» Health Care Where the World Finds Bioethics Fri, 21 Nov 2014 15:35:55 +0000 en-US hourly 1 Time To Stop Paying For Pepsi With Food Stamps Fri, 21 Nov 2014 13:51:23 +0000 Continue reading ]]> 0 Resolving Medical Futility Disputes – Alberta follows Ontario in Chalifoux v. Alberta Health Services Thu, 20 Nov 2014 09:00:00 +0000 0 The Ethics of Uterus Transplantation Thu, 20 Nov 2014 03:11:10 +0000 0 Martha Perez – Texas Family Charges Organs Procured BEFORE Death Wed, 19 Nov 2014 08:30:00 +0000 I recently summarized a few cases in which a patient was either negligently or intentionally declared dead prematurely.  

But this recent case reported by Fox News in Dallas Fort Worth indicates misunderstanding by the family rather than error by the clinicians.  

26-year-old Martha Perez dies from injuries sustained in an car wreck involving a suspected drunk driver.  Perez was a registered organ donor and doctors told the family they were prepared to harvest the organs for donations.

The family objected: “But she still has heart and lung functions,” said family member Juan Martinez.  Unfortunately, this statement indicates that the family does not understand that these cardiopulmonary functions are compatible with legal death in Texas.  They can be artificially sustained even after death is determined (on neurological criteria).   

On the other hand, the family also alleges: “They took her off the life support and she was still breathing.”  If that is true, then the determination of death must have been wrong.  A person breathing on their own (without ventilation support) cannot be dead under either cardiopulmonary or neurological criteria.

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Found: Billions of Wasted Medicare Dollars Tue, 18 Nov 2014 13:48:39 +0000 Continue reading ]]> 0 Texas Legislature to Address Marlise Munoz Dead Pregnant Situation Tue, 18 Nov 2014 10:30:00 +0000 0 Elderspeak: Words Can Hurt Tue, 18 Nov 2014 07:04:33 +0000 by Craig Klugman, Ph.D.

During the season premiere of the HBO comedy, Getting On, I noticed the excessive use of toddler-speak toward patients portrayed as being elderly. The show takes place in a senior rehab/hospice unit in a community hospital. Whenever one of the health care providers (physician or nurse) was speaking to one of the patients, they tended to use baby talk—higher pitch, lilting tone, longer spaces between words, elongated space around vowels, and using simple, shortened words.…

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Genetic Testing Can’t Do Our Behavioral Dirty Work Mon, 17 Nov 2014 18:04:36 +0000 Continue reading ]]> 0 Janina Kolkiewicz Wakes Up in Morgue after Pronounced Dead Mon, 17 Nov 2014 09:30:00 +0000 0 The New Abortion Issue: The Moral Status of Women Mon, 17 Nov 2014 03:11:17 +0000 0 Oregon Death with Dignity Act – 20th Anniversary Mon, 17 Nov 2014 00:14:00 +0000 0 The Importance of Ethical Standards Sun, 16 Nov 2014 15:22:21 +0000 Read More »]]> 0 Top 30 Bioethics Journals on Earth Sun, 16 Nov 2014 10:00:00 +0000 0 First Execution under Obamacare Death Panels? Sat, 15 Nov 2014 08:30:00 +0000 0 Is it right to compel hospital staff to care for patients with Ebola? Fri, 14 Nov 2014 23:46:22 +0000 Read More »]]> 0 Patient Modesty: Volume 70 Fri, 14 Nov 2014 21:44:00 +0000 0 My Burrito Has How Many Calories?!? Fri, 14 Nov 2014 19:49:25 +0000 Continue reading ]]> 0 Finding a Voice Fri, 14 Nov 2014 16:42:41 +0000 0 Dhaka Hospital Withdraws Life Support without Consent or Consultation Fri, 14 Nov 2014 12:57:00 +0000 0 Three Items About Human Research Ethics Fri, 14 Nov 2014 01:27:33 +0000 Read More »]]> 0 Patients and Clinicians Discuss Only 2 of 11 Goals of Care Elements Thu, 13 Nov 2014 09:30:00 +0000 Studies showing lackluster rates of advance care planning are nothing new.  But this new study in the Canadian Medical Association Journal is particularly disturbing.  

The authors identified 11 recommended elements of goals-of-care discussions that are the most important to older adults patients in hospital with serious illness and their family members.  They found that these elements are VERY infrequently addressed by health care providers in hospital.
  1. Asked the respondent about preferences for care in event of life-threatening illness
  2. Inquired about the respondent’s values
  3. Discussed prognosis 
  4. Gave an opportunity for the respondent to express fears or concerns
  5. Asked the respondent if they had additional questions about goals of care
  6. Provided information about outcomes, risks, benefits of comfort care
  7. Asked about prior discussions or written documents
  8. Offered a time to meet to discuss goals of care
  9. Provided information about outcomes, risks, benefits of life sustaining treatments
  10. Provided information to review about advance care planning before discussions
  11. Helped access legal documents to record advance care plans

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Wisdom Does Come with Age Thu, 13 Nov 2014 03:11:09 +0000 0 A Look at How M.D. Anderson Cancer Center Uses Bioethics Educational Materials Wed, 12 Nov 2014 17:39:41 +0000 0 Outpatient Spending Is Catching Up To Hospital Expenditures Wed, 12 Nov 2014 13:50:14 +0000 Continue reading ]]> 0 UK Hospital Places DNR Order without Consent or Consultation Wed, 12 Nov 2014 10:00:00 +0000 Leon Scoble and his sister Danni say that Basildon University Hospital put a “do not resuscitate” order on their father Paul Scoble without consulting them. (Echo)

On a Facebook page the family states:

"The doctors have twice put a Do Not Resuscitate on our Dad, we managed to get it lifted the first time but doctors refuse to lift it now their reason for this is due to a faulty heart valve." 

"He needs an operation on his heart to fix two faulty valves but the hospital have refused due to his size. We have heard about TAVI Mitral valve surgery by Dr Vinayak Bapat at St Thomas' Hospital in London and men much bigger than Dad have survived this operation."

"All we ask is that our Dad is given a chance at life, if he doesn't get this operation he will die. His situation has become pretty desperate over the last couple of weeks, he has been having panic attacks brought on by hearing doctors discussing switching off the machine. As you can imagine, he's terrified and so are we."

"The doctors have met and decided he is to receive no more treatment, even though the drugs being given are damaging to the kidneys, should a problem arise they have already stated that they will take no action."

"They tell us we cannot move our father to another hospital, as he is from Harlow."

"We want our Dad moved to a hospital that has the capability and desire to save his life (preferably St Thomas') He's a 48 year old father of two, who hasn't yet walked his only daughter down the aisle or held a first grandchild. He isn't a statistic, he's our world, so much more than just a father and we refuse to give up on him because he's never given up on us."

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Susan Tolle Wins MacLean Center Prize in Clinical Ethics for Work on POLST Wed, 12 Nov 2014 10:00:00 +0000 The 2014 MacLean Center Prize in Clinical Ethics, an award of $50,000, will be presented to Susan Tolle, MD, who has pioneered efforts to improve communication between health care providers and patients regarding end-of-life care.

Tolle will receive the MacLean Prize, the largest award in the clinical medical ethics field, during the 26th annual Dorothy J. MacLean Fellows Conference on ethics in medicine. The conference will be held at the University of Chicago Law School, on Friday and Saturday, Nov. 14 and 15.

“Dr. Susan Tolle’s dedication, scholarship and hard work to ensure that patient’s wishes are honored at the end of life has transformed the care of dying patients in the U.S.,” said Mark Siegler, MD, Lindy Bergman Distinguished Service Professor of Medicine and Surgery and director of the MacLean Center. “I’m very proud of how Dr. Tolle continues to improve patient care and advance the field of clinical medical ethics.”

Tolle, a professor of medicine in the Oregon Health & Science University School of Medicine and director of the OHSU Center for Ethics in Health Care, is one of the founders of the Physician Orders for Life-Sustaining Treatment (POLST) movement in Oregon in the early 1990s. In a specific subset of patients — those with advanced illness or frailty — Tolle and others found that advanced directives were insufficient to safeguard patients’ wishes about how they wanted to be treated in life-threatening situations. By contrast, POLST orders work to allow patients to receive the level of care they want in the setting they want.

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Dying and Dignity Wed, 12 Nov 2014 02:06:06 +0000 Read More »]]> 0 A Park Bench That Tells You You’re Fat? Tue, 11 Nov 2014 14:23:30 +0000 Continue reading ]]> 0 Making a Case for Case Studies Tue, 11 Nov 2014 10:11:43 +0000 0 Taiwan End-of-Life Policies Inflict Unwanted Pain & Torture Tue, 11 Nov 2014 09:00:00 +0000 0 Ruby Graupera-Cassimiro Survives 45 Minutes without Pulse Tue, 11 Nov 2014 01:36:00 +0000 0 Ethics in Neonatology Symposium Mon, 10 Nov 2014 11:00:00 +0000 0 "Lethal Malformations" and Language of "Futility" Mon, 10 Nov 2014 08:30:00 +0000 0 Death – a New 5 Part Series on NPR Mon, 10 Nov 2014 01:02:00 +0000 To the Best of Our Knowledge, a nationally syndicated radio show from Wisconsin Public Radio just started a five part series on Death.  

Death: The Reckoning
Did you hear? There's a death movement going on in America. After decades of sanitized death, with dying, funerals, burial and grief shielded from public view, some people are now working to make death a greater part of life. In this hour, we talk with experts about how to begin these difficult conversations, and how they can transform both the dying and the surviving.

Death: Exit Plan
We live much longer than we used to, thanks to medical advances, but what are the emotional and financial costs of extending the end of life?  In this hour, we talk with physicians and bioethicists about planning for more humane and less prolonged deaths, about how some doctors don't know how to talk with their patients about preparing for death, and about one family's story of working within Oregon's "Death with Dignity" law. Tune if for a discussion of “a good death” and the story of a pioneering psychiatrist who's using hallucinogens to ease the anxiety of terminally-ill cancer patients.

Death: The Last Moment
Resuscitation science is revolutionizing medical care and reviving people who are clinically dead. With proper care, people who suffer heart attacks and lose brain function–even for two hours — can be brought back to life with no brain damage. What has that revealed about the the medical, spiritual and psychological mysteries of death?  We’ll hear conflicting perspectives on the debate over near-death experiences. Do these extraordinary experiences reveal a transcendent reality, or are they simply the biochemical product of a brain that’s shutting down? Tune in for conversations about "conscious death," and how people are reclaiming the final moments of their lives.

Death: The Wake
hat does it mean to grieve well? "Griefwalker" Stephen Jenkinson says that many cultures have “deep and skilled practitioners of grief." In this hour, explore the pain and healing power of grief, and learn about burial and mourning rituals throughout history.  We'll also hear poignant personal stories from people whose jobs bring them into daily contact with death, from a woman who worked for nine years in an inner-city funeral home, to a Ghanaian man who creates “fantasy coffins.”

Death: The Afterlife
Is death what gives life meaning? Looking at the prominence of death and the afterlife in so many religions, you might think so. But for millennia, people have also dreamed about immortality, and now transhumanists are actively trying to extend life by merging our bodies with machines.  In this hour, we explore the philosophical and religious dimensions of mortality and the afterlife. We talk about the art and poetry of remembrance, and now that much of our lives are lived on-line, how do we plan for our digital afterlives?

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Six Key Themes on Life-Sustaining Treatment Decisions from Australian Jurisprudence Sun, 09 Nov 2014 09:00:00 +0000 0 World Association for Medical Law – 21st Annual Congress Sat, 08 Nov 2014 09:30:00 +0000 0 Embodying a right to health care Fri, 07 Nov 2014 20:43:53 +0000 Read More »]]> 0 Responding to Ebola: Health Care Professionals’ Obligations to Provide Care Fri, 07 Nov 2014 14:54:00 +0000 Joel Frader and Lainie Friedman Ross]]> 0 Here’s Why Funding Medical Education Helps Vulnerable Patients Fri, 07 Nov 2014 13:50:14 +0000 Continue reading ]]> 0 2014 European Declaration on Palliative Care Fri, 07 Nov 2014 10:00:00 +0000 0 On Testimonial and Argument in Bioethics Fri, 07 Nov 2014 04:04:31 +0000 Read More »]]> 0 Deliberation and Education in Bioethics: Overview Thu, 06 Nov 2014 19:34:38 +0000 0 Deliberation and Bioethics Education: A Case Study of Public Health Emergency Response Thu, 06 Nov 2014 18:47:54 +0000 0 Live from Salt Lake City Thu, 06 Nov 2014 16:11:10 +0000 0 Cheaper by the Dozen Thu, 06 Nov 2014 12:10:46 +0000 ]]> 0 Alabama Unilateral DNR Policy Challenged by Federal Class Action Lawsuit Thu, 06 Nov 2014 09:30:00 +0000 0 Brittany Maynard: A Terminal Cancer Patient’s Controversial Choice Thu, 06 Nov 2014 04:11:19 +0000 0 Bioethics Commission Discusses Law and Neuroscience Wed, 05 Nov 2014 22:40:15 +0000 0 Bioethics Commission Deliberates Consent Capacity Wed, 05 Nov 2014 21:20:26 +0000 0 Bioethics Commission Deliberates Neuroscience-Related Recommendations Wed, 05 Nov 2014 19:50:23 +0000 0