Blog Posts (45)
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 »
November 21, 2014
At last month’s ASCO Palliative Care conference in Boston, one of the presentations was a survey, done by resident physicians (doctors 1-3 years out of medical school, doing hospital-based, post graduate training) at Tufts Medical Center. The topic: what their fellow residents thought about conducting conversations with patients about Do Not Resuscitate (DNR) orders. Some background: most of the time, these conversations would arise in... // Read More »
November 11, 2014
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 »
November 6, 2014
We all know, as Steve Phillips reminded us yesterday, that Brittany Maynard took the pills this past Sunday, one day later than she had originally planned. In the days before that, she appealed to our compassion for her in her suffering—and powerfully at that. Equally powerful were stories from the likes of Kara Tippetts and, as Steve pointed out, Maggie Karner, two women with terminal... // Read More »
November 5, 2014
Physician assisted suicide (PAS) is in the news in a way that is different than before. It is not because it is election time and a state has a ballot initiative about legalizing PAS. It is because a 29 year old woman with an aggressive malignant brain tumor, Brittany Maynard, has chosen to use PAS to end her life and chosen to do it very... // Read More »
October 30, 2014
Last weekend, I attended the inaugural Palliative Care conference for the American Society of Clinical Oncology (ASCO). Fifty years into ASCO’s existence, it now takes the formal position that good cancer medicine means integrating palliative care—addressing symptoms and “whole person” aspects of medical care—throughout the treatment of a person’s cancer, not just at the end of life. And there has been a move to establish... // Read More »
October 13, 2014
The story of Brittany Maynard, a 29-year old newlywed who has been given the diagnosis of terminal glioblastoma, an especially aggressive brain tumor, has gone viral over the past week. Many know the story already, but it centers on her decision to end her life by taking an oral medication prescribed by her physician, who will be sitting at her bedside with her husband and... // Read More »
September 25, 2014
Perhaps you’ve seen it already: the ever-more-present Dr. Emanuel has a piece in The Atlantic entitled “Why I hope to die at 75.” Follow the link and you can read it for free online. I confess that, upon learning of the title and the author, my mind was flooded with wisecracks. I publicly repent of those and will repeat none of them here. I don’t... // Read More »
September 10, 2014
Thanks to the popularity of medical television shows, most people have witnessed hundreds of fictional cardiac arrests in their lifetime. In most of these scenes, the patient loses consciousness, and the medical team rushes to the bedside: “He’s in V-fib.” … Continue reading →
August 28, 2014
World magazine suggests that the movie version of Lois Lowry’s youth novel The Giver is an important entrée to discussions about human dignity, abortion, and euthanasia. My wife and I saw it last weekend. Our response to the above: Maybe, but probably not. The overwhelming message of the movie seems to be about human freedom: If people have freedom, they will make bad choices, but... // 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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