Tag: medical futility blog

Blog Posts (321)

September 28, 2014

Festering Mistrust over Brain Death

I was disappointed to see this newsletter article from the Life Issues Institute and the Terri Schiavo Life & Hope Network titled "The Market for Brain Death."   The primary focus seems to be on aid in dying, particularly involuntary or ...
September 27, 2014

Congress Urges CMS to Adequately Reimburse Physicians for Advance Care Planning

This week, 34 Members of the House of Representatives, sent a letter to Centers for Medicare & Medicaid Services (CMS) Administrator, Marilyn Tavenner, to adopt recommendations that would adequately reimburse Medicare providers for having...
September 26, 2014

Australian Medical Association Position Statement on Medical Futility

Earlier this month, the Australian Medical Association released a new "Position Statement on End of Life Care and Advance Care Planning 2014." The statement outlines policy on issues such as medical futility, decision making capacity, advance care planning, artificial nutrition and hydration, bereavement, workforce, and community awareness.

Futile Treatment is defined as "Treatment that no longer provides a benefit to a patient or treatment where the burdens of treatment outweigh the benefits. Doctors are not required to offer treatment options they consider neither medically beneficial nor clinically appropriate."

Here are the three sections on medical futility:

"7.1  Doctors should understand the limits of medicine in prolonging life and recognise when efforts to prolong life may not benefit the patient. In end of life care, medically futile treatment can be considered to be treatment that gives no, or an extremely small, chance of meaningful prolongation of survival and, at best, can only briefly delay the inevitable death of the patient."

"7.2  Whilst doctors are generally not obliged to provide treatments that are considered medically futile, where possible it is important that the doctor discuss their reasons for determining a treatment to be medically futile with the patient (and/or the SDM, carers, family members) before deciding the treatment should not be offered."

"7.3  In some cases, a treatment may not offer a benefit in terms of curing a patient’s condition, or significantly extending life or improving quality of life, but it may benefit the patient in other ways. For example, a ‘medically futile’ treatment may briefly extend the life of the patient so he or she can achieve their wish of saying goodbye to a relative who is arriving shortly from overseas."

September 25, 2014

Denying Others the Right to Die (cartoon)

September 24, 2014

POLST - New US Map of POLST Paradigm Programs

The National POLST Paradigm Task Force has updated its national map of POLST programs.  Here are the definitions of the different statuses.  

Mature status - the highest level of endorsement by the NPPTF is reserved solely for states with statewide POLST programs that, among other requirements are the standard preferred method of advance care planning for persons with advanced illness or frailty. Mature POLST programs are used by 50% or more of hospitals, nursing homes, and hospices in each region (as defined by established criteria such as EMS, Department of Health, or the Dartmouth Atlas) of the state. These programs are actively gathering data for quality assurance programs and have considered centralized POLST databases.

EndorsedThe NPPTF will endorse state POLST programs when they have developed and implemented a POLST program and form meeting the NPPTF standards. Endorsed programs are POLST programs that have become standard components of advance care planning in their location. These programs have addressed legal and regulatory issues associated with POLST, and have developed strategies for ongoing implementation and quality assurance.

Developing - Programs are recognized as “developing” when they have both: (1) submitted the Developing State Status Application form and (2) presented the state’s POLST form and progress to the NPPTF’s Developing State Assistance Committee (DSAC). Developing POLST Paradigm Programs may be at various stages of development, ranging from the initial design of a POLST form to active usage of POLST forms, but are working towards the goal of implementing the POLST program statewide. In general, programs at this step are starting to contemplate addressing all Seven Core Elements of Sustainability.

NonconformingMaryland legislation that went into effect in 2013 mandates the completion of POLST forms for certain patients. Their program violates the POLST Paradigm’s tenant that completion of a POLST is always voluntary.  The current Massachusetts form does not include the “limited intervention” section that is the heart of POLST and where data documents the highest level of effectiveness but, instead, has a variety of questions. This lack of structure in the form causes confusion and lacks clarity and likely reduces effectiveness in honoring patient wishes.  The current Vermont form is cumbersome and unclear, potentially causing confusion. It also incorporates elements of the state’s advance directive statute, mentioning the concept of futility with respect to the CPR/DNR order section.

No ProgramWhen states are exploring the development of a regional or statewide POLST Paradigm program they can formally connect with the NPPTF. This level is for states not yet ready to complete the Developing POLST Paradigm documentation but who would like to participate in the National POLST Paradigm Program (e.g., receive emails from the national office, attend various education sessions put on by the National Office or the NPPTF, etc).

September 23, 2014

Hospice Ethics Policy and Practice in Palliative Care

Oxford University Press has just published Hospice Ethics: Policy and Practice in Palliative Care.   Hospice is one of the fastest-growing segments of the U.S. healthcare system, a trend that is expected to accelerate as the median age of the pop...
September 21, 2014

Health Care Reform Implementation in Minnesota: Mission Advanced But Not Accomplished

September 21, 2014

Careers & Pro Bono Opportunities in Bioethics & Law

September 20, 2014

Both Sides Now: Living with Dying: An Immersive Arts Experience

Puppetry, theater, visual arts, and more.  A very cool arts experience is happening this weekend in Singapore called Both Sides Now.  The "immersive arts experience" provides the opportunity for the living to encounter dying.  Organizer...
September 20, 2014

Both Sides Now: Living with Dying: An Immersive Arts Experience

Puppetry, theater, visual arts, and more.  A very cool arts experience is happening this weekend in Singapore called Both Sides Now.  The "immersive arts experience" provides the opportunity for the living to encounter dying.  Organizer...

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