Blog Posts (5230)
June 20, 2018
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
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
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
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
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
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,
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.
“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 —
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.
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
RIC1607135, claims 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 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
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
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
“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.”
A 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
June 13, 2018
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
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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June 7, 2018 9:00 am
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
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
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
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
International health organizations are in discussions with the Democratic Republic of Congo about how and whether to deploy treatments in addition to a vaccine.
March 8, 2018 9:00 am
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
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.
December 29, 2017 9:00 am
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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