Hot Topics: End of Life Care

Blog Posts (51)

September 24, 2014

Sophie’s Choice: Can Machines Do Any Better?

by Craig Klugman, Ph.D.

In the 1979 novel Sophie’s Choice by William Styron, the reader meets a Holocaust survivor who was forced in the camps to choose which of her two children would die immediately.…

September 18, 2014

A simple change? The IOM Report on “Dying in America”

by Craig Klugman, Ph.D.

Say there was a simple change that could be made to the health care system that would reduce cost, reduce demand, increase patient’s quality of life and satisfaction, address the whole patient and not just the disease, improve care coordination, and increase patient autonomy.…

September 3, 2014

A Distinction for the Debate over Brain-Death

<p style="line-height: 19.0400009155273px;"><span style="line-height: 19.0400009155273px;">There has been a good bit of debate lately in bioethics circles over the concept and proper definition of death.   The disagreement is between those who think that the cessation of brain activity or ‘brain-death’ is sufficient for death, on the one hand, and those who think that brain-dead patients whose circulatory systems continue to function are still alive, on the other.  Consider, for example, the recent tragic case of Jahi McMath.  McMath suffered complications from a surgery to correct sleep apnea which resulted in cardiac arrest and her being placed on a ventilator.  Shortly after physicians at Oakland Children’s Hospital pronounced her brain-dead and so legally dead.  Her family, however, disagreed, and appealed to the courts for Jahi to be maintained via mechanical ventilation and PEG tube.</span></p> <p style="line-height: 19.0400009155273px;">Although Jahi’s family disagrees with the claim that she is brain-dead (insisting that she is merely ‘brain-damaged’), suppose the Oakland physicians are correct in their diagnosis of brain death.  Nonetheless, even after the pronouncement of brain-death Jahi’s body continued to exhibit the sort of homeodynamic equilibrium—at least for the time being, and with assistance from mechanical ventilation and other life-sustaining interventions—characteristic of living organisms.  It was warm to the touch; her heart continued to pump blood through her veins; and so on.  Indeed the bodies of brain dead patients have in some cases remained functional for weeks and even months, performing such surprising feats as undergoing puberty and even gestating fetuses. This has led certain physicians and philosophers to question whether brain death is really sufficient for death.  Patients who are truly dead, after all, could not be warm to the touch or gestate fetuses.  Could they?  </p> <p style="line-height: 19.0400009155273px;"><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 20px;">The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our <a style="text-decoration: underline; color: #000099;" href="http://www.amc.edu/Academic/bioethics/index.cfm">website</a>.</strong><span style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 20.3999996185303px;"> </span></p>
August 27, 2014

Brain Death Is a Flash Point in End-of-Life Law, Ethics and Policy

by Thaddeus M. Pope, J.D., Ph.D.

The August 2014 issue of the American Journal of Bioethics includes nearly 20 articles on the status of death determined by neurological criteria (DDNC or “brain death”). …

August 21, 2014

Suicide and Terminal Diseases: A Personal Choice and Rational Approach

by Craig Klugman, Ph.D.

My spouse and I have an ongoing conversation, really more of an argument, about one end-of-life scenario.…

August 12, 2014

Lessons from France: Decision-Making At the End-of-Life

by Craig Klugman, Ph.D.

In the United States, the notion of autonomy is held in high regard. Since the development of patient’s rights in the early 1970s, the notion that an individual has the capacity of self-governance is a cornerstone of medical ethics and a standard of medical care.…

July 16, 2014

de Beauvoir’s A Very Easy Death

My dissertation advisor recommended that I read Simone de Beauvoir’s A Very Easy Death when I was writing my dissertation on ambivalence. …

June 16, 2014

MEDICAL FUTILITY, THEN AND NOW

by Barron H. Lerner, M.D., Ph.D.

When an article promoting the idea of medical futility appeared in the Annals of Internal Medicine in 1990, my father was thrilled. …

May 21, 2014

National Healthcare Decisions Day: The Need to Reach New Audiences

<p>The seventh annual <a href="http://www.nhdd.org/">National Healthcare Decisions Day</a> (NHDD) was held on April 16<sup>th</sup> of this year, and events at national, state and local levels were held to educate people about the importance of advance care planning and encourage participants to complete advance directives. Providing resources and information that drives home the message about how important it is to let others know one’s preferences for healthcare and end of life care is intended to promote conversation and documentation of these wishes which are then implemented when the individual is no longer able to express preferences for themselves. But does it do enough to generate interest in those who prefer to avoid such unpleasantries?</p> <p class="MsoNormal">Repeated studies show that advance directive completion rates are low in the US. People simply do not like to talk about end of life, and it is not clear that the NHDD, however well intended, is making the topic any more palatable. Designating a day to recognize the importance of advance directives is an important start, and the materials are often excellent. <a href="https://www.agingwithdignity.org/five-wishes.php">Five wishes</a>, for example, gives a carefully crafted set of questions to help people thoughtfully consider what matters most to them when it comes to medical intervention, particularly in the end of life context. Still, this only works if people come to the table for the conversation.</p> <p class="MsoNormal"><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 20px;">The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our <a style="text-decoration: underline; color: #000099;" href="/Academic/bioethics/index.cfm">website</a>.</strong></p>
May 20, 2014

What we are forgetting in the case of Jahi McMath: Culture and its impact on medical decision-making

by Keisha Ray, Ph.D.

Like many others, I followed the very unfortunate case of Jahi McMath. McMath is a 13 year-old black child who went into cardiac arrest and suffered irreparable brain damage after undergoing a tonsillectomy to relieve sleep apnea.…

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Published Articles (4)

American Journal of Bioethics: Volume 14 Issue 8 - Aug 2014

Brain-Dead and Pregnant in Texas Thomas Wm. Mayo

American Journal of Bioethics: Volume 13 Issue 3 - Mar 2013

Withdrawal of Nonfutile Life Support After Attempted Suicide Samuel M. Brown, C. Gregory Elliott & Robert Paine

American Journal of Bioethics: Volume 13 Issue 3 - Mar 2013

Suicide and the Sufficiency of Surrogate Decision Makers Hywote Taye & David Magnus

AJOB Neuroscience: Volume 4 Issue 1 - Feb 2013

Communicating with the Minimally Conscious: Ethical Implications in End-of-Life Care Kathrine Bendtsen

News (358)

August 12, 2014 1:54 pm

Briton with advanced heart failure launches new gene therapy trial

A 37-year-old British man who needs a mechanical pump to keep his heart working has kicked off tests to see if gene therapy could help him recover and potentially avoid the need for a heart transplant.

July 22, 2014 11:28 am

Germany allows seriously ill patients to grow their own cannabis

A German court ruled on Tuesday that some people suffering from chronic pain should be able to cultivate their own cannabis “for therapeutic purposes”.

June 23, 2014 1:55 pm

Critical Care Challenge: Dying with Dignity in the Intensive Care Unit

After a long ICU stay because of septic shock and multiple complications, a frail 77-year-old man had a fall and suffered an acute subdural hematoma and hemorrhagic contusion. Twelve days after evacuation of the subdural hematoma, he remains in a coma and is still receiving mechanical ventilation. How should decisions be made about further treatment?

June 3, 2014 2:01 pm

End-of-Life Doc Payment Plan Returns to the Fray

The federal government may reimburse doctors for talking to Medicare patients and their families about “advance care planning,” including living wills and end-of-life treatment options — potentially rekindling one of the fiercest storms in the Affordable Care Act debate.
May 19, 2014 2:46 pm

‘Right to Try’ laws spur debate over dying patients’ access to experimental drugs

Colorado, Missouri and Louisiana are poised to become the first states in the nation to give terminally ill patients the right to try experimental drugs without the blessing of the Food and Drug Administration, setting the stage for what could be a lengthy battle over who should decide whether a drug is too risky to try.

May 9, 2014 7:58 pm

For elderly hospital patients, CPR often has poor outcome: study

When older hospitalized patients need revival by CPR, more than half are likely to die before they are discharged, according to a new study.

May 6, 2014 3:44 pm

Lawmakers propose incentives for end-of-life planning

If you are one of the estimated 70 percent of Americans who have not documented your end-of-life healthcare preferences, Republican Senator Tom Coburn of Oklahoma hopes a cash incentive will prompt you to do the paperwork.

April 16, 2014 2:08 pm

National event urges Americans to plan for the end

With taxes filed, Americans today are being asked to consider life’s other certainty: death, and the myriad complications that often now accompany it.

April 16, 2014 2:04 pm

Is a patient ‘vegetative?’ The crucial answer may be quite wrong.

It seems as if barely a year goes by without a painful, public and often politicized controversy over whether or not someone is in a “vegetative state,” beyond consciousness and some say the need for life support. The most famous case was that of Terri Schiavo in 1990.

March 28, 2014 2:46 pm

Mother of brain-dead Jahi McMath says daughter is 'still sleeping'

The mother of Jahi McMath, the 13-year-old Oakland girl declared brain dead by multiple neurologists more than three months ago, insisted Thursday that her daughter was “asleep” and “blossoming into a teenager.”

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