Hot Topics: End of Life Care

Blog Posts (64)

July 15, 2015

Medicare Considers the Value of Advance Care Planning

<p><span style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">Last week the Centers for Medicaid and Medicare <a href="http://www.huffingtonpost.com/2015/07/08/medicare-end-of-life-counseling_n_7757036.html">announced a proposal</a> that would provide Medicare reimbursement for providers to spend time with patients discussing advance care planning. </span><span style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">Though some have argued that this process will carry an inherent bias toward non-treatment, the purpose of such conversations is to seek direction from patients about preferences, values, and expectations should they lose the ability to <a href="http://www.nytimes.com/2015/07/09/health/medicare-proposes-paying-doctors-for-end-of-life-counseling.html?_r=2">express these things for themselves</a>.</span><span style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;"> While many persons who articulate their treatment preferences indicate the desire to forego aggressive intervention, this is hardly unanimous. There are plenty of folks who want all possible treatment offered to sustain life. The point of having discussions with healthcare providers is to determine what any given individual prefers.</span></p> <p class="MsoNormal" style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;"><span style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">Acute care providers have long been left with challenging dilemmas when patients are unable to communicate their healthcare goals, and the default is to treat and often treat aggressively. When a patient arrives to an acute care setting with documentation of preferences for treatment, interventions and goals can be set based on the individual’s prior wishes – whether this is to sustain life using any possible technology, or to allow a natural, uninterrupted dying process. The default of treating when there is any doubt will not change, but the opportunities for patients to discuss and document their own preferences will be enhanced with this legislative support. Providing muscle in the form of funding for these important conversations will only encourage more of a good thing. </span></p> <p><span style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 19.0400009155273px;"><strong>The Alden March Bioethics Institute offers a Master of Science in Bioethics, a</strong> </span><strong style="line-height: 19.0400009155273px; color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px;">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="color: #000099; text-decoration: underline;" href="/Academic/bioethics/index.cfm">website</a>.</strong></p>
June 17, 2015

Can An Advance Directive Ever Justify Cessation of Eating in an Alzheimer’s Patient?

by Craig Klugman, Ph.D.

Margot Bentley did what end-of-life care advocates say we should all do—she completed an advance directive. She wrote hers in 1991 when she was working as a nurse and stated that she did not resuscitation, surgery, respiratory support, or nutrition and hydration.…

May 14, 2015

Raging Against the Dying of the Light

by Craig Klugman, Ph.D.

When do we die? The legal and medical answer is we are dead when we either (a) have experienced total loss of all brain function or (b) cessation of cardiopulmonary activity.…

April 24, 2015

Human Remains for Compost: Repugnant or Resourceful?

<p><span style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">I am a lousy gardener. Just this year I am considering a small attempt at growing a few vegetables organically in my backyard. Maybe it was the long winter, maybe it is a drive to live more sustainably, maybe it is the challenge of overcoming decades of plant growing failures. After carefully selecting a few packets of easy to grow seeds and starting a few slow-growers inside, I have turned my attention to creating the best growing environment for these fragile plants. Part of this effort includes learning how to create compost from kitchen and yard waste materials. While I search for a suitable compost bin to take position behind the garage, I am diligently collecting fruit cores, egg shells, coffee grounds, and discarded greens in airtight containers in my fridge. Researching my options, I stumbled across an article that had me doing a double take, “A Project to Turn Corpses Into Compost” in the </span><a style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;" href="http://www.nytimes.com/2015/04/14/science/a-project-to-turn-corpses-into-compost.html?action=click&amp;contentCollection=N.Y.%20%2F%20Region&amp;module=MostEmailed&amp;version=Full&amp;region=Marginalia&amp;src=me&amp;pgtype=article&amp;_r=0">New York Times</a><span style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;"> online. I gasped in horror. Could this possibly be an ethical option for burial? Could this be legal? Was this environmentally safe? Was this a joke?</span></p> <p><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 19.0400009155273px;">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="color: #000099; text-decoration: underline;" 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: 19.0400009155273px;"> </span></p>
March 31, 2015

Terri Schiavo: Ten Years Later

by Craig Klugman, Ph.D.

Today acknowledges the tenth anniversary since the final death of Terri Schiavo. Her feeding tube was removed on March 18 and her body took its last breath on March 31, 2005.…

February 9, 2015

Canadian Supreme Court: Legal Assisted Suicide In a Year

by Craig Klugman, Ph.D.

A year from now, all Canadians may have the right to assisted suicide. In February 6, the Canadian Supreme Court ruled “that the prohibition on physician-assisted dying is void insofar as it deprives a competent adult of such assistance where (1) the person affected clearly consents to the termination of life; and (2) the person has a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.” In other words, a competent and capacitated person with a serious and unresolvable condition that creates suffering has a right to have assistance to end his or her life.…

January 28, 2015

Still Alice: A Portrait of Familial Alzheimer’s Disease

by Craig M. Klugman, Ph.D.

This past weekend I spent a cold, snowy day in the theater watching the movie Still Alice.…

November 12, 2014

Wisdom Does Come with Age

<p style="line-height: 19.0400009155273px;">Reminders of our finitude always lurk close by, like <a href="http://www.theatlantic.com/features/archive/2014/09/why-i-hope-to-die-at-75/379329/">Ezekiel Emanuel's</a> article in last month's Atlantic, "Why I Hope to Die at 75." The head of the <a href="http://bioethics.nih.gov/about/">Clinical Bioethics Department</a> at the National Institutes of Health gives reasons for not living beyond 75: inevitable decline, disability, incapacity, and diminishment of "creativity, originality, and productivity." According to Emanuel, we wish to be remembered for our good years, prior to decline.</p> <p style="line-height: 19.0400009155273px;"><span style="line-height: 19.0400009155273px;">There are grains of truth here. Many of us "die" well before we are officially declared dead. I've seen patients kept alive for far too long in permanent vegetative states, while family dynamics, emotions, finances and scarce medical resources are depleted. We pay a high price for medical "progress." I also know thriving, vibrant elderly, themselves significantly disabled and incapacitated.</span></p> <p style="line-height: 19.0400009155273px;"><strong style="line-height: 19.0400009155273px; color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px;">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></p>
November 12, 2014

Why the right to die movement needed Brittany Maynard

by Keisha Ray, Ph.D.

Brittany Maynard was diagnosed with brain cancer. At the age of 29 she decided to end her own life and “die with dignity” under Oregon’s “Death with Dignity Act.” There have been many articles written in support of Maynard’s choice and many articles written condemning her choice to die.…

November 5, 2014

Brittany Maynard: A Terminal Cancer Patient’s Controversial Choice

<p class="MsoNormal" style="line-height: 19.0400009155273px;"><span style="line-height: 22.3999996185303px;">The cover story of the October 27, 2014, issue of <a href="http://www.people.com/article/terminally-ill-brittany-maynard-decision-to-die">PEOPLE Magazine</a> featured Brittany Maynard, a 29-year-old Oregon woman with terminal brain cancer. </span><span style="line-height: 22.3999996185303px;">In the article, Ms. Maynard announced that she would end her life on November 1, 2014, on her own terms, availing herself of the physician-assisted suicide option under the 1997 Oregon<a href="http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Pages/index.aspx">Death With Dignity Act</a> (DWDA). </span><span style="line-height: 22.3999996185303px;">As planned, and according to her own schedule and timetable, she <a href="http://www.usatoday.com/story/news/nation-now/2014/11/02/brittany-maynard-/18390069/">died peacefully at home</a> – surrounded by family and friends – on Saturday, November 1. </span><span style="line-height: 22.3999996185303px;">She had signaled earlier in the week that she might <a href="http://www.usatoday.com/story/news/nation-now/2014/10/30/brittany-maynard-puts-off-ending-her-life/18166161/">delay taking her own life</a>, but in the end, it occurred as she <a href="http://www.washingtontimes.com/news/2014/oct/30/brittany-maynard-terminally-ill-cancer-patient-ret/">originally planned</a>.</span></p> <p class="MsoNormal" style="line-height: 19.0400009155273px;"><span style="line-height: 22.3999996185303px;"></span><span style="line-height: 22.3999996185303px;">In electing assisted suicide, Ms. Maynard said, “I’m choosing to put myself through less emotional and physical pain.” She continued, “I don’t want to die, but I’m dying. My cancer is going to kill me, and it’s a terrible, terrible way to die. … When I look at both options I have to die [dying from the cancer versus dying from an overdose], I feel this [a fatal dose] is far more humane.” But rethinking the possibilities after developing a rather extensive plan in orchestrating one’s death with a terminal illness is not that unusual either. Roughly 40% of those who obtain the lethal doses of medicine under Oregon’s DWDA in the end die not from suicide but disease. According to an article in </span><em style="line-height: 22.3999996185303px;"><a href="http://www.thenewatlantis.com/publications/ten-years-of-death-with-dignity">The New Atlantis</a></em><span style="line-height: 22.3999996185303px;">, written to report a 10-year experience under the DWDA, author Courtney Campbell wrote, “In ten years, 541 Oregon residents have received lethal prescriptions to end their lives; of this number, 341 patients actually ingested the drugs.”</span></p> <p class="MsoNormal" style="line-height: 19.0400009155273px;"><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 19.0400009155273px;">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></p>

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Published Articles (5)

American Journal of Bioethics: Volume 15 Issue 1 - Jan 2015

Ethical Obligations and Clinical Goals in End-of-Life Care: Deriving a Quality-of-Life Construct Based on the Islamic Concept of Accountability Before God (Taklīf) Aasim Padela & Afshan Mohiuddin

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 (372)

July 8, 2015 5:29 pm

California assisted suicide bill stalls before committee

A contentious physician-assisted suicide bill that would allow some terminally ill patients in California to legally obtain medication to end their lives has stalled, state lawmakers said on Tuesday, amid staunch opposition from religious leaders.

July 6, 2015 1:31 pm

What remains unsaid about assisted suicide

Sick patients sometimes ask for help in hastening their deaths, and some doctors will hint, vaguely, how to do it.

July 1, 2015 4:01 pm

California Mom Christy O’Donnell Fights to Die on Her Own Terms

A terminally ill single mom who has been given months to live is fighting the state of California for the right to die. Now, a judge has ordered an expedited review of her suit, which will be heard later this month.

June 30, 2015 3:47 pm

Supreme Court Allows Use of Controversial Sedative for Lethal Injection

On Monday, the Supreme Court ruled 5-4 in the case of Glossip v. Gross, deciding that it is indeed constitutional to use the controversial execution drug midazolam for death penalty sentences fulfilled by lethal injection — the same drug that was used as a sedative in botched executions over the last two years.

June 23, 2015 1:48 pm

California bill gives terminally ill patients Right To Try experimental drugs

Not long after he was diagnosed with ALS, Jim Barber clung to a small dose of hope: The East Bay resident became eligible to enter a 5-year-long clinical trial for a drug that sought to slow the progression of the incurable neurodegenerative, life-sapping disease.

May 21, 2015 3:25 pm

California Medical Association drops opposition to doctor-assisted suicide

The California Medical Association on Wednesday dropped its three-decade opposition to physician-assisted suicide, possibly paving the way for already-introduced legislation that would make the practice legal for terminally ill patients in the state.

April 23, 2015 5:07 pm

High morale linked to longer survival among elderly

Whether it is cause or effect is unclear, but high morale seems to go along with a longer life, according to a new Scandinavian study.

April 22, 2015 4:55 pm

Death in Secret: California’s Underground World of Assisted Suicide

Physician-assisted suicide is illegal in California. But that doesn’t mean it doesn’t happen. Sick patients sometimes ask for help in hastening their deaths, and some doctors will explain, vaguely, how to do it.

March 23, 2015 7:43 pm

Reimburse doctors for helping patients plan end of life care, experts say

Physician incentives are needed to improve end of life care in the U.S., health experts said Friday at an Institute of Medicine (IOM) forum.

February 26, 2015 6:18 pm

Couple Married 67 Years Dies Holding Hands

After spending 67 years together as devoted husband and wife, there was no question how Floyd and Violet Hartwig would end their lives — together.

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