Tag: medical futility blog

Blog Posts (315)

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...
September 19, 2014

Ethical Issues in End-of-Life Care: MacLean Center Interdisciplinary Faculty Seminar Series

Check out this amazing roster of nearly 30 world class seminars on end-of-life issues in the MacLean Center's 2014-2015 Interdisciplinary Faculty Seminar Series.

In the past 50 years, medicine has developed new and unprecedented technologies like breathing machines and dialysis that can prevent or delay death. These technologies have changed how people die, where people die, and physicians’ responsibilities to dying patients. During these 50 years, physicians and society have gradually learned how to best apply these life-saving technologies and how to stop them. In the vast majority of cases in which death is anticipated, patients, families and physicians reach prudent and “negotiated” decisions on when to stop aggressive care.

Yet questions remain. Advance directives have not been the panacea they were hoped to be and deciding for patients who are unable to speak for themselves remains painfully difficult for families and practitioners. Newer technologies such as implanted cardiac defibrillators, left ventricular assist devices, extracorporeal membrane oxygenation continue to raise new questions. Euthanasia and physician assisted suicide remain contentious subjects. Even questions that were thought settled, such as brain death and palliative sedation, have generated new controversies. Further, the cost of caring for patients at the end of life continues to consume a large percentage of the health budget, raising questions about the optimal and just use of health care resources.

THE ETHICS OF GLOBAL PALLIATIVE CARE
KATHEY FOLEY
Wednesday, October 8

THE DEFINITION OF DEATH: NEWLY EMERGING CONTROVERSIES
ROBERT VEATCH
Wednesday, October 15

STARTING VERY SMALL: NEWBORN PERSPECTIVES ON THE BIG DECISIONS
PERRIS KLASS
Wednesday, October 22

BEING MORTAL: MEDICINE AND WHAT MATTERS IN THE END
ATUL GAWANDE
Thursday, October 23

VOLUNTARILY STOPPING EATING AND DRINKING: SEPARATING THE WHEAT FROM THE CHAFF
DANIEL SULMASY
Wednesday, October 29

THE LACK OF CONSENSUS ABOUT FUTILITY
ALAN MEISEL
Wednesday, November 5

TRANFORMING HOW WE CARE FOR THOSE NEAR THE END OF LIFE
SUSAN TOLLE
Wednesday, November 12

COMMUNICATING ABOUT PROGNOSIS AND END-OF-LIFE CARE IN PATIENTS WITH ADVANCED CANCER
JENNIFER TEMEL
Wednesday, November 19

THE FIVE HORSEMEN: MANAGING ‘WICKED’ GLOBAL CRISES
DANIEL CALLAHAN
Wednesday, December 3

SEDATION, CONSCIOUSNESS AND PERSONHOOD: CLINICAL AND ETHICAL PERSPECTIVES IN A PALLIATIVE SETTING
TIMOTHY QUILL
Wednesday, December 10

DONATION AFTER CARDIAC DEATH (DCD): ACADEMIC DISSENT FAILS PATIENTS
TRACY KOOGLER
Wednesday, January 7

THE COST OF END-OF-LIFE CARE
TOMAS PHILIPSON
Wednesday, January 14

MEDICAL STUDENT REFLECTIONS ON CARING FOR DYING PATIENTS
MARK KUCZEWSKI
Wednesday, January 21

WHEN GOOD INTENTIONS AREN’T ENOUGH: BARRIERS TO OPTIMAL END-OF-LIFE CARE
RANJANA SRIVASTAVA
Wednesday, January 28

END-OF-LIFE DECISIONS IN PEDIATRICS: WHY THEY ARE DIFFERENT
JOEL FRADER
Wednesday, February 4

PREDICTING END OF LIFE
BILL MEADOW
Wednesday, February 11

DEMOCRATIC LEGITIMACY AND END-OF-LIFE DECISIONS
DAN BRUDNEY
Wednesday, February 18

THE PROMISE OF A TREATMENT: CARDIAC ARREST AND ITS EFFECT ON CONTEMPORARY MEDICINE
DAN BRAUNER
Wednesday, February 25

ETHICAL OBLIGATIONS AND CLINICAL CARE IN END-OF-LIFE CARE: DERIVING A QUALITY-OF-LIFE CONSTRUCT BASED ON THE ISLAMIC CONCEPT OF ACCOUNTABILITY BEFORE GOD
AASIM PADELA
Wednesday, March 4

TORT LIABILITY IN END-OF-LIFE CARE
NADIA SAWICKI
Wednesday, March 11

ETHICAL ISSUES IN DISCONTINUING LVADS
SAVITRI FEDSON
Wednesday, April 1

IMPROVING QUALITY REDUCES COSTS: ETHICAL ASPECTS OF CARE FOR THE SERIOUSLY ILL
DIANE MEIER
Wednesday, April 8

PERSONS WITH DEMENTIA: ARE THEY THE CANARY IN THE COAL MINE?
JOAN TENO
Wednesday, April 15

WHAT’S SO HARD ABOUT END-OF-LIFE DECISION-MAKING?
PETER UBEL
Wednesday, April 22

A GENERATION LATER: WHY HAS THE END-OF-LIFE DEBATE ENDED?
RICHARD EPSTEIN
Wednesday, April 29

ECMO AS A ‘BRIDGE TO NOWHERE’: ETHICALLY CHALLENGING POIGNANT CASES FROM THE TECHNOLOGICAL EDGE
KEN PRAGER
Wednesday, May 6

LAST EXIT OFF THE CARDIAC FREEWAY: ETHICAL CONSIDERATIONS IN PALLIATIVE CARE AND CARDIOVASCULAR IMPLANTABLE ELECTRONIC DEVICES
JAMES KIRKPATRICK
Wednesday, May 13

ONE EXPLORER’S MAP INTO THE WORLD OF PALLIATIVE CARE CHAPLAINCY RESEARCH
LINDA EMANUEL
Wednesday, May 20

September 18, 2014

Better to Be Dead than Disabled?

The disability rights group Not Dead Yet is leading a three-day protest vigil against the World Federation of Right to Die Societies which is holding a meeting that I am attending in Chicago.  

Disability rights advocates have certainly expressed some valid concerns about the expansion of options to hasten death.  Legislators, regulators, and clinicians should seriously grapple with concerns like risks of bias and coercion.  

Unfortunately, the disability groups reach far beyond their valid concerns to make hyperbolic comments.  For example, Not Dead Yet president Diane Coleman stated: "We are here to contradict the message of these groups that it’s better to be dead than disabled."  

That is emphatically not the message of any group attending this meeting.  The core thesis of this meeting is that particular individuals, after careful deliberation, may determine that in their own situation they want to avoid the effects of advanced illnesses like severe dementia.  They would rather die than live a life that they find intolerable. 

There has not been a single suggestion about what individuals ought to choose.  The focus remains on what individuals may choose, on what they have a right to choose for themselves.

September 18, 2014

Improving Quality and Honoring Individual Preferences Near the End of Life (IOM 2014)

Yesterday, the Institute of Medicine released its 500-page report, Improving Quality and Honoring Individual Preferences Near the End of Life. A substantial body of evidence shows that broad improvements to end-of-life care are within reach. In Dying ...
September 17, 2014

Prevalence of Non-Beneficial ICU Treatment

The Ventura County Star has a new story and a poll on medical futility.  In addition to recounting the widely discussed UCLA research, health care reporter Tom Kisken interviews clinicians at other Southern California hospitals. "I think it happe...
September 17, 2014

International Resource Library on Adult Guardianship

The 3rd World Congress on Adult Guardianship recently convened in Washington, DC. One of the goals of this Congress was to form an online International Resource Library on Adult Guardianship.  That resource is now available here.

The organizers are also looking for more submissions, including papers, brochures, manuals, handbooks and more, are welcome if they would be of help to others.  Submissions may be made by emailing info@nationalguardianshipnetwork.org with the subject line “resource library.” Please provide, in English, a description regarding the document(s) you send, so that they can name and categorize them. 


September 16, 2014

Emotional, Religious Reasons to Keep Grandson in PVS on Life Support

This sad story in the Chicago Tribune powerfully illustrates why one grandmother could not consent to comfort care only for her grandson.  

The grandmother's daughter had been shot by a gang member while still pregnant.  "To Jefferson, the baby looked just like her daughter — her face, her color, her hands. But doctors told her [the baby] would remain in a persistent vegetative state, unable to see, hear or breathe on his own."  Clinicians "urged her to remove him from life support, telling her his condition would never improve." 

The grandmother "set the date to pull the plug — Oct. 20, 2011, what would have been her daughter's 18th birthday.  But she had a change of heart as she entered Advocate Christ Medical Center that day.  

"I couldn't see turning the machine off on him . . ..   Who am I to judge whether he lives or dies, OK?  I think at (the hospital) a lot of them were kind of disappointed with me because they thought actually I was
going to turn the machine off. . . .  But my faith didn't allow me to do it."

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