 developed countries. While the U.S. ranked high on the availability and quality of end-of-life care, its cost of care was one of the highest.
July 11, 2012 6:41 pm
“Countries differ greatly in demography, culture and organization of medical care,” Lo, who is also director of the medical ethics program at the University of California, San Francisco, wrote in a comment accompanying the study. More in- depth information is needed to better understand how patients and physicians reach their decisions, he said.
July 10, 2012 4:23 pm
There are calls for a Queensland doctor to be stripped of his right to practice medicine and investigated over allegations he prematurely ended the lives of patients under his care. Former Queensland Medical Board investigator Jo Barber says the doctor’s actions are so dangerous he could have been charged with manslaughter or murder. Ms Barber says there are a number of deaths linked to the doctor, who, after fronting the state’s medical board, was allowed to continue practising as long as he was not working in intensive care.
July 9, 2012 9:12 pm
Protecting the health and wellbeing of the population directly or indirectly involved with death and dying is a huge public health challenge. Currently, high quality end of life care is not yet available in most parts of the world, and in those countries where it is available it is not accessible or not initiated timely for all in need, independent of their disease, age, gender, socioeconomic, or ethnic background. Largely as a result of that, a large majority receives overly aggressive treatment until death or shortly before death, has undertreated psychological and physical symptoms at the end of life, and is not able to die in a place or manner that accords with their personal preferences.
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