Tag: medical futility blog

Blog Posts (839)

September 2, 2015

SY Tan on Medical Futility (video)

Prof S.Y. Tan (St. Francis International Center for Healthcare Ethics) gave a lectures on medical futility at KTPH in Singapore.  This is a pretty basic and accessible overview of the issues.  
September 2, 2015

Gramp - Just before [EOL in Art 114]

September 1, 2015

New Amended Texas Advance Directives Act Starts Today

The dispute resolution provisions in the 1999 Texas Advance Directives Act have not been amended since 2003.  But the 2015 amendment (H.B. 3074) take effect today.   TADA now exempts clinically assisted nutrition and hydration from the scope...
September 1, 2015

Eighth Annual Pediatric Bioethics Conference (Nov. 6, 2015)

I am delighted to be a part of the Eighth Annual Pediatric Bioethics Conference.
September 1, 2015

Gramp - 1954 vs 1974 [EOL in Art 113]

This is from the back cover of Dan and Mark Jury's 1976 book Gramp.
August 31, 2015

Kevorkian "Fever" [EOL in Art 112]

August 31, 2015

Revisiting CPR Survival Rates Depicted on Popular TV Shows

Jaclyn Portanova and colleagues at the USC Davis School of Gerontology have just published  "It Isn’t Like This on TV: Revisiting CPR Survival Rates Depicted on Popular TV Shows" in Resuscitation.  Compared to Diem & Lantos' similar 1996 study, accuracy rates of television CPR depictions appear to not be improving. 

The authors found that Grey's Anatomy and House portrayed CPR as more effective than actual rates. Overall, the shows portrayed an immediate survival rate nearly twice that of actual survival rates. Inaccurate TV portrayal of CPR survival rates may misinform viewers and influence care decisions made during serious illness and at end of life.


"Public perceptions of cardiopulmonary resuscitation (CPR) can be influenced by the media. Nearly two decades ago, a study found that the rates of survival following CPR were far higher in popular TV shows than actual rates."


"In recent years, major strides toward enhanced education and communication around life sustaining interventions have been made. This study aimed to reassess the accuracy of CPR portrayed by popular medical TV shows."


"Three trained research assistants independently coded two leading medical dramas airing between 2010 and 2011, Grey's Anatomy and House. CPR was depicted 46 times in the 91 episodes, with a survival rate of 69.6%. Among those immediately surviving following CPR, the majority (71.9%) survived to hospital discharge and 15.6% died before discharge. Advance directive discussions only occurred for two patients, and preferences regarding code status (8.7%), intubation (6.5%) and feeding (4.3%) rarely occurred."


Here is one nice counterexample:





August 30, 2015

Neysi Perez Buried Alive, Wakes Screaming Inside Coffin

Pregnant teenager Neysi Perez was buried alive.  She was removed from her tomb and coffin after family members heard her screaming. 

Her mother said she was still warm. “We were all so happy. After being declared dead for such a long time, everybody was saying that she had come back to life. We were all so happy." (Independent)

 
August 30, 2015

Kevorkian "Coma" [EOL in Art 111]

In "Coma" Jack Kevorkian depicts an unconscious patient being slowly pulled into the mouth of a macabre death mask. Helpless. The death's head resembles the opening of a CAT scan machine, a symbol of modern medical technology.
August 30, 2015

New Futility Case: Siner v. Kindred Hospital Indianapolis

The Court of Appeals of Indiana issued a decision that allows a family to proceed with its medical malpractice action alleging that a hospital's unilateral DNR order caused the patient's death. 

Facts
"October 26, 2007, eighty-six-year old Geraldine Siner became a patient at Kindred Hospital. Geraldine suffered from advanced dementia caused by Alzheimer’s disease and as a result could no longer care for herself. Geraldine’s son, John Siner, was designated as her health care representative and had power of attorney."

"Upon Geraldine’s admission to Kindred, and several times thereafter, John informed . . . Geraldine’s attending physician, that Geraldine was to be a ‘full code’ patient. On November 16, 2007, Kindred’s Ethics Committee decided to make Geraldine a No Code/Do Not Resuscitate (“DNR”) patient, meaning that Kindred staff would not attempt to resuscitate her in the event that she went into respiratory or cardiac arrest (otherwise known as “coding”)."

"The Ethics Committee did not receive approval from John or any other family member to change Geraldine’s status in this manner. Geraldine’s health continued to decline over the following two weeks and Kindred declined to keep Geraldine on ‘full code’ status despite her family’s protests."

Expert Testimony
Plaintiff's expert Timothy Pohlman opined both that the hospital was negligent and that this negligence caused Siner's death.

"Kindred’s Ethics Committee recommended over-riding the wishes of the family and instructions of the patient’s medical representative for full treatment, and instituted Do Not Resuscitate (DNR) order, which ruled out such alternative treatments."

"Gerri Siner was also suffering from over-whelming infection, and septic shock at the time of intake. There is no documentation produced for me that indicate SCCM Surviving Sepsis Guidelines, . . . were followed . . . . These guidelines were not followed apparently because the patient was under a DNR order."

"Full damages and suffering that more likely than not resulted from re-prioritization of treatment modalities for Gerri Siner based on her existing ‘DNR’ order that was left in place without full agreement and consent of her Surrogate decision makers . . . ."

Appellate Ruling
The trial court granted summary judgment in favor of Kindred Hospital, finding the family had failed to introduce any evidence on causation.  The appellate court reversed, because Pohlman's testimony does create a disputed fact as to causation

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