» Health Care Where the World Finds Bioethics Thu, 30 Oct 2014 20:07:35 +0000 en-US hourly 1 How Medicare Is Punishing Hospitals That Care For Poor People Wed, 29 Oct 2014 13:16:30 +0000 Continue reading ]]> 0 Ebola and Human Nature Wed, 29 Oct 2014 11:05:37 +0000 Read More »]]> 0 Jahi McMath – Prematurely Fostering Mistrust Wed, 29 Oct 2014 08:00:00 +0000 0 If no travel restrictions, then….quarantine? Wed, 29 Oct 2014 01:34:35 +0000 Read More »]]> 0 Responding to Ebola: The Question of Quarantine Tue, 28 Oct 2014 14:54:00 +0000 Karyn L. Boyar]]> 0 More Secret DNR Orders in UK – Barbara Gibson Tue, 28 Oct 2014 08:30:00 +0000
In the UK, clinicians may write a DNR order without consent, if they deem that to be in the patient's best interest.  But clinicians must still consult with the patient or family.  In other words, they may write a unilateral DNR order.  But they may not write a "secret" DNR order.
Yet, as I have recounted on this blog more than a dozen times, this continues to happen.   One of the most recent cases occurred in August 2014 at Ayr Hospital.

In an apology letter to the family, the said: “I wish to offer my sincere apologies again on behalf of all the staff concerned for the distressing events you have described, and wish to reassure you that lessons have been learned and that practice around DNACPR decisions are being reviewed and improved as a matter of urgency across the organization. . . .  It is evident from the review of Mrs Gibson’s medical records, and discussions with staff involved, there were failures in communicating the medical decisions around resuscitation to Mrs Gibson and yourselves.”

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Bioethics Commission FAQs from ASBH Mon, 27 Oct 2014 15:35:15 +0000 0 Must we all die with forced hand-feeding in Advanced Dementia? Will others honor our Living Will? Mon, 27 Oct 2014 14:32:00 +0000 0 Brittany Maynard Urges Palliative Care Specialist to Stop Misrepresenting Her Case Mon, 27 Oct 2014 07:30:00 +0000 Brittany Maynard urges palliative care specialist Ira Byock to stop misrepresenting her case prior to his debate with Compassion & Choices President Barbara Coombs Lee on the Diane Rehm Show this week
In comments that Brittany posted on the website for Rehm’s nationally-syndicated NPR show, she denied claims by Byock and other opponents of death with dignity that Compassion & Choices is using her to advance the aid-in-dying movement. Rehm read part of Brittany’s comments during her show. 

“I am Brittany Maynard and it concerns me that Dr. Ira Byock will speak on my ‘behalf’ at all again. I watched a special on PBS where this same individual spoke about my case as though he knew personal details about me, saying some things that were quite frankly not true.

“For example, he said that a gentle death would be available to me easily through hospice, unfortunately that would be after a great length of time, with lots of suffering (physical and emotional), and loss for my young body. He is right that this is not being accomplished successfully for many terminally ill Americans on a widespread basis across our country. This needs to change too, I agree with him there."

“But perhaps most disturbingly, Byock claimed that Compassion & Choices had somehow taken advantage of me through ‘exploitation’ and that I feel compelled to die now based on public expectations. I DO NOT, this is MY choice, I am not that weak. The day is my choice, I have the right to change my mind at any time, it is my right. I am very confident about this. This is a patient right that is critical to understanding Death with Dignity."

“The claim of exploitation is utterly false considering I had gone through the entire process of moving, physician approval for DWD [death with dignity], and filled my prescription before I EVER even spoke to anyone at Compassion and Choices about volunteering and decided to share my story. I support the organization because I support the cause. I believe this is a healthcare right and CHOICE that should be available to ALL terminally ill Americans."

“I made my decisions based on my wishes, clinical research, choices, discussions with physicians, and logic. I am not depressed or suicidal or on a ‘slippery slope.’ I have been in charge of this choice, gaining control of a terrifying terminal disease through the application of my own humane logic. We as a country have real issues with the way doctors are trained to speak about, educate and embrace realities of death."

“As a terminally ill patient, I find it disrespectful and disturbing when people discuss my personal health with details that are not accurate to push an agenda. My request is that physicians speak only what they directly know to be factually true and have a right to discuss. The best change for all our community, physicians and patients, will come from us pulling together and developing policies to protect the severely ill based on honesty, education, and humane treatment of suffering."

“I wish nothing but peace and healing for whom it is available, and a peaceful passing of comfortable choice for whom it is not.”

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Authorship in Global Health Research Mon, 27 Oct 2014 03:10:52 +0000 0 Medical Overview of Brain Death (Video) Sun, 26 Oct 2014 09:34:00 +0000 0 Making Decisions for Others – Surrogates & Unrepresented Patients (May 7-8, 2015) Sat, 25 Oct 2014 08:30:00 +0000 Ethical dilemmas commonly arise in healthcare regarding patients who are unable to make their own medical decisions.  
  • Who is best positioned to speak for these patients, and what decisions should we allow them to make? 
  • What if the patient has no friends or close family members, or close relatives disagree on the best course of action? 
  • Should there be a limit on what parents can decide for minor children? 

Cases involving decisions by others are often the most difficult cases that health care providers confront.  Yet policies pertaining to such decisions are frequently problematic, and education for providers about these issues is rarely prioritized.

The UAMS Intensive Healthcare Ethics Workshop for 2015 aims to bring together an interdisciplinary group of scholars to share research and experiences about decision-making for others. The workshop is designed for only a limited number of participants in order to be highly interactive, and will include keynote speaker and small group sessions, as well as submitted papers and posters.   

Submit proposals here by January 12, 2015.  

Jessica Berg, JD, MPH
Interim Dean, Professor of Law and Biomedical Ethics, and Associate Director of the Law-Medicine Center
Case Western Reserve University

Douglas B. White, MD, MAS
UPMC Endowed Chair for Ethics in Critical Care Medicine and Director, Program on Ethics and Decision Making in Critical Illness
University of Pittsburgh Medical Center

D. Micah Hester, PhD
Chief, Division of Medical Humanities, Clinical Ethicist
University of Arkansas for Medical Sciences and Arkansas Children’s Hospital

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Surprised by Joyousness Fri, 24 Oct 2014 22:40:04 +0000 Read More »]]> 0 Do Doctors Have a Duty to Treat Patients With Ebola? Fri, 24 Oct 2014 11:44:11 +0000 0 Today Is Jahi McMath’s Birthday Fri, 24 Oct 2014 07:30:00 +0000 0 The “Brains” Behind the Bioethics Commission and Why a Multidisciplinary Approach is the Smartest Approach Thu, 23 Oct 2014 16:06:34 +0000 0 Fear and Loathing in Liberia Thu, 23 Oct 2014 12:31:43 +0000 ]]> 0 Hope vs Realism in Cancer Research Thu, 23 Oct 2014 12:22:10 +0000 Read More »]]> 0 Supreme Court’s Decision in Tschumy: Told from the Front Line by the Lawyers Who Litigated the Case Thu, 23 Oct 2014 08:30:00 +0000 The Minnesota State Bar Association is presenting:  "The Supreme Court’s Decision in Tschumy: Told from the Front Line by the Lawyers Who Litigated the Case."  

The Minnesota Supreme Court recently issued its long awaited opinion in the important case of In re: the Guardianship of Jeffers J. Tschumy.  In a divided opinion, the Court found that a professional guardian can order the removal of life-support from patients without court review, as long as there is no dispute about that decision among interested parties.  The case raised the difficult issue of what powers a guardian has over removing life support when a patient has no hope of recovery.  

Please join the Health Law Section for a discussion of the Supreme Court’s decision by the two attorneys who litigated this important matter.
  • Michael J. Biglow, Law Offices of Michael J. Biglow
  • Robert A. McLeod, Lindquist & Vennum LLP

Friday, November 21, 2014, 8:00 AM to 9:00 AM
River Room / Town and Country Club  Saint Paul
Please join us for breakfast beginning at 7:30 a.m.

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The Ethics of Sperm Freezing for Teenage Boys Thu, 23 Oct 2014 03:10:12 +0000 0 VA Hospital Mistakenly Places DNR Order on Roland Mayo Wed, 22 Oct 2014 07:30:00 +0000 0 Barbara Mancini: Innocent of Assisted Suicide Tue, 21 Oct 2014 18:21:00 +0000 0 North Dakota Personhood Amendment – Impact on End-of-Life Care Tue, 21 Oct 2014 08:00:00 +0000 0 Multidisciplinary Learning for Medical Students Tue, 21 Oct 2014 03:10:07 +0000 0 Jean Davies – Successful VSED Mon, 20 Oct 2014 07:00:00 +0000 0 VSED Interview – Not Here by Choice with Phyllis Shacter Sun, 19 Oct 2014 07:30:00 +0000 0 "Brain Death" : Facilitating Family/Hospital Dialogue about Death by Neurological Criteria Sun, 19 Oct 2014 02:20:00 +0000 0 Jahi McMath Family Gathering Better Evidence Refuting Death Diagnosis Sat, 18 Oct 2014 22:28:00 +0000 0 What If You Had To Keep PAYING Life Support Machine To Stay Alive? Sat, 18 Oct 2014 13:22:00 +0000 0 Where Have All the Heroes Gone…? Sat, 18 Oct 2014 13:21:11 +0000 Read More »]]> 0 Barbara Mancini Assisted Suicide Case Sat, 18 Oct 2014 07:30:00 +0000 0 Metaphor: Shopping Sat, 18 Oct 2014 02:38:46 +0000 Read More »]]> 0 Death by Neurologic Criteria 1968 – 2014: Changing Interpretations Fri, 17 Oct 2014 09:00:00 +0000 0 Ebola and the Challenge of Public Conversations Fri, 17 Oct 2014 03:26:28 +0000 Read More »]]> 0 The Best-Selling Biologic Drugs Thu, 16 Oct 2014 19:18:45 +0000 Continue reading ]]> 0 Minnesota Sentences Melchert-Dinkel to 178 Days in Jail for Assisted Suicide Thu, 16 Oct 2014 08:00:00 +0000 Even in the five states (MT, NM, OR, VT, WA) where aid in dying is legal, assisted suicide is not.  

Aid in dying is for capacitated, terminally ill patients like Brittany Maynard.  In contrast, assisted suicide occurs under less controlled and less justifiable circumstances.  

Case in point:  William Melchert-Dinkel, who was just re-sentenced in Minnesota for preying upon suicidal people — encouraging two to take their lives.

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Dying in America: IOM Recommendations and Next Steps for Stakeholders Thu, 16 Oct 2014 06:07:00 +0000 On September 17, 2014, the Institute of Medicine released the report Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life, in which an expert committee identified “persistent major gaps in care near the end of life that require urgent attention from numerous stakeholder groups.” The committee made comprehensive recommendations in the areas of care delivery, clinician–patient communication and advance care planning, professional education and development, payment systems and policies, and public engagement and education.

On November 10, 2014 (1:00 ET), the IOM will present a webinar that will review the recommendations, explore possible next steps and barriers to implementation, and provide an opportunity for stakeholder groups to join the conversation. (Register here)  The webinar will feature brief presentations and an extended Q&A session with: 

  • Philip Pizzo (committee co-chair), Stanford University School of Medicine
  • David M. Walker (committee co-chair), Former U.S Comptroller General
  • Christian Sinclair (committee member), Gentiva Health Services (through September 2014)
  • Adrienne Stith Butler (study director), Institute of Medicine

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Bioethics Commission to Offer Presentations at ASBH This Week Wed, 15 Oct 2014 19:16:14 +0000 0 Family Update on Jahi McMath Wed, 15 Oct 2014 11:20:00 +0000 0 Contain AND Extinguish Wed, 15 Oct 2014 01:22:59 +0000 Read More »]]> 0 Why we ignored Ebola until recently Wed, 15 Oct 2014 00:52:30 +0000 by Craig Klugman, Ph.D.

Ebola burst onto the scene in 1976 when a thirty-old man arrived at the Yambuku Mission Hospital in Zaire complaining of severe diarrhea. He left the hospital two days afterwards and was never found again. In the days and weeks that followed, people who were patients or care providers at this facility when he was there all died after experiencing dehydration, fever, vomiting, diarrhea, and bleeding everywhere. The death rate was staggering, as over 80% of affected patients did not recover.…

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Supreme Court of Canada Hears Arguments on Aid in Dying Tue, 14 Oct 2014 08:30:00 +0000 0 New Jersey Urges Medicare Coverage for Advance Care Planning Tue, 14 Oct 2014 03:53:00 +0000 A New Jersey Senate Concurrent Resolution urges CMS to provide reimbursement to physicians for advance care planning consultations with Medicare participants.  A related bill (S.2435) would provide Medicaid coverage.  Here is the text of the resolution:

WHEREAS, Advance care planning is the practice of making explicit written instructions to caregivers, family and friends on measures for delivering health care and for preserving that adult’s dignity in the event that the adult is unable, because of incapacity, to make those instructions known when needed at a later time; and

WHEREAS, Advance care planning provides support for patients and their families making difficult life decisions; and

WHEREAS, Advance care planning ensures that the patient’s informed end-of-life health care choices are known, documented, and respected; and

WHEREAS, Advance care planning provides competent adults with a legal tool to designate a health care agent and express preferences about health care options to go into effect only after the adult loses the ability to make or communicate health care decisions, including deeply personal decisions about end-of-life care; and

WHEREAS, Advance care planning includes the use of advance health care directives, health care powers of attorney, and medical orders for life-sustaining treatment that can be administered effectively within the health care system; and 

WHEREAS, Studies funded by the Agency for Healthcare Research and Quality have shown that individuals who talked with their families or physicians about their preferences for care had less fear and anxiety, felt that they had more ability to influence and direct their medical care, believed that their physicians had a better understanding of their wishes, and indicated a greater understanding and comfort level than they had before the discussion; and 

WHEREAS, New Jersey has helped promote and facilitate advanced care planning in this State with the enactment of the “New Jersey Advance Directives for Health Care Act,” P.L.1991, c.201 (C.26:2H-53 et seq.) and the “Physician Orders for Life-Sustaining Treatment Act,” P.L.2011, c.145 (C.26:2H-129 et seq.); and 

WHEREAS, An increasing number of private health insurance plans reimburse physicians for advance care planning discussions held with patients, but the federal Medicare program and most state Medicaid programs do not; and 

WHEREAS, The Specialty Society Relative Value Scale Update Committee, a body of the American Medical Association that advises the federal Centers for Medicare & Medicaid Services on Medicare physician reimbursement, has recently recommended that Medicare begin to cover advance care planning discussions; now, therefore,

BE IT RESOLVED by the Senate of the State of New Jersey (the General Assembly concurring):  This Legislature respectfully urges the Centers for Medicare & Medicaid Services to provide reimbursement to physicians for advance care planning consultations with Medicare participants.

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The Indignity of a Death with Dignity Tue, 14 Oct 2014 03:03:14 +0000 Read More »]]> 0 Barbara Mancini: Innocent of Assisted Suicide – November 13 in Saint Paul Mon, 13 Oct 2014 19:48:00 +0000 0 October 13th:  Bioethics, Women and Pain Disparity Mon, 13 Oct 2014 16:22:00 +0000

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Let Harrison Bergeron Dance Mon, 13 Oct 2014 13:51:07 +0000 ]]> 0 Tim Quill on "Near-Futile" Treatment Mon, 13 Oct 2014 08:00:00 +0000 0 Belief In Ultimate Truth: Does it make for peaceful living? Mon, 13 Oct 2014 04:10:31 +0000 0 The Price of Drugs Sun, 12 Oct 2014 15:06:51 +0000 Read More »]]> 0