» Health Care Where the World Finds Bioethics Sat, 23 May 2015 09:00:01 +0000 en-US hourly 1 Jahi McMath – Status in May 2015 Sat, 23 May 2015 09:00:00 +0000 0 Victor Hugo on His Deathbed [EOL in Art 13] Sat, 23 May 2015 09:00:00 +0000 0 Absence of POLST Leads to Criminal Charges Sat, 23 May 2015 02:32:00 +0000 0 The Question Isn’t Whether We Are Overdiagnosing Cancer, But How Much Fri, 22 May 2015 14:19:25 +0000 Medical experts now agree that as a result of aggressive screening programs, we have an epidemic of cancer overdiagnosis in the United States. With mammograms finding tiny cancers and PSA tests discovering unpalpable prostate cancers, we are now unearthing some … Continue reading

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Dying without Dignity – Investigations by the Parliamentary and Health Service Ombudsman into Complaints about End of Life Care Fri, 22 May 2015 11:47:00 +0000 The UK Parliamentary and Health Service Ombudsman has just published an alarming report on the end of life care, “Dying Without Dignity.”  It is a painful and sad read.

The report identifies six key themes, all illustrated with case studies
  1. Not recognising that people are dying, and not responding to their needs – if the needs of those who are close to death are not recognised, their care cannot be planned or co‐ordinated, which means more crises and distress for the person and their family and carers.
  2. Poor symptom control – people have watched their loved ones dying in pain or in an agitated state because their symptoms have been ineffectively or poorly managed.
  3. Poor communication – poor communication is an important element in our complaints on end of life care. It is clear that healthcare professionals do not always have the open and honest conversations with family members and carers that are necessary for them to understand the severity of the situation, and the subsequent choices they will have to make.
  4. Inadequate out‐of‐hours services – people who are dying and their carers suffer because of the difficulties in getting palliative care outside normal working hours.
  5. Poor care planning – a failure to plan adequately often leads to the lack of co‐ordinated care, for example, GPs and hospitals can fail to liaise.
  6. Delays in diagnosis and referrals for treatment – this can mean that people are denied the chance to plan for the end of their life and for their final wishes to be met.

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Marcel Proust on His Deathbed [EOL in Art 12] Fri, 22 May 2015 09:30:00 +0000 0 Conscience and Proper Medical Treatment Fri, 22 May 2015 00:21:00 +0000 0 Don’t Be Afraid to Team Up with Your Doctor about Healthcare Costs Thu, 21 May 2015 12:24:06 +0000 Here is a fine story in the Los Angeles Times written by Lisa Zamosky about the importance of talking with your doctor about your out of pocket medical costs. Despite high medical costs topping Americans’ list of financial concerns, many … Continue reading

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Terminally Ill Patients Visit the Museum [EOL in Art 11] Thu, 21 May 2015 09:30:00 +0000 0 Aid in Dying: An Important Possibility at the End of Life Thu, 21 May 2015 09:00:00 +0000 0 These Americans Are Rich – Should We Celebrate? Wed, 20 May 2015 20:55:29 +0000 American manufacturing has declined precipitously in the past few decades. Companies that were once the source of fabulous wealth for Americans – the U.S. Steel profits that enriched the Carnegie family, the Ford Motor F -1.29% Company profits that enriched … Continue reading

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Grief and Mourning at Death [EOL in Art 10] Wed, 20 May 2015 09:00:00 +0000 0 Physicians Should Not Act Like Judges (video) Wed, 20 May 2015 08:30:00 +0000 0 New Educational Module from the Bioethics Commission on Informed Consent in Neuroscience Now Available Tue, 19 May 2015 15:55:08 +0000 0 Aruna Shanbaug Dies after 42 Years in PVS Tue, 19 May 2015 15:37:00 +0000 Aruna Shanbaug has died in Mumbai after spending 42 years in a vegetative state.

Shanbaug suffered brain damage from a sexual assault and strangling in 1973 by a cleaner at the hospital where she worked. She remained in a vegetative state in Mumbai’s King Edward Memorial Hospital until her death this week.  (Wall Street Journal)

In 2011, the Supreme Court considered Shanbaug’s case after her biographer and friend, Pinki Virani, filed a petition asking judges to order the hospital to stop feeding her and “allow her to die peacefully.”  But, as I wrote at the time, the court denied Virani's petition.

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Monet and Camille [EOL in Art 9] Tue, 19 May 2015 09:00:00 +0000 Monet lived to 86.  But his wife Camille Doncieux died at just 32.

“Camille Monet sur son lit de mort,” or “Camille on Her Deathbed” (1879) is one of Monet’s most powerful paintings of his wife.

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Monet and Camille [EOL in Art 9] Tue, 19 May 2015 09:00:00 +0000 Monet lived to 86.  But his wife Camille Doncieux died at just 32.

“Camille Monet sur son lit de mort,” or “Camille on Her Deathbed” (1879) is one of Monet’s most powerful paintings of his wife.

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Should someone who does not want biological children be diagnosed as infertile? Tue, 19 May 2015 08:05:43 +0000 0 Whispering of Death [EOL in Art 8] Mon, 18 May 2015 09:00:00 +0000 Arnold Böcklin painted this self-portrait in 1872.  Since there seems to be only one string left on the violin, it seems that death is whispering, "I'm coming for you soon."

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Texas House Votes to Narrow Futility Law Mon, 18 May 2015 08:00:00 +0000 0 History of Cardiac Arrest and Its Effect on Contemporary Medicine (video) Sun, 17 May 2015 09:30:00 +0000 0 Death Will Come for You [EOL in Art 7] Sun, 17 May 2015 09:00:00 +0000 0 Minnesota Case: Final Exit Network Found Guilty of a Crime for Mere Speech Sat, 16 May 2015 22:40:00 +0000 0 An Official ATS/AACN/ACCP/ESICM/SCCM Policy Statement: Responding to Requests for Potentially Inappropriate Treatments in Intensive Care Unit Sat, 16 May 2015 15:26:00 +0000 Almost all of the major professional association guidelines on medical futility are more than a decade old.  Finally, a new multi-society policy was published online yesterday.  I was pleased to be a part of it.

There is controversy about how to manage requests by patients or surrogates for treatments that clinicians believe should not be administered.  This multi-society statement provides recommendations to prevent and manage intractable disagreements about the use of such treatments in intensive care units. 

The recommendations were developed using an iterative consensus process, including expert committee development and peer review by designated committees of each of the participating professional societies (American Thoracic Society, American Association for Critical Care Nurses, American College of Chest Physicians, European Society for Intensive Care Medicine, and Society of Critical Care). 

The committee recommends: 

  • Institutions should implement strategies to prevent intractable treatment conflicts, including proactive communication and early involvement of expert consultants. 
  • The term “potentially inappropriate” should be used, rather than futile, to describe treatments that have at least some chance of accomplishing the effect sought by the patient, but clinicians believe that competing ethical considerations justify not providing them.
  • Clinicians should explain and advocate for the treatment plan they believe is appropriate. 
  • Conflicts regarding potentially inappropriate treatments that remain intractable despite intensive communication and negotiation should be managed by a fair process of conflict resolution; this process should include hospital review, attempts to find a willing provider at another institution, and opportunity for external review of decisions.

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Ignoring the Approach of Death [EOL in Art 6] Sat, 16 May 2015 08:00:00 +0000 0 Baby Samuel – Court Vacates DNR over Mom’s Objections Fri, 15 May 2015 23:15:00 +0000 In January, when Samuel Flaherty Irvin was less than a month old, the Arizona Department of Child Safety took him from his mother Fawn Flaherty due to  "child abuse, neglect."  (KVOA)

Samuel was placed in a foster home for the medically fragile.  But later that month he choked when they were feeding him and went without oxygen for a prolonged period.  Samuel's treating clinician recommended that he “not receive resuscitation efforts if he deteriorates.”  So, DCS got a Tuscon Judge to authorize a “do not resuscitate” order.   

But Fawn's parental rights had not been terminated.  So, consistent with the law in other states, at the end of April, an appellate court vacated the “do not resuscitate” order.

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Last Portrait of Mother [EOL in Art 5] Fri, 15 May 2015 08:00:00 +0000 0 Engaging Parents and Children Throughout Pediatric Research: A New Report from the Nuffield Council on Bioethics Thu, 14 May 2015 15:11:58 +0000 0 What Physicians Could Learn from Accountants and Veterinarians Thu, 14 May 2015 13:22:08 +0000 Rebecca Plevin, from KPCC public radio in California, is quickly becoming one of my favorite health reporters. She is really digging in to the strange world of health economics. Here’s a nice piece she did, comparing how people talk about … Continue reading

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Assisted Suicide: Death with Dignity or Legalized Killing Thu, 14 May 2015 12:36:00 +0000 0 Death Leading the Doctor [EOL in Art 4] Thu, 14 May 2015 08:30:00 +0000 0 EMS SignPost – Medical ID on a Refrigerator Magnet Thu, 14 May 2015 08:00:00 +0000 0 Why Do We Over Treat Patients in the U.S.? Thu, 14 May 2015 04:05:39 +0000 0 Bioethics Commission recommends establishing clear requirements for identifying legally authorized representatives for research participation Wed, 13 May 2015 15:42:30 +0000 0 ETHICS OF THE POLITICS OF PAIN Wed, 13 May 2015 14:42:00 +0000 Picking Up the Gauntlet
On May 1, the Center for Practical Bioethics hosted an ethics symposium, something they do every spring. What made this event special enough that it moved me to write about it was the topic, Healing What Hurts: The Politics of Pain.

I’m a bit of an oddball in the pain world. I am not a healthcare professional, nor am I person with chronic pain. I am not an academician or researcher; I don’t work in industry. I am someone who came in the ‘side door’ to the pain world providing services like strategic planning, meeting coordination, and program/project management to organizations like the Center. I can’t truthfully say that helping to change the way pain is perceived, judged and treated is a personal passion of mine. But it has become something I believe in and care about, a testament to the incredible people at the Center with whom I have the privilege of working, and my exposure to the thinking and work of individuals like those who presented last week.

At the symposium, I felt like I was witnessing the creation of a beautiful tapestry, with each speaker picking up the thread of those who came before and continuing to weave the threads together until the complicated (and troubling) reality of the polarizing space in which pain currently resides was achingly clear. Some threads:
  • Historian and author Dr. Keith Wailoo’s spellbinding historical dissection of the poles our policymakers and courts have swung between in answering the questions, “Whose pain matters and who deserves care?” While historians feel more comfortable looking back instead of ahead, Dr. Wailoo did offer some insight into my question of how to have success this time around in making sure that reimbursement model changes follow our ability to demonstrate that comprehensive multi-modal pain care holds down costs and improves outcomes.
  • Dr. Kathy M. Foley (I view her as the Grand Dame of this continent’s pain movement) exposing the harsh realities of care being forced to focus on what’s reimbursable vs. what’s best for the person with pain.
  • Dr. Bob Twillman laying bare the damage caused when overly simplistic policy and action around harm reduction focuses solely on cutting down on the supply of prescription narcotics, without looking at the demand side and asking, “In which patients should we use opioids, at what doses, for how long, with which adjunctive treatments, and with what precautions?”
  • Dr. Richard Payne sharing some pretty mind-blowing emerging science about how the social determinants of health most closely associated with underserved populations actually affects one’s biology. Melissa Robinson from the Black Health Care Coalition made it real for the impoverished in Kansas City.
  • And, pain pioneer Dr. Lynn Webster, pain advocate Janice Lynn Shuster, and public policy expert Katie Horton reminding us all that the lives of people in pain matter and their stories must be heard.
Having worked in this arena for over a decade, I will own that the fight to make things better for people with pain feels akin to running a marathon in five feet of mud – it’s a slow slog even on good days. The assembled audience sensed there may still be some dark days ahead before the pendulum swings back towards reason and progress. But the conviction that things will get better and that we must continue the fight was evident in abundance.

Who else but the Center could and would provide the kind of thought provoking and engaging delve into the ethics of the politics of pain? There may be others, but the Center picked up the gauntlet and ran with it. And for that, they have my love, admiration and respect. [In the spirit of full disclosure, I currently do some consulting work for the Center on the PAINS Project.]

Written By Ann J. Corley, MS

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Showing Doctors How to Lower Healthcare Costs Wed, 13 May 2015 13:43:11 +0000 There are lots of things we need to do to get healthcare costs under control in the United States. Critical to most of our efforts, however, is to get physicians to practice cost-conscious care. Here is a nice story on … Continue reading

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POLST – An Authoritative Summary Wed, 13 May 2015 08:30:00 +0000 0 Overtreatment in 1848 [EOL in Art 3] Wed, 13 May 2015 08:30:00 +0000 0 New Education Materials from the Bioethics Commission on Research Design Now Available Tue, 12 May 2015 16:40:40 +0000 0 What Do Cancer Centers Think Patients Are Looking For? Tue, 12 May 2015 13:28:21 +0000 If you were a cancer center trying to get patients to come to receive care at your facility, what message would you send them? In other words, what would you as a cancer center director think people would value in … Continue reading

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Respice Finem [EOL in Art 2] Tue, 12 May 2015 09:00:00 +0000 0 Ethical Reflection in End-of-Life Decisions: Dutch Perspective (UMN) Mon, 11 May 2015 21:58:00 +0000 0 POLST or Advance Directive? [EOL in Art 1] Mon, 11 May 2015 12:30:00 +0000 0 Social Media and Patient Information Mon, 11 May 2015 01:05:01 +0000 0 Duty to Transfer Brain Dead Individual Sat, 09 May 2015 12:18:00 +0000 0 New Multi-Society Futility Policy Sat, 09 May 2015 08:30:00 +0000 0 Christians and Aggressive End-of-Life Care Sat, 09 May 2015 01:28:00 +0000 0 When did same-sex marriage become morally acceptable to you? Fri, 08 May 2015 14:25:47 +0000 A same-sex marriage decision is due from the Supreme Court June. Given it has been almost exactly a decade since I changed my position on same-sex marriage, I figure now is a good time to reflect on the nature of that change.

Until about my sophomore year of college I was against same-sex marriage. Moreover [...]

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Delaware Passes POLST Bill (DMOST) Fri, 08 May 2015 11:21:00 +0000 Yesterday, the Delaware Senate passed H.B. 64, which the House passed at the end of March. Once signed by the governor, this will add a new title 25A to title 16 of the Delaware Code:  "Delaware Medical Orders for Scope of Treatment Act” (DMOST Act)."

Getting a legal status for POLST in Delaware has been a long a bumpy road.  I review some of that here.

This summer, I will be assessing this and other new POLST and surrogate decision making statutes for the 2016 supplement to the RIGHT TO DIE legal reference treatise.

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Use of Unproven Interventions is Never Obligatory Fri, 08 May 2015 08:05:30 +0000 0