Tag: medical futility blog

Blog Posts (1362)

August 27, 2016

Law of Brain Death in Los Angeles,California

With the media attention on the latest developments in the Israel Stinson case, it might be worth refreshing on the basics of the law of brain death in California.   Here is a video of a 2015 Los Angeles conference where I explained the history a...
August 25, 2016

How technology has changed the definition of death (2 min video)

Vox has a nice, basic 2-minute video on the history of the determination of death.
August 24, 2016

Avoiding Overtreatment at the End of Life: Physician-Patient Communication and Truly Informed Consent

Barbara Noah has posted her new 65-page article in Pace Law Review: "Avoiding Overtreatment at the End of Life: Physician-Patient Communication and Truly Informed Consent."

This Article considers how best to ensure that patients have the tools to make informed choices about their care as they near death. Informed decision making can help reduce excessive end-of-life care and unnecessary suffering, and result in care that aligns with patients’ well-considered values and preferences. The many factors that contribute to dying patients receiving too much therapy and life-prolonging care include: the culture of denial of death, physicians’ professional culture and attitudes toward treatment, physicians’ fear of liability, physicians’ avoidance of discussions about prognosis, and the impact of payment incentives that encourage overutilization of medical technologies.

Under the doctrine of informed consent, physicians have an ethical and legal obligation to provide patients with timely and accurate information that will enable patients to make informed decisions about end-of-life care. However, compliance with the informed consent law does not ensure that patients’ decisions are truly informed. The Authors provide several tools and techniques available to help physicians and patients achieve the goal of truly informed decision making, including training to promote the practice of shared decision making and the use of decision aids.
August 23, 2016

Patient, Family, and Clinician Experiences with Voluntarily Stopping Eating And Drinking (VSED)

A symposium that I edited is coming out shortly from Johns Hopkins University Press:  "Patient, Family, and Clinician Experiences with Voluntarily Stopping Eating And Drinking (VSED)." The symposium includes 15 personal narratives from those invo...
August 22, 2016

Israel Stinson v. Children's Hospital LA - the LASC Lawsuit

Israel Stinson was declared dead in early April 2016.  But his parents were able to continue organ support by obtaining court injunctions and stays in state and federal court.  They later transferred him to Guatemala.  He is now in Los Angeles.   

The Los Angeles Superior Court is now the 4th court to be involved in this case.  Previous rulings were issued by Placer County Superior Court, the U.S. District Court for the Eastern District of California, and the U.S. Court of Appeals for the Ninth Circuit.

On  Thursday, Israel's mother obtained an ex parte temporary restraining order against Children's Hospital LA.

An order to show cause re preliminary injunction is scheduled for September 9, 2016, at 9:30 a.m.   Any opposition is to be filed and served by Septem­ber 1, 2016, and any reply is to be filed and served by September 6, 2016.

August 21, 2016

Right before I Die - Photographic Exhibition

"Right before I Die" is a new photographic exhibition at the LA Museum of Tolerance.  The photographs show people facing serious illness along with the subject's words of wisdom and hope.  
August 20, 2016

Photo Series Captures Death and Dying in Palliative Care Unit

Western Sydney Local Health District multimedia manager Carlos Furtado recently had the privilege of photographing a day in Mt Druitt Hospital’s Supportive and Palliative Care Unit.  

With the consent of patients and families, Mr Furtado was given access to photograph the most intimate of moments when patients, families and staff were dealing head-on with the reality of dying and death.

August 19, 2016

Hastening Death by Voluntarily Stopping Eating and Drinking: Clinical, Legal, Ethical, Religious and Family Perspectives

August 19, 2016

Need to Ration ICU Access

Paul E. Marik published "The Cost of Inappropriate Care at the End of life Implications for an Aging Population" in the American Journal of Hospice and Palliative Care.

Marik presents the case of an 86-year-old female who spent almost 3 months in ICU prior to her death. The fully allocated hospital costs for this patient were estimated to $5100 per day.  That is a lot.  But the stronger argument may focus on the patients deprived of the opportunity to benefit from ICU care when this patient was there and the ICU was full.   

With the increasing age of the population and the projected increased demand for ICU beds, he reviews the benefits and burdens of admitting elderly patients to the ICU.

  • Elderly patients patients (older than 65 years) account for only 11% of the US population yet they account for 34% of health care expenditure. 
  • The disproportionate usage of health care costs by elderly patients is in striking contrast with that of other Western Nations. It is likely that these differences are largely due to variances in hospitalization and the use of high technology health care resources at the end of life. 
  • The United States has 8 times as many intensive care unit (ICU) beds per capita when compared to other Western Nations. 
  • In the United States, elderly patients currently account for 42% to 52% of ICU admissions and for almost 60% of all ICU days.
  • A disproportionate number of these ICU days are spent by elderly patients before their death. 
  • In many instances, aggressive life supportive measures serve only to prolong the patient’s death. Such treatment inflicts pain and suffering on the patient (with little prospects of gain) 

August 18, 2016

Trisomy 13 and 18—Treatment Decisions in a Stable Gray Zone

In a new JAMA editorial, John Lantos shows that what was long framed a "futile" is really just a value judgment framed as a medical judgment. "Thirty years ago, pediatric residents were taught that trisomy 13 and 18 were lethal congenital anomalies. P...

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