» Health Care Where the World Finds Bioethics Fri, 05 Feb 2016 23:45:41 +0000 en-US hourly 1 Stingy Insurance + Low Income = Bad Combination Fri, 05 Feb 2016 14:38:35 +0000 The Commonwealth Fund recently circulated information on the widespread difficulty many Americans have paying for their medical care, even when they have insurance. Burdened by high co-pays and high coinsurance rates, these out-of-pocket expenses are putting people on the financial … Continue reading

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Comments on the New ATS/AACN/ACCP/ESICM/SCCM Statement: Responding to Requests for Potentially Inappropriate Therapies in the ICU Thu, 04 Feb 2016 23:32:00 +0000 0 How Philosophy Training Helps Me Overcome the Persuasive Power of Advertising Thu, 04 Feb 2016 14:26:25 +0000 Advertising is about persuasion. Companies spend billions of dollars per year trying to convince us to buy their products. But sometimes, rigorous philosophical training can help us avoid that influence. Consider the following ad: Only deep immersion in Immanuel Kant … Continue reading

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Can Our Minds Live Forever? Thu, 04 Feb 2016 10:00:00 +0000 Can you freeze your brains and preserve the pattern of information that represents you—your thoughts, memories and personality—your self

A story in Scientific American reports on a company that is trying.  It has started with rabbit brains.

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Can’t Afford Medical Care? Welcome to America! Wed, 03 Feb 2016 14:42:43 +0000 David Blumenthal and colleagues recently wrote a wonderful piece in the New England Journal on the future of Medicare. In it, they present a powerful picture comparing how often people in 11 countries have difficulty accessing medical care because of … Continue reading

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When Is CPR Futile? Wed, 03 Feb 2016 09:30:00 +0000 0 Bioethics & the Status of Women Filmmakers Wed, 03 Feb 2016 05:39:00 +0000 There are currently less than 7% of films created by women making it to major film festivals —that is 7%, per year, worldwide. This percentage has remained low and static for 25 years. Film festival screenings constitute theatrical releases. Theatrical releases are required for film and/or television distribution.

Low access to film festivals limit women’s ability to earn livings behind the camera in their industry. The number of screen stories genuinely reflecting women’s experiences is also disproportionately diminished. Omission of the perspective of women in film complicates matters in the purview of bioethics: beneficence, autonomy and justice. 

23 percent of people surveyed consider entertainment television as the top three sources of their health information. That health information is being controlled through a male perspective as shots are usually called by male producers, directors and writers. It is a bioethical tenant that equality does not equal sameness. This was learned when in 1993, the US federal government mandated women and racial minorities be included in drug research. Clinical observation showed women and minorities were being harmed by lack of inclusion as women’s responses to pain and pain medications were significantly different from those of men. These new observations coincided with increasing the critical mass of women and peoples of color in the medical profession. Women in film seems to represent a parallel situation.

Women filmmakers are denied the opportunities to reflect functional abdominal pain, menopause, postpartum depression, caregiver burnout, forced sterilization. We are not seeing these stories; yet women struggle to comprehend their meanings in gyms, carpools and walks on dirt roads to schools around the world.

What is to be done? The 38th Mill Valley Film Festival (MVFF) in October 2015, piloted its “Mind the Gap” programming. This is a conscious efforts to seek and evaluate more films by women. The “Mind the Gap” goal is to change the disproportionately low numbers of films in major festivals, representing women working behind the camera, —directors, writers, cinematographers and producers. However, it is also an attempt to participate in a dialog about the origin of the problem. Mind the Gap includes a commitment to search for those films which do manage to be made by women, despite nearly insurmountable barriers. The hope is to help establish models which can be replicated to improve women filmmakers access to the industry. 

The MVFF is among the oldest and most respected USA film festivals. It is juried through the coveted Audience Awards, bestowed by a historically film savvy 60,000 MVFF patrons. In 2015, some 170 films were screened. Programmers of the MVFF are legendary for their curatorial capacity. Many of the independent, international, documentary, short and feature films seen at this festival are U.S, North American or World Premieres. MVFF’s influence derives from consistently programming and hosting major award winners well before the beginning of the award nomination season.
In the October 2015 MVFF, roughly thirty-three percent of films screened were developed by women behind the camera. That is a better female to male ratio than most top tier film festivals: compare Toronto, Cannes, Berlin, Sundance. However, the California Film Institute, the parent organization sponsoring the MVFF, has even higher aspirations. The CFI-MVFF goal is a fifty-fifty, female to male film director ratio, a far cry from the current international paltry 7% representation of women’s films in festivals. 

Among the 2015 MVFF premieres, with significant women’s content and as it happens also other forms of diversity, which you may not find in the Oscar lineup, were: Under the Same Sun (dir. Mitra Sen), A LIGHT BENEATH THEIR FEET (dir. Valerie Weiss), INTERWOVEN (dir.V.W. Scheich), and THE ASSASSIN (dir.You Hsiao-Hsien.)

Smith, S., Pieper, K. et al, Gender & Short Films: Emerging Female Filmmakers and the Barriers Surrounding Their Careers examining short films and directors., accessed February 1, 2016.

Smith, Stacy L., Choueiti, M. et al. Inequality in 700 Popular Films: Examining Portrayals of Gender, Race,
accessed February 1, 2016

MVFF Mind the Gap accessed February 1, 2016.

NIH Guidelines on the Inclusion of Women and Minorities as Subjects in Clinical Research US Public Health Service Accessed Feb 1, 2016

Cross Reference:
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A Health Insurance Double Whammy Tue, 02 Feb 2016 16:38:11 +0000 In case you missed it, I am recirculating a picture put together by the Kaiser Family Foundation , which reveals two unsettling facts about health insurance in United States. First, the cost of employer-based health insurance has risen 61% since … Continue reading

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Founding Father Thomas Paine on Medical Futility and Brain Death Tue, 02 Feb 2016 10:30:00 +0000 0 Best Email of the Week Mon, 01 Feb 2016 15:26:45 +0000 I got an unusual email message a little while ago. It was from someone I had never met before, and it wasn’t obvious to me, at first, why this person was contacting me. The email began like this: “I am … Continue reading

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TOUGH CASES: Code of Ethics Now Available for Healthcare Ethics Consultants Mon, 01 Feb 2016 14:09:00 +0000 Tarris Rosell, PhD, DMin    
Consider the following hypothetical case scenarios:

Case #1

Jessica, APN, is a member of the Hospital Ethics Committee and serves also on the HEC’s ethics consultation team. Each week, one of eight volunteer consultants takes first call on the dedicated Ethics pager. Two other team members serve as back up to the on-call ethics consultant. 

One day, a consult request is forwarded to the Ethics pager, which Jessica is carrying. It involves a patient on the Medical ICU where Jessica is also a nurse manager. She knows the patient and family, and is all too aware of their conflicted situation with hospital staff regarding goals of care. Jessica also supervises the nursing staff, which rotates care duties on Patient Joe so as not to get too burned out, given his dementia-related raging and flailing. As Jessica reads the ethics consult order, she feels conflicted about her multiple roles in this challenging situation. She wants to be of assistance for ethics, but isn’t certain that she can do so without confusion about what “hat” she’s wearing up on the unit.

What ought Jessica to do, and how would she know?

Case #2

Jonathan, PhD, is taking first call on the Ethics pager this week. One of three consult requests received involves a very messy situation involving a difficult discharge. The 56 -year old female patient, Helen, is homeless and had come to the emergency department weeks earlier in a police cruiser.

At the point when she becomes medically stable, a dilemma is encountered. How could we safely discharge this patient back to the street where she insists on going “if,” as she says, “you won’t let me stay here?” It’s cold outside, and Helen is barely ambulatory, with some signs of dementia. Follow-up self-care would require daily insulin injections and finger sticks for glucose monitoring. While the patient claims ability to do so, the attending isn’t convinced. 

Ethics is consulted, and Jonathan convenes a multi-disciplinary care meeting, including the patient. Consensus eventually is reached on a discharge plan. Helen agrees to go to a homeless shelter with a clinic. 

However, after leaving the hospital, the cab driver lets her off at a downtown intersection instead, as directed by his rider. It is a blustery and frigid winter day. Helen is wearing the thin autumn coat and sandals she had been wearing upon admission. A newspaper journalist happens to stop at the intersection where Helen stands shivering, and notes her hospital bracelet. He rolls down the window and asks if Helen is okay. She mutters that City Hospital left her off here to die. The journalist calls 911, and then makes a call to the hospital operator asking to speak with someone in Ethics. 

When Jonathan receives this page and phone call, what should he say, or not say, to the journalist, and how would he know?

Code of Ethics 

Ethics consultation, like any other professional practice in healthcare, requires professionalism of the consultant. Ethics consultants can either help or hurt those who request assistance. Sometimes even life and death hang in the balance, especially when it is unclear as to which of those two options would be the worse outcome for a critically ill patient. Always there is confidential information to be handled with care and in compliance with HIPAA rules. 

Ethics professionalism matters.

Until recently, healthcare ethics consultants familiarized themselves with the codes of ethics pertaining to other professions, but had none of their own. Jessica and Jonathan might have discerned successfully what they ought to do about their professional ethics dilemmas in the scenarios described. Now their decisions may also be guided by a code of ethics and responsibilities drafted specifically for healthcare ethics consultants.

The American Society for Bioethics and Humanities has posted A Code of Ethics and Professional Responsibilities for Healthcare Ethics Consultants as a downloadable document at The document lists seven ethical responsibilities for healthcare ethics consultation (HCEC):

1. Be competent.
2. Preserve integrity.
3. Manage conflicts of interest and obligation.
4. Respect privacy and maintain confidentiality.
5. Contribute to the field.
6. Communicate responsibly.
7. Promote just healthcare within HCEC.

Each of these responsibilities is explained in the ASBH document, with illustrative examples provided. 

Applying the Code

In Jessica’s case, she might recuse herself from ethics consultation on grounds of #3, the need to manage conflicts of interest and obligation. One of her back-up consultant colleagues can be called upon to respond instead. 

Jonathan would be guided in his own ethics dilemma by responsibilities #4 and #6 especially, and possibly #7. The probably well-intended journalist may benefit from clarification of the situation with Helen; but any communications with him must be done responsibly, perhaps by a designated hospital spokesperson, and with HIPAA-protected privacy ensured both for the patient and her healthcare providers.

Center for Practical Bioethics personnel contributed to the development and publishing of the ASBH Code of Ethics and Professional Responsibilities for Healthcare Ethics Consultants. It is currently being utilized in hospitals in Kansas City and elsewhere for professional performance improvement toward the goal of excellence in ethics consultation.

Tarris Rosell, PhD, DMin, is the Rosemary Flanigan Chair at the Center for Practical Bioethics. He also serves as Co-Chair of the Hospital Ethics Committee and Director of the Ethics Consultation Team at the University of Kansas Hospital.
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Boston’s Fine Arts Museum Offers Doctors Time for Reflection [EOL in Art 197] Mon, 01 Feb 2016 10:30:00 +0000 Doctors and nurses at Boston’s Brigham and Women’s Hospital are honing their communication and teamwork skills in an unexpected environment: an art museum.

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Bioethics and A Recent Trip to Cuba Mon, 01 Feb 2016 06:15:45 +0000 Read More »]]> 0 Jahi McMath – Update on the Malpractice Litigation Sun, 31 Jan 2016 10:00:00 +0000 0 Brand New Futile Care Fellowship Created Sat, 30 Jan 2016 09:30:00 +0000 0 I had to laugh… Fri, 29 Jan 2016 21:44:19 +0000 ]]> 0 Drawing the Human Heart Fri, 29 Jan 2016 15:33:08 +0000 0 Responding to Zika: Ethical Challenges of Zoonotic Diseases Fri, 29 Jan 2016 14:54:00 +0000 0 Minnesota Compassionate Care Act (Jan. 30, 2016) Fri, 29 Jan 2016 14:27:00 +0000 0 Boston Hospital Ignores POLST Fri, 29 Jan 2016 10:30:00 +0000 Sandra Furrier is accusing Melrose-Wakefield Hospital of labeling her father, Arthur Fairfield, a “Do Not Resuscitate” patient without permission.

Furrier said the hospital called after her father died told her that he was listed as DNR.  Furrier says that she never authorized that.  About a month before his death, Furrier filled out a MOLST form, which called for resuscitation and ventilation should her dad need it.  (Boston Herald)

“They didn’t call me. They didn’t ask me. They never mentioned DNR. It was never discussed with me at any time at all.”

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Terri Schiavo Used to Support Jeb Bush Thu, 28 Jan 2016 23:58:00 +0000 0 Terri Schiavo Used to Support Jeb Bush Thu, 28 Jan 2016 23:58:00 +0000 0 ASBH 18th Annual Meeting October 6-9, 2016 – Call for Proposals Thu, 28 Jan 2016 09:30:00 +0000 0 Judging Policies by Their Supporters Wed, 27 Jan 2016 19:23:34 +0000 The world is complicated. It’s hard to know what the federal government should do about a whole range of problems. That’s why most people take a shortcut, and judge policies based on their opinion of the people who support or … Continue reading

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The History of Bioethics Series – National Bioethics Commissions Wed, 27 Jan 2016 16:33:35 +0000 0 When Hospitals Incorrectly Declare Brain Death Wed, 27 Jan 2016 10:30:00 +0000 Mindful of new reports and court cases on variability in the criteria and standards for brain death, this Alabama personal injury law firm is advertising for cases in which hospitals incorrectly declare brain death.

"If you have been involved in a situation in which you believe the brain death of a loved one was incorrectly determined, contact us at (877) 336-0776 to speak with an Alabama medical negligence attorney. We offer a free initial case review to all new clients."

"Malpractice occurs when a medical professional acts in a negligent or unprofessional way. In extreme cases, malpractice can lead to wrongful death,  especially in the case of incorrectly declaring brain death. There have been several examples over the years of hospitals incorrectly identifying a patient as 'brain-dead' when there is still some activity."

"Generally, a patient is classified brain-dead after being studied by a neurologist but, this is a tricky situation as the term and policies vary from hospital to hospital. Only 33% of hospitals require a neurologist to be present, and most policies don’t even mention who on the staff is required to make this very important judgment. Recent studies have found that most policies regarding brain death are highly inconsistent."

"While new policies are being put into place, incorrectly declaring brain death still occurs all too often and is, not only traumatic for the family, but put’s the hospital at risk for a malpractice suit."

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The Sky is Falling: How Much Do We Owe A Patient? Tue, 26 Jan 2016 21:13:42 +0000 by Craig Klugman, Ph.D.

Imagine if a patient went sky diving without a parachute and survived. You fixed up her body and explained to her the dangers of her activities. You refer her to a program that offers free parachutes and trains people on how to use them. Upon discharge, she does the same thing again and ends up back in your hospital? Do you perform the same surgeris again? What if she does this 3 times? Four times? Is there a point at which we “give up” on patients when they consistently return for the same problem from the same cause after ignoring all advice?…

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New Program Will Bring Advance Care Planning to African-American Faith Communities Tue, 26 Jan 2016 17:06:00 +0000
Richard Payne, MD

Participating Congregations in Atlanta, Chicago, Dallas, Houston, Kansas City, Philadelphia and West Palm Beach 

African Americans die at excessive levels from chronic disease1 yet use only eight percent of hospice services nationally.2 Advance care planning – the process of communicating with a healthcare agent about the care they would want if unable to speak for themselves – and increased use of hospice services could greatly improve quality of life for one of the most vulnerable populations in America, elderly African Americans. 

A new project funded by the John and Wauna Harman Foundation and others will enable the Center for Practical Bioethics to implement a two-year program working with African American faith communities and community collaborators (i.e., hospices) in four cities to increase advance care planning and use of hospice services. Cities include Atlanta, Chicago, Dallas,  Kansas City, Philadelphia, and West Palm Beach.

The rationale for the program is rooted in American history and culture. Many African Americans distrust our healthcare system – which once practiced segregation, involuntary sterilization and unethical research practices – and are understandably reluctant to engage in a process that they perceive could put them at greater risk of being underserved. African Americans are also markedly more religious than the U.S. population and more reliant on faith leaders to help them make healthcare decisions. 

The project, launched on December 1, 2015, includes four phases:

Phase I – Congregations in targeted cities will recruit two-to-three Advance Care Planning (ACP) Ambassadors to commit to a six-month advance care planning program. Project faculty and staff from the Center for Practical Bioethics and partners will hold a four-hour training session for ACP Ambassadors at the Samuel Dewitt Proctor Leadership and Lay Conference in Houston on February 15-18, 2016.

Phase II – ACP Ambassadors will design and implement a project to facilitate and complete advance care planning documents in their congregations. Faculty and staff will provide coaching and advice on how to teach their congregants about advance care planning, encourage them to discuss their end-of-life care with their loved ones, and assist them in completing advance care planning documents.

Phase III – Faculty and staff will work with ACP Ambassadors and their community collaborators to organize a one-day Crossing Over Jordan Conference in November 2016, where  the Ambassadors will share their project design and outcomes with the community. 

Phase IV – This phase consists primarily of post-project tracking. Faculty and staff will develop and conduct ongoing surveys of participating congregations for one year following the conclusion of local advance care planning projects to track the project’s impact.

For more information about the project, please contact Leslie McNolty, Program Associate, or 816-979-1394.

2 National Hospice and Palliative Care Organization’s Facts and Figures: Hospice Care in America, 2014 Edition, p. 5.

Richard Payne, MD, is the John B. Francis Chair at the Center for Practical Bioethics and the Esther Colliflower Professor of Medicine and Divinity at Duke Divinity School, Duke University.
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Physician Aid-In-Dying – Legal Overview Tue, 26 Jan 2016 10:30:00 +0000 This new 35-page article from University of Houston law student Christina White provides a nice overview of the legal status of physician aid-in-dying in the United States.  

Here is the abstract:

For a terminally ill patient, physician aid-in-dying (PAD) is about gaining control over an agonizing, terrible death. In most states it is illegal for a doctor to prescribe a lethal dose of medication or advise a patient on taking her own life when she is ready. Only five states have legalized PAD: Oregon, Vermont, Washington, Montana, and, most recently, California. In order for other terminally ill patients to achieve control over their death, PAD should be legalized—and, therefore, regulated—in all states.

PAD could become legal in three ways: 
  1. The U.S. Supreme Court could determine there is a constitutional right for mentally competent, terminally ill, adult patients to seek assistance from their physician to die with dignity
  2. State courts could find either a state constitutional right or a statutory construction permitting PAD
  3. State legislatures, or citizens in states with the option of ballot initiatives, could enact statutes legalizing PAD. 
The best solution for legalizing PAD is a combination of a U.S. constitutional ruling that a right to PAD exists along with state statutes regulating that right.

This Comment proceeds in three parts, and addresses only PAD, not euthanasia. Part II discusses the current state of the laws: first analyzing the Supreme Court cases addressing PAD, then considering the state laws legalizing PAD. Following the discussion of the current laws, Part III of this Comment addresses some of the arguments against PAD, and why many of those arguments are not sound. Lastly, Part IV addresses the solutions briefly discussed above.

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2016 Minnesota Legislative Preview: Key Health Care Issues Mon, 25 Jan 2016 20:42:00 +0000 0 Response to Call for Essays: Apple and Google Plan to Reinvent Health Care. Should We Worry? Mon, 25 Jan 2016 14:54:00 +0000 Tamar Sharon]]> 0 The New Yorker’s Roz Chast Nails the Topic of Healthcare Price Transparency Mon, 25 Jan 2016 12:54:25 +0000 The post The New Yorker’s Roz Chast Nails the Topic of Healthcare Price Transparency appeared first on

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European Neonatal Ethics Workshops (June 1-2, 2016) Mon, 25 Jan 2016 10:30:00 +0000 Plan to be in Oxford on June 1-2, 2016.  

When is it ethical to withhold or withdraw life-sustaining treatment from a newborn infant?
Dr Dominic Wilkinson

How should neonatologists counsel parents about outcomes?
Professor John Wyatt

Communication and end of life decisions: Insights from paediatric palliative care
Dr Emily Harrop

 The law and treatment decisions for newborn infants- ‘Keeping things out of Court’
Prof Margot Brazier

Debate: Has therapeutic hypothermia impacted the we think and manage stopping resuscitation and intensive care in neonatal care
For: Dr Sijo Francis
Against: Dr Alok Sharma
Audience Discussion facilitated by Dr S Babarao

Workshop 1: Advanced Communication
Workshop 2 Simulated Cases for Discussion
Workshop 3 Simulated Workshop 

European Neonatal Ethics Conference – “Sharing Ethical Practice Together’’  June 2nd 2016

Ethical Principles in Neonatal Care Professor 
Dominic Wilkinson

Should parents’ ability to take care of the child be taken into account in decision-making about treatment in the NICU?
Dr Sofia Moratti

Shared decision-making in the NICU and PICU. Theory vs Practice
Dr Mirjam De Vos

Ethical dilemmas in the NICU in developing countries Professor
Ingrid Miljeteig

Debate- Nuffield and BAPM Guidelines around extremely premature infants – Are they still valid? 
Neil Marlowe, John Wyatt, Margot Brazier

“Case Presentations” and panel Facilitator
Dr Mike Hall

Controversies in Neonatal organ donation 
Dr Joe Brierley

Ethical challenges in prenatally diagnosed severe congenital malformations

Communication around End of Life Decisions 
Prof Neil Marlow
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Jahi McMath Brain Death Hearing on January 29, 2016 Sun, 24 Jan 2016 10:30:00 +0000 0 Jahi McMath Hearing on January 29, 2016 Sun, 24 Jan 2016 10:30:00 +0000 0 Uterine Transplantation Redux: Another Boundary Issue in Medicine Sat, 23 Jan 2016 21:56:51 +0000 Read More »]]> 0 Death: is it your right to choose? [EOL in Art 196] Sat, 23 Jan 2016 10:00:00 +0000 0 Minnesota Compassionate Care Act (Jan. 30, 2016) Sat, 23 Jan 2016 10:00:00 +0000 0 Colorado Addresses Decision Making for Unrepresented Patients Fri, 22 Jan 2016 10:30:00 +0000 0 Can there be a “Right to Die?” Fri, 22 Jan 2016 02:16:14 +0000 Read More »]]> 0 2016 MNHPC Conference (April 10-12, 2016) Thu, 21 Jan 2016 11:00:00 +0000 0 Minnesota Compassionate Care Act (in Minnesota Physician) Thu, 21 Jan 2016 00:23:00 +0000 0 Breast cancer screening recommendations clarify science but muddy political waters Wed, 20 Jan 2016 23:29:47 +0000 0 Response to Call for Essays: Could DTC Genome Testing Exacerbate Research Inequities? Wed, 20 Jan 2016 14:54:00 +0000 Christine Aicardi, Maria Damjanovicova, Lorenzo Del Savio, Federica Lucivero, Maru Mormina, Maartje Niezen, Barbara Prainsack]]> 0 More Facilities Fined for Resuscitating DNR Patients Wed, 20 Jan 2016 10:30:00 +0000 0 New guidelines for euthanasia in the Netherlands Wed, 20 Jan 2016 00:59:05 +0000 Read More »]]> 0 The Supreme Court and Health Care Access for Undocumented Immigrants Tue, 19 Jan 2016 14:54:00 +0000 0 Eight Fresh New Reasons for Advance Care Planning Tue, 19 Jan 2016 09:30:00 +0000 There are thousands of articles and websites promoting the importance and benefits of advance care planning.  So, it was refreshing to see the value of ACP framed in a fresh new way.

Monica Williams-Murphy's recent blog post gives a "different perspective." She explains the value of ACP in terms of just how bad things can get.  She calls them "unorthodox reasons."  Here are just 4 of her 8 reasons.
  1. You don’t want your Aunt Bertha changing your diapers.
  2. The loudest person in your family may not have your best interest in mind. 
  3. I’ll bet you know who you don’t want making decisions for you. 
  4. Grudges can come back to bite you.

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Can Health Care Providers Love Their Patients? Mon, 18 Jan 2016 13:00:12 +0000 by J.S. Blumenthal-Barby

Ms. Clara [name changed] is one of our patient partners on a PCORI funded project. PCORI is unique in that they aim to include patients and other stakeholders in all stages of research—from conceptualization of projects and their aims to the dissemination of results. We’ve been working closely with Ms. Clara and other patient partners for almost two years now. A few months ago, when visiting Ms. Clara in the hospital, her eyes became teary and she exclaimed, “I love you guys.…

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Right to Die – Slow Evolution in India Mon, 18 Jan 2016 10:00:00 +0000 0