Hot Topics: Health Care

Blog Posts (5230)

June 20, 2018

3rd International Conference on End-of-Life Law, Ethics, Policy, and Practice

Join me at the 3rd International Conference on End-of-Life Law, Ethics, Policy, and Practice, which takes place March 7-9, 2019 in Ghent, Belgium. ICEL1 (in Brisbane) and ICEL2 (in Halifax) were world class. So, this should be too.

ICEL3 will be a 2 ½ day deep dive into stopping/not starting potentially life-sustaining treatment, palliative sedation, medical assistance in dying, and the next generation end of life issues.

This is a multidisciplinary, multisectoral, and multinational conference, with presenting disciplines including, but not limited to, law, medicine, nursing, philosophy and bioethics, and sectoral representation spanning practitioners, academics, NGOs, and regulators an policy-makers. 

ICEL3 will engage with empirical evidence about, and legal and ethical analysis of, many of the most pressing and vexing issues of our time. Leading experts from around the world will present on their findings. Participants will engage with others who are wrestling with the challenges of end of life care. 

Abstract submission is open until 1 September 2018.

June 19, 2018

Patient Decision Aids - Important for Bioethics & Health Law

I was surprised, this afternoon, when only two or three in a room full of medical ethicists (at the IME Summer Research Conference in Oxford) were familiar with patient decision aids. This is the same response that I received, last week, in a room fu...
June 19, 2018

Vaccines: Modern Trolley Car Dilemmas

The Trolley Car dilemma is back in bioethics news. For those unfamiliar with the trolley car dilemma, you alone are responsible to operate a trolley track switch to divert an out-of-control trolley car away from five workers on one section of track only to cause the death of a lone worker on the only alternate …

Continue reading "Vaccines: Modern Trolley Car Dilemmas"

June 19, 2018

New Advance Directives for Dementia

Judy Schwarz at End of Life Choices New York gave a great webinar (also recorded and archived) a few days ago on EOLCNY's new advance directive for dementia.  This unique written advance directive is designed for those with an early stage of...
June 17, 2018

Jayden Auyeung "Dies" During Court Conflict over Brain Death with Children's Hospital of Philadelphia

In May 2018, the parents of 10-year-old Jayden Auyeung obtained a temporary restraining order in Philadelphia Common Pleas Court, after Children's Hospital of Philadelphia declared him brain dead and planned to remove organ-sustaining treatment. That b...
June 15, 2018

California Appeals Court Suspends Lower Court Ruling, Reinstates End of Life Option Act

A California appeals court today granted emergency motions by the two terminally ill adults and a physician represented by Compassion & Choices for an “automatic stay” to immediately suspend a lower court’s judgment invalidating the End of Life Option Act. The appeals court also granted a motion by Attorney General Xavier Becerra for a “discretionary stay” of the lower court ruling. The rulings reinstate the law, effective immediately.

Similar to laws in Washington, D.C. and six states, the California law gives mentally capable, terminally ill adults with six months or less to live the option to request prescription medication they can decide to take to end unbearable suffering and die peacefully in their sleep.

On May 15, Riverside County Superior Court Judge Ottolia granted the plaintiffs’ motion in the lawsuit to invalidate the End of Life Option Act by Life Legal Defense Foundation, American Academy of Medical Ethics and several physicians. On May 24, he issued a judgment that was required to actually invalidate the law. Judge Ottolia ruled the legislature violated the state constitution by passing the law during a special session Gov. Brown proclaimed was limited to health care, despite the fact that Gov. Brown signed the bill into law.

The 4th District Circuit of Appeal granted Compassion & Choices motion for an “immediate stay” order that reinstates the law pending further review (see ruling at: The appeals court order concluded:

“The request for an immediate stay is GRANTED. The trial court's order of May 21, 2018, and judgment of May 24, 2018, are hereby STAYED pending determination of the [appeal].”

“This stay is a huge win for many terminally ill Californians with six months or less to live because it could take years for the courts to resolve this case,” said Kevin Díaz, national director of legal advocacy for Compassion & Choices, whose sister organization, Compassion & Choices Action Network, led the campaign to pass the End of Life Option Act. “Thankfully, this ruling settles the issue for the time being, but we know we have a long fight ahead before we prevail.”

“The appeals court made the legally correct decision by reinstating the status quo of the law being in effect, before the lower court ruling, until the courts resolve this case,” said John Kappos, a partner in the O’Melveny law firm working with Compassion & Choices, which has filed several motions in the case. “Ultimately, we are confident the courts will rule the law is constitutional and valid.”

“This ruling is a key first step towards righting the wrong,” said Jon B. Eisenberg, Esq, of Healdsburg (Sonoma County), an expert in appellate law working with Compassion & Choices legal team. “It is great news for terminally ill Californians who have been in legal limbo for the last few weeks, a limbo that could have lasted much longer without the stay because this case could last months or years, and they would have not access to the law in the meantime.”

Last June, Compassion & Choices released a report estimating that 504 Californians have received prescriptions for medical aid in dying since it took effect on June 9, 2016. Last July, the California Department of Public Health released a report showing 191 terminally ill Californians received prescriptions from 173 doctors for aid-in-dying medication during the nearly seven month period from June 9, 2016 until Dec. 31, 2016; 111 of those individuals (58%) decided to self-ingest the medication.

Polling shows 76 percent of Californians across the political and demographic spectrum support medical aid in dying. This majority support includes 82 percent of Democrats, 79 percent of independents, 67 percent of Republicans, 75 percent of whites, Latinos and Asian Americans, and 52 percent of African Americans.

California is one of seven states — including Colorado, Montana, Oregon, Vermont, Washington, and Hawai‘i — as well as the District of Columbia, that have authorized medical aid in dying. Collectively, these eight jurisdictions represent nearly one out of five Americans (19%) and have 40 years of combined experience safely using this end-of-life care option.

Case Background:

On June 8, 2016  the day before the End of Life Option Act took effect on June 9, 2016  Life Legal Defense Foundation, American Academy of Medical Ethics and several physicians filed a lawsuit against the California attorney general and Riverside County district attorney in Riverside Superior Court seeking to invalidate the law. The lawsuit, Ahn vs. Hestrin — Case RIC1607135claims the law violates the due process and equal protection guarantees of the U.S. and California constitutions because it fails “to make rational distinctions” between terminally ill adults “and the vast majority of Californians not covered by the Act.” The suit also claims the legislature did not have the state constitutional authority to pass the health care law during a special session limited to health care.

On July 19, 2016, Compassion & Choices filed a friend-of-the-court brief opposing a motion by the plaintiffs for a preliminary injunction to suspend the End of Life Options Act.

On Aug. 26, 2016, Riverside County Superior Court Judge Daniel A. Ottolia rejected the preliminary injunction motion to suspend the law, but he allowed the suit to move forward.

On June 16, 2017, Judge Ottolia ruled that the lawsuit would proceed to trial to determine the merits of the case, but the End of Life Option Act remained in effect.

On May 15, 2018, Judge Ottolia granted the plaintiffs’ motion in the case to invalidate the law because he claimed the legislature violated the state constitution by passing it during a special session limited to health care issues. He gave Attorney General Xavier Becerra five days to appeal the ruling, and the attorney general did so on May 21.

On May 23, 2018, the 4th District Circuit of Appeal denied a separate motion by the attorney general for a stay to suspend the ruling, but ordered the plaintiffs to show cause why the appeals court should not overturn the ruling in 25 days. Despite the appeals court’s denial of the stay, Judge Ottolia’s original ruling didn’t invalidate the law because he had not yet issued a judgment giving effect to his decision reflected in his order on May 24.

On May 30, 2018, Judge Ottolia rejected a motion filed by Compassion & Choices on behalf of a physician and two terminally ill adults urging the judge to “vacate” (i.e., cancel) his judgment on May 24 invalidating the End of Life Option Act. However, he scheduled a hearing on June 29 to consider a separate motion by California Attorney General Xavier Becerra to vacate the judgment.

June 15, 2018

A safety concern with gene editing

Hat-tip to Dr. Joe Kelley for bring this to my attention… As readers of this blog will recall, there is keen interest in exploiting recent discoveries in genetic engineering to “edit” disease-causing gene mutations and develop treatments for various diseases.  Initially, such treatments would likely use a patient’s own cells—removed from the body, edited to change the cells’ genes in a potentially therapeutic way, then... // Read More »
June 14, 2018

End-of-Life Group Urges Congress to Reject Legislation to Repeal D.C. Death with Dignity Act

Compassion & Choices urged Congress to reject a policy rider attached to a government funding bill approved by the House Appropriations Committee late Wednesday night that would repeal the D.C. Death with Dignity Act. 

The policy rider is part of the Financial Services and General Government Appropriations bill for fiscal year 2019 that starts on Oct. 1, 2018.

Similar to laws in seven states, the D.C. Death with Dignity Act gives mentally capable, terminally ill adults with six months or less to live the option to get prescription medication they can take to end unbearable suffering and die peacefully in their sleep. 

Congressional opponents of medical aid in dying tried to repeal the law in February 2017 during a 30-legislative-day review period and during last year’s appropriations process, but they failed both times.

“Opponents of medical aid in dying should give up imposing their values on D.C. residents and focus on the issues impacting their constituents,” said Kim Callinan, CEO for Compassion & Choices, which led the campaign to pass the D.C. Death with Dignity Act. “Despite their efforts, the D.C. law remains in effect, and we are working closely with the D.C. Department of Health to make it easier for terminally ill patients to access the law.”

In addition to Washington, D.C., medical aid in dying has been authorized in seven states: Colorado, Hawai‘i, Montana, Oregon, Vermont, Washington, and California. However, the California law currently is facing a legal challenge based on a technicality. Collectively, these eight jurisdictions represent nearly one out of five Americans (19%) and have 40 years of combined experience safely using this end-of-life care option.

“Members of Congress from the seven states with medical aid-in-dying laws would be hypocrites if they supported this policy rider when their constituents have this end-of-life care option to peacefully end unbearable suffering,” said Callinan. “We cannot allow this federal power grab to succeed or it will spur efforts to try to ban medical aid-in-dying laws nationwide.”

The D.C. Council approved the Death with Dignity Act on Nov. 15, 2016, by a veto-proof 11–2 margin and the law went into effect on February 18, 2017Polling shows two-thirds of D.C. residents (67%) support medical aid in dying. 

Medscape online survey shows 7,500 doctors nationwide from 25 medical specialties nationwide support medical aid in dying by nearly a 2–1 margin (57% to 29%).

National and state polls show a majority of Americans across the ethnic, political and religious spectrum support medical aid in dying. This majority includes African Americans, Asian Americans, Latinos, conservatives, Democrats/Democratic-leaning independents, liberals, moderates, Republicans/Republican-leaning independents, Catholics, Christians, Protestants, people of other faiths, and people living with disabilities.

June 13, 2018

Aid-in-Dying is Health Care

Kathryn L. Tucker, the Executive Director of the End of Life Liberty Project, has a new piece in JURIST discussing the ongoing legal challenge to the California End of Life Options Act.
June 12, 2018

End of Life Care Strategic Plan for New Jersey

The New Jersey Health Care Quality Institute has released the "End of Life Care Strategic Plan for New Jersey." From the executive summary:

"New Jersey performs poorly on end-of-life care compared with almost every other state in the nation. The statistics translate into real people treated with unnecessary and unwanted medical care at the end of their lives. Too many people who want to die at home instead die in Intensive Care Units (ICUs). Too few benefit from hospice care — or benefit too late. . . . Our plan focuses on four key areas:"

Technology. We need a financially sustainable statewide electronic Practitioner Orders for Life Sustaining Treatment (POLST) registry so physicians and advanced practice nurses, in consultation with patients and caregivers, can document their end-of-life care wishes in a state recognized POLST form that is accessible to emergency and medical staff no matter where the person may be. We should connect Advance Directives and POLST forms to Electronic Health Records (EHR) systems, incorporate electronic reminders into the EHR to prompt providers to conduct advance care consultations with identified patients, and achieve wide-spread use of technology to identify those patients in greatest need of an end-of-life care plan. These steps are all achievable in the near term.

Payment. We must increase reimbursement and expand how we reimburse for valuable end-of-life consultations to promote greater use of this service. This should be done in our state Medicaid program and State Health Benefit Program. In addition, we must rethink reimbursement policies and rates for palliative care. Moreover, alternative payment models should reward providers that perform well on end-of-life care quality measures.

Education. Physicians and nurses in practice as well as those in medical and nursing school need education and coaching on how to have these difficult discussions with their patients and their caregivers. The medical and nursing schools in the state should develop a common curriculum to be implemented in their programs. Health systems and professional societies should provide and scale both web-based and in-person training, including simulation labs where providers can practice their skills with trained actors. Evidence based programs that address all of these education needs exist and can be implemented in short order.

Culture. The issue goes beyond the world of medicine. We need to change the culture around end-of-life care discussions. This includes an awareness campaign to educate our residents about care options at the end-of-life, including how to discuss care preferences with their providers and caregivers, and how to document decisions so that they will be followed. This work involves community leaders, clergy, social workers, public health departments, senior centers and libraries, and county surrogates. This work must be culturally sensitive and shared in multiple languages. 

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Published Articles (80)

AJOB Primary Research: Volume 9 Issue 2 - Jun 2018

Cross-cultural perspectives on decision making regarding noninvasive prenatal testing: A comparative study of Lebanon and Quebec Hazar Haidar, Meredith Vanstone, Anne-Marie Laberge, Gilles Bibeau, Labib Ghulmiyyah & Vardit Ravitsky

AJOB Primary Research: Volume 9 Issue 2 - Jun 2018

How acceptable is paternalism? A survey-based study of clinician and nonclinician opinions on paternalistic decision making Kunal Bailoor, Thomas Valley, Chithra Perumalswami, Andrew G. Shuman, Raymond DeVries & Darin B. Zahuranec

American Journal of Bioethics: Volume 18 Issue 5 - May 2018

What's in a Name? The Ethical Importance of Respecting a Patient's “Unexplained” Medical Concerns Kayhan Parsi & Nanette Elster

AJOB Neuroscience: Volume 9 Issue 1 - Mar 2018

Disorders of Consciousness, Agency, and Health Care Decision Making: Lessons From a Developmental Model Megan S. Wright, Claudia Kraft, Michael R. Ulrich & Joseph J. Fins

AJOB Neuroscience: Volume 9 Issue 1 - Mar 2018

When Does Consciousness Matter? Lessons From the Minimally Conscious State Joseph Vukov

AJOB Primary Research: Volume 8 Issue 1 - Mar 2018

“God is the giver and taker of life”: Muslim beliefs and attitudes regarding assisted suicide and euthanasia Chaïma Ahaddour, Stef Van den Branden & Bert Broeckaert

American Journal of Bioethics: Volume 18 Issue 3 - Mar 2018

The Default Position: Optimizing Pediatric Participation in Medical Decision Making Aleksandra E. Olszewski & Sara F. Goldkind

American Journal of Bioethics: Volume 18 Issue 3 - Mar 2018

Pediatric Participation in Medical Decision Making: Optimized or Personalized? Maya Sabatello, Annie Janvier, Eduard Verhagen, Wynne Morrison & John Lantos

American Journal of Bioethics: Volume 18 Issue 2 - Feb 2018

I, My Love, and Apps Craig Klugman

American Journal of Bioethics: Volume 18 Issue 1 - Jan 2018

From “Longshot” to “Fantasy”: Obligations to Pediatric Patients and Families When Last-Ditch Medical Efforts Fail Elliott Mark Weiss & Autumn Fiester

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News (2093)

June 7, 2018 9:00 am

What Explains The Rising Overdose Rate Among Latinos? (NPR)

Opioid overdose deaths among Latinos are surging nationwide as well. While the overall death toll is still higher for whites, it’s increasing faster for Latinos and blacks, according to data from the Centers for Disease Control and Prevention. Latino fatalities increased 52.5 percent between 2014 and 2016 as compared to 45.8 percent for whites. (Statisticians say counts for Hispanics are typically underestimated by 3 to 5 percent.) The most substantial hike was among blacks — 83.9 percent.

June 6, 2018 9:00 am

To be herself, she needs to change her body. But first, comes the battle with insurers (CNN)

The Trump administration has signaled its intention in recent months to rewrite a federal rule that bars health care discrimination based on gender identity. In its current form, that rule is one of the precious few tools transgender patients have to fight insurance denials for various medical treatments and procedures that fall under the broad umbrella of gender-affirming or transition-related care. Even with the rule in place, Jasmine and four other patients in different states detailed protracted battles for coverage.

May 30, 2018 9:00 am

Health Care for All (Harvard Medical School)

Shining light on a little-known moment in the struggle for racial justice in the United States, a new hour-long documentary film traces the momentous fight to secure equal access to health care for all Americans in the 1960s.

May 25, 2018 9:00 am

FDA just approved the first drug to prevent migraines. Here’s the story of its discovery—and its limitations (Science)

Worldwide, migraines strike roughly 12% of people at least once per year, with women roughly three times as likely as men to have an attack. The Migraine Research Foundation estimates that U.S. employees take 113 million sick days per year because of migraines, creating an annual loss of $13 billion. The toll underscores how little current treatments—not just drugs, but nerve-numbing injections, behavioral therapies, and special diets—can help many people. On the horizon, however, is a new class of drugs that many scientists believe can stop migraines at their root.

May 22, 2018 9:00 am

Experimental drugs poised for use in Ebola outbreak (Nature)

International health organizations are in discussions with the Democratic Republic of Congo about how and whether to deploy treatments in addition to a vaccine.

May 4, 2018 9:00 am

Up to 270 women may have died after England breast cancer screening failures (CNN)

As many as 270 women in England may have died because they were not called for a final breast cancer screening, the British government disclosed on Wednesday. UK Health Secretary Jeremy Hunt announced an independent inquiry into the failings, attributed to a computer algorithm error. An estimated 450,000 women failed to get a letter inviting them to their final screening, he said.

March 8, 2018 9:00 am

Like It Or Not, Personal Health Technology Is Getting Smarter (NPR)

With a network of smart devices collecting information on sleep, exercise, heart activity, weight and more, a clinical team equipped with powerful AI might be empowered to make more medical decisions remotely, he says, with fewer office visits.

March 7, 2018 9:00 am

U.S. Immigration Policy Threatens Shake-Up In Home Health Business (NPR)

On a rare rainy night in Albuquerque, two dozen students are learning the proper way to care for older people. Teacher Liliana Reyes is reviewing the systems of the body — circulatory, respiratory and so on — to prepare them for an upcoming exam. These students are seeking to join a workforce of about 3 million people who help older adults remain in their homes. They assist these clients with things like bathing, dressing, and taking medication on time. About a quarter of these workers are immigrants.

January 2, 2018 9:00 am

Retirement home shut down months after attack on 86-year-old (CNN)

December 29, 2017 9:00 am

Doctor faces charges over opioid prescriptions and 5 patient deaths (CNN)

A Pennsylvania doctor charged with causing the deaths of five patients by unlawfully prescribing opioids surrendered his license to prescribe controlled substances at a federal court hearing.

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