» End of Life Care Where the World Finds Bioethics Tue, 22 Apr 2014 22:10:42 +0000 en-US hourly 1 Senator Advances Bill To Pay Medicare Beneficiaries to Register Advance Directives Mon, 21 Apr 2014 20:56:52 +0000 by Craig Klugman, Ph.D.

U.S. Senators Tom Coburn (R-OK) along with Senators Christopher Coons (D-DE) and Richard Blumenthal (D-CT) introduced a bill to the U.S. Senate (S. 224) that would “encourage Medicare beneficiaries to voluntarily adopt advance directives guiding the medical care they receive.”  The regulations for this bill are to be created by a broad group of stakeholders.

Specifically, the bill would:

(a) Establish an Advance Directive Certification Program
(b) Accredit vendors of online and written stored advance directives
(c)  Provide an incentive for completing an advance directive.…

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National Health Care Decisions: A Week of Dying in America Thu, 17 Apr 2014 21:26:41 +0000 by Craig Klugman, Ph.D.

This week is host is National Healthcare Decisions Day. The goal of this April 16th event is to “inspire, educate, and empower the public and providers about the importance of advance care planning.” Events are being held nation-wide to encourage people to complete advance directive forms as well as to have conversations with their friends and family about end-of-life health care wishes.

The latest study shows that 26% of people in general have completed advance directives.…

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National event urges Americans to plan for the end Wed, 16 Apr 2014 18:08:11 +0000 0 Is a patient ‘vegetative?’ The crucial answer may be quite wrong. Wed, 16 Apr 2014 18:04:42 +0000 0 Mother of brain-dead Jahi McMath says daughter is ‘still sleeping’ Fri, 28 Mar 2014 18:46:07 +0000 0 Crowdsourcing medical decisions: Ethicists worry Josh Hardy case may set bad precedent Mon, 24 Mar 2014 18:34:20 +0000 0 Death Panels: Can We Handle the Truth? Mon, 17 Mar 2014 22:57:13 +0000 by Thaddeus Mason Pope, JD, PhD

In December, I defended the term “death panel” on this blog.  Specifically, I demonstrated that we already have, and for over 50 years have had, quite a number of tribunals that act as death panels.  For example, at least daily, UNOS denies potentially life-saving organ transplant requests.  While the term “death panel” has a pejorative connotation, the essential concept and function is necessary.  Particularly in situations of strict scarcity, life and death decisions must be made. …

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Company Makes Drug Available To Ailing Boy Following Public Outcry Thu, 13 Mar 2014 19:41:34 +0000 0 How LaCrosse Wisconsin sets a new example when it comes to Advance Directives Mon, 10 Mar 2014 03:03:19 +0000 0 Mom: Hopeful signs seen in teen called brain dead Thu, 20 Feb 2014 22:47:46 +0000 0 Brain-dead pregnant woman to be laid to rest after being removed from life support Mon, 27 Jan 2014 22:45:10 +0000 0 What’s at issue in Texas battle over brain-dead pregnant woman Fri, 24 Jan 2014 19:02:31 +0000 0 Ethicists criticize treatment of brain-dead patients Fri, 10 Jan 2014 19:34:41 +0000 0 It’s the Ventilator’s Fault Fri, 10 Jan 2014 14:55:25 +0000 by Craig Klugman, Ph.D

If you were from a foreign nation looking at the United States news right now, you would think that this was a nation that had declared war on death. Or perhaps we could state it better as a total denial of death. In California, Jahi McMath, a teenage girl who has been medically and legally dead for nearly a month (death certificate was issued December 12) has been moved to an unnamed facility and given surgical procedures to introduce air, water, and food more easily while her body continues to degrade and decay.…

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Brain Death Really Is Death Mon, 06 Jan 2014 22:02:19 +0000 0 Defining Brain Death Mon, 06 Jan 2014 21:59:39 +0000 0 The Year in Bioethics That Was Wed, 01 Jan 2014 21:05:33 +0000 by Craig Klugman, Ph.D.

Happy New Year. The ending of one year and the beginning of another is often a time for reflection, for reviewing the year that has passed and for making plans/predictions for the year to come. 2013 was the first full year of the re-launch of the editor’s blog as well.

Ten bloggers in addition to myself worked for us this year and we are thankful for their contributions: Maurice Bernstein, Arthur Caplan, Jennifer Chevinsky, Nanette Elster, Ellen Fox, Jessica Jerome, David Magnus, Steven Miles, Kayhan Parsi, and Thaddeus Pope.…

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Distinguishing Science from Nonsense Tue, 31 Dec 2013 21:18:46 +0000 by Arthur Caplan, Ph.D.

As Americans enter 2014 there is grave concern among our political leaders that we are lagging behind other nations in terms of our children’s’ scientific literacy.  This past December an international survey confirmed—too many American kids don’t understand science and they continue to fall behind children from other nations, many much poorer than we are in science and math skills.

Students in the United States slipped deeper in the last international science literacy rankings amid fast-growing competition abroad. …

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“Getting On” provides a look at aging and dying Thu, 26 Dec 2013 04:36:52 +0000 by Craig Klugman, Ph.D.

This has been a rich year for depictions of end-of-life and assisted living  in television this year. Back in August, I reported on a PBS series looking at life in assisted living and just last month I wrote about a Showtime documentary series about people at the end of life. The year in television is also ending with another show about the end-of-life, this one produced by HBO where all 6 episodes are available. Getting On is the story of 3 nurses and their demoted medical director, who run a woman’s rehabilitation unit affiliated with a hospital.…

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Death, brain death, and life support Wed, 25 Dec 2013 18:26:04 +0000 by Arthur Caplan Ph.D.

Concepts matter in doing the right thing in medicine.  This could not be more obvious then the utter confusion on display over the concepts of ‘brain death’ and ‘life support technology’ that has resulted in two dead people being kept on artificial life support in California and Texas.

In Oakland, California 13 year old Jahiu McMath has been maintained on machines since an elective tonsillectomy went horribly wrong on December 9.  She has been in the ICU on life-support at the Children’s Hospital since then.…

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Bioethicist: Girl’s tragic case can’t change reality of brain death Thu, 19 Dec 2013 18:56:55 +0000 0 Top 10 North American Death Panels Mon, 16 Dec 2013 17:36:58 +0000 by Thaddeus Pope, JD PhD

The term “death panel” is slippery.  It has been used either to describe or to disparage a rather motley group of initiatives and entities.  Here, I review the top ten North American “death panels.”  While common, applying the term “death panel” in the first two instances is inaccurate and misleading.  Indeed, most popular usage of the term “death panels” remains mere calumny.  But, sometimes, the “death panel” nomenclature is actually befitting.  In the remaining eight cases, the term “death panel” fits reasonably well.…

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When Parents Disagree With the Doctor Tue, 10 Dec 2013 05:21:19 +0000 by Craig Klugman, PhD

“You are considered sane until you disagree with the doctor” is an old adage in clinical ethics circles. We rarely question a patient’s ability to make decisions if the patient’s choice agrees with what the physician wants. I have had several cases where I’ve been asked to look at capacity issues for a patient showing signs of dementia. When I asked who consented for that patient’s procedures to that point, the response was usually, “the patient.” This incongruence seemed to escape notice.…

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When Less is More—Saying No to the Technological Imperative at the End of Life Thu, 05 Dec 2013 22:08:36 +0000 Nanette Elster, JD, MPH

Bioethicist and octogenarian Daniel Callahan wrote an op-ed in the New York Times this week about society’s quest to extend life. He opined, “Adding years to a life doesn’t necessarily make it any fuller.”  I understand Callahan’s view.  I recently assumed the role of healthcare power of attorney for an elderly relative who suffered a traumatic brain injury compounding a previously existing dementia.   I have posed a similar question to Callahan’s observation to every healthcare provider I have encountered during my relative’s most recent hospitalization. …

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Cuthbertson v. Rasouli: Limited Guidance from Supreme Court of Canada Mon, 25 Nov 2013 17:05:19 +0000 by Thaddeus Mason Pope, JD, PhD

On October 18, 2013, the Supreme Court of Canada issued its long-awaited opinion in Cuthbertson v. Rasouli.  Many lawyers and ethicists have already offered significant commentary on the case.  So, after briefly summarizing the litigation and the ruling, I will proceed to draw some important, but less obvious, observations and implications.

Summary of the Case
Cuthbertson v. Rasouli was a typical medical futility dispute.  The patient, Hassan Rasouli, has been a patient in Toronto’s Sunnybrook Health Sciences Center for over three years, dependent on life-sustaining treatment. …

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How Doctors Die: Showing Others the Way Tue, 19 Nov 2013 23:01:28 +0000 0 “Time To Die” Means Time to Talk Wed, 13 Nov 2013 07:35:50 +0000 by Craig M. Klugman, Ph.D.

Media images of dying surround us everyday. In an average hour of dramatic television, bodies fly across the screen as they are shot, knifed, bled, disintegrated, run over, and even decapitated. Heroes in these shows regularly kill the bad guys and in one case, the hero is the bad guy as serial murderer. And that’s before the news comes on.

While we are surrounded by death in our entertainment, these depictions have been blamed for numbing us to mortality and make us less likely to stare death in the face.…

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Paralyzed Hunter Chooses to End Life Support Thu, 07 Nov 2013 18:42:00 +0000 0 Texas woman with cancer pressuring experimental drug maker for “compassionate” access Mon, 23 Sep 2013 19:47:12 +0000 0 Stop Therapeutic Obstinacy: Penalties for Administering Futile ICU Interventions Wed, 18 Sep 2013 17:36:45 +0000 by Thaddeus Pope JD Ph.D.

Intensive care clinicians and clinical ethicists have long known that the provision of interventions perceived to be “futile” is a major problem in U.S. hospitals.  Medical futility is frequently reported to be a leading reason for ethics consultations.  Last week, a new study in JAMA Internal Medicine further quantified the prevalence and cost of interventions perceived to be “futile.”

In the study, a “futile” intervention was defined as treatment administered in situations satisfying one or more of five conditions:

  1. The burdens grossly outweigh the benefits.
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Long-term care panel suggests cutting 3-day hospital stay rule for SNFs Sat, 14 Sep 2013 16:04:20 +0000 0 Almost One-In-Five Intensive Care Patients May Be Getting Futile Treatment Wed, 11 Sep 2013 19:20:32 +0000 0 Anthony Yahle, Ohio Man, Comes Back To Life After Being Declared Dead Fri, 23 Aug 2013 21:12:35 +0000 0 Near death experiences could be surge in electrical activity Mon, 12 Aug 2013 19:34:53 +0000 0 Rebuttal to Jason Manne re Dangerous Catholic Attack on POLST Tue, 06 Aug 2013 23:36:02 +0000 This is a brief rebuttal to Jason Manne’s recent response to my post “ Dangerous Catholic Attack on POLST .”

Manne’s letter misses the point. First, POLST is not just a form but also a process and conversation. And POLST is continually improving: (1) through conducting a range of research projects to determine best practices, (2) through enhancing education, and (3) through quality assessment. POLST Paradigm continues to work toward better patient-centered care by encouraging advance care planning conversations, for those nearing the end of their lives, to ensure that clinicians honor both patient wishes to receive and patient wishes to limit treatment.

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The Television Truth of Assisted Living Fri, 02 Aug 2013 13:35:56 +0000 Craig Klugman, Ph.D.

When I was a child, every Sunday afternoon was dominated by a visit to Grandma in the nursing home. Today, we would call the place a “skilled nursing facility.” For a kid, this was not how I wanted to spend a weekend day. There were lines of people in wheelchairs “parked” against the walls. Those who would talk at all complained about the food, their medications, the staff, or their families. You had to speak quietly and sit still.…

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In Response to Professor Thaddeus Pope’s article “Dangerous Catholic Attack on the POLST?” Thu, 25 Jul 2013 19:33:49 +0000 Dear Sir or Madam:

I read with interest Professor Thaddeus Pope’s article ”Dangerous Catholic Attack on the POLST?”  The title of that article is insensitive inasmuch as the words “dangerous Catholic” imply a religious bias that I am sure was not intended.  Beyond this Pope’s article warrants rebuttal because it overstates the evidence supporting the form and is misleading.

Professor Pope asserts that “a number of scientifically rigorous studies have demonstrated POLST’s material benefits.”  This is an exaggeration. There are only two scientifically rigorous studies of the POLST and these are large NIH funded studies in which a POLST advocate was the principal investigator. …

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Dangerous Catholic Attack on POLST Fri, 19 Jul 2013 18:53:29 +0000 Thaddeus Mason Pope, JD PhD

The Physician Orders for Life-Sustaining Treatment (POLST) program is proving to be a highly effective mechanism for assuring that the life-sustaining treatment seriously ill patients want is the same treatment those patients get.  A number of scientifically rigorous studies have demonstrated POLST’s material benefits.  And a growing number of states have been adopting POLST through legislation, regulation, or clinical consensus.  But despite this notable quality improvement, a number of Catholic leaders and organizations have called on Catholic healthcare facilities to “not accept POLST forms and to decline to participate in POLST programs.”

POLST is a tool for translating patient’s goals of care into medical orders so that they are easily located and portable across care settings. …

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Wisconsin court upholds parents’ convictions in prayer death Thu, 04 Jul 2013 18:49:08 +0000 0 Defending Disability Discrimination Fri, 31 May 2013 19:06:41 +0000 by Thaddeus Mason Pope J.D., Ph.D.

In May 2013, Oklahoma enacted the Nondiscrimination in Treatment Act (NITA).  This law provides: “A health care provider shall not deny to a patient a life-preserving health care service the provider provides to other patients, and the provision of which is directed by the patient or [surrogate] . . . on the basis of a view that treats extending the life of an elderly, disabled, or terminally ill individual as of lower value than extending the life of an individual who is younger, nondisabled, or not terminally ill.”

Like a similar statute enacted in Idaho in 2012, the Oklahoma NITA is directed at disability discrimination. …

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Good People Doing Bad Things for Good Reasons Tue, 28 May 2013 21:14:21 +0000 Maurice Bernstein, MD

What is ethical or not is often in the eye of the beholder. That is why often the ethics of decisions or acts that we deal with in medicine is established through the process of consensus. And I don’t necessarily mean consensus by only scholars, lawyers or ethicists or even physicians. I think in ethical consensus the many voices of society should be included. I think that an understanding of reason for the divergent views that may occur in ethical analysis can be expressed by what Marcia Angell, former editor-in-chief of the New England Journal of Medicine has said in the past.…

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Vermont Passes Physician-Assisted-Suicide Thu, 16 May 2013 19:52:12 +0000 Craig Klugman, Ph.D.

Awaiting the governor’s signature, Vermont is poised to become the fourth state to legalize physician-assisted suicide. While Oregon and Washington legalized physician-aid-in-dying through public referendum and Montana through a court decision, Vermont’s is occurring through the legislative process.

The first U.S. aid-in-dying law was the Oregon 1994 Death with Dignity Act. The law faced a referendum to appeal it in 1997 and a Bush administration court challenge was ruled on in 2006.

The Vermont law mirrors those of Oregon and Washington.…

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Alzheimer’s sufferer dies from snake bite after his family chooses NOT to give him anti-venom Thu, 02 May 2013 19:56:51 +0000 0 Patients should decide what the end of life is like, study says Thu, 21 Mar 2013 18:41:48 +0000 0 Check out AJOB Volume 13 Issue 3!!! Mon, 18 Mar 2013 17:06:34 +0000 AJB 13(3)_200In this issue:



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The CPR Death At Glenwood Gardens: What Really Happened And Five Lessons You Should Learn Wed, 06 Mar 2013 21:08:43 +0000 0 Ethics required medical staff to do CPR, even if policy doesn’t, bioethicist writes Mon, 04 Mar 2013 20:18:14 +0000 0 ‘Cost of Dying’ series wins national health care journalism award Wed, 27 Feb 2013 23:53:55 +0000 0 A Directive Too Far Wed, 27 Feb 2013 22:44:11 +0000 Craig Klugman, Ph.D.

For two decades, people in bioethics and medicine have extolled the virtues of advance directives. These documents allow a person to (a) list procedures, treatments, and values regarding desired future medical care and (b) designate an individual to be a surrogate decision-maker, when the patient lacks the capacity to make decisions and communicate them. Studies show that nearly 21% of adults today have completed such documents. And yet there is substantial evidence that advance directives are of limited utility.

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Withdrawal of Nonfutile Life Support After Attempted Suicide Wed, 27 Feb 2013 19:40:52 +0000 0