» Health Care Where the World Finds Bioethics Fri, 12 Sep 2014 23:56:29 +0000 en-US hourly 1 Palliative Care – Free Webinar Series Fri, 12 Sep 2014 23:56:00 +0000 0 Keeping up with Clinical Research with Human Embryonic Stem Cells Fri, 12 Sep 2014 01:26:09 +0000 Read More »]]> 0 Health Reform Watch: Study finds fewer deaths after MA health reform Thu, 11 Sep 2014 18:54:17 +0000 0 Addressing Dual Agency: Getting Specific About the Expectations of Professionalism Thu, 11 Sep 2014 18:45:11 +0000 0 Clever Graphic to Stop Public Urination – Yes, Urination Thu, 11 Sep 2014 12:55:35 +0000 Continue reading ]]> 0 West Virginia e-Directive Registry – Model for Other States Thu, 11 Sep 2014 11:04:00 +0000 0 Extending the Zadroga Act Thu, 11 Sep 2014 10:56:14 +0000 ]]> 0 Who’s Afraid of GMO? Thu, 11 Sep 2014 04:09:48 +0000 0 What is Democratic Deliberation? A Q&A with Bioethics Commission Chair Amy Gutmann Wed, 10 Sep 2014 16:46:11 +0000 0 Are Some Life Saving Treatments Overkill? Wed, 10 Sep 2014 12:42:54 +0000 Continue reading ]]> 0 What Should We Forget? Wed, 10 Sep 2014 00:55:22 +0000 Read More »]]> 0 Responding to Ebola: Organizational Ethics, Frontline Perspectives Tue, 09 Sep 2014 14:54:00 +0000 Chelsea Jack and Nancy Berlinger]]> 0 Can Social Media Save Us from the “Spiral of Silence?” Tue, 09 Sep 2014 13:37:06 +0000 ]]> 0 Health Insurance Prices Declining under Obamacare Tue, 09 Sep 2014 12:55:42 +0000 Continue reading ]]> 0 Drug Innovation and Government-Operated Health Systems Tue, 09 Sep 2014 11:09:31 +0000 0 7th Annual Pediatric Bioethics Conference Tue, 09 Sep 2014 07:00:00 +0000 On November 7, 2014, Wolfson Children’s Hospital, in partnership with the University of North Florida and the Florida Bioethics Network, presents the Seventh Annual Pediatric Bioethics Conference.

Welcoming Remarks 
Alissa Hurwitz Swota, PhD
University of North Florida and Wolfson Children’s Hospital, Jacksonville, FL

Wolfson Lecture: Ethical Dilemmas in Pediatric Nursing Administration
Veronica Scott-Fulton, DNP, MPH, RN, NEA-BC
Vice President, Operations & Patient Care Services
Wolfson Children’s Hospital

Ethical and Clinical Challenges in Caring for Children with Cancer in the Era of Chemotherapy Drug Shortages: The Not so Good, the Bad, and the Ugly 
Yoram Unguru, MD, MS, MA
Attending Physician, Division of Pediatric Hematology/Oncology, The Herman and Walter Samuelson Children’s Hospital at Sinai Core Faculty, Johns Hopkins Berman Institute of Bioethics; Assistant Professor, Johns Hopkins University School of Medicine

Living with Illness: A Sibling Perspective  
Moderator: Kelly Komatz, MD, MPH, FAAP, FAAHPM
Assistant Professor, UF COM Jacksonville, Department of Pediatrics/Community Pediatrics

Conflict Resolution in Healthcare: Beyond Bioethics Mediation 
Haavi Morreim, JD, PhDProfessor, Department of Internal Medicine, College of Medicine, University of Tennessee; Principal, ADR Institute, LLC

Can We Reasonably Hope to Transform Unreasonable Hopes? 
Ralph Baergen, PhD, MPH 
Professor of Philosophy, Idaho State University

Child Abuse: Working with Parents who may have put their Child in the Hospital 
Kathleen Dully, MD
Medical Director, First Coast Child Protection Team

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Limning the Limits Tue, 09 Sep 2014 02:18:54 +0000 Read More »]]> 0 Top U.S. health adviser wants end to partisan fighting over Obamacare Mon, 08 Sep 2014 22:47:02 +0000 0 Power of Analogy Mon, 08 Sep 2014 17:44:23 +0000 Continue reading ]]> 0 Interventions at the End of Life – Social, Comparative and Historical Analysis to Promote Global Improvement Mon, 08 Sep 2014 10:00:00 +0000 The Wellcome Trust has awarded a Senior Investigator Award in the Medical Humanities, entitled: "Interventions at the End of Life – Social, Comparative and Historical Analysis to Promote Global Improvement."  

The research involves a rigorous assessment of the world’s end of life care needs – and will propose strategies for improvement. It will also seek to generate more sustainable and appropriate end of life interventions, across various cultures and settings.

David Clark at the University of Glasgow more fully describes the project here.

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Kathryn Tucker Now at Disability Rights Legal Center Sun, 07 Sep 2014 09:00:00 +0000 The Disability Rights Legal Center part of the Public Interest Law Center of Loyola Law School Los Angeles has announced Kathryn L. Tucker, Esq., as its new Executive Director and Director of Advocacy and Legal Affairs.  

Tucker joins DRLC from the national nonprofit organization Compassion & Choices, where she worked to improve patient rights and choice at the end of life as Director of Advocacy and Legal Affairs for two decades.  

Tucker also served as lead counsel in two landmark end of life care cases before the United States Supreme Court, which established the right of dying patients to aggressive pain management. Her work has furthered the rights of patients in many states to better end of life care. She helped successfully defend Oregon’s Death with Dignity Act and was instrumental in successful campaigns to pass similar laws in other states.

Tucker has held a faculty appointment at Loyola for a number of years, teaching "Law, Medicine and Ethics at the End of Life.”  Her new position will enable her to continue work on behalf of patients with serious illness, as DRLC  includes the Cancer Legal Resource Center and the HIV Law and Policy Project.

Given the historic tension between end of life choice advocates and much of the Disability Advocacy community, the DRLC Board's selection of Tucker is impressive and commendable.  It is also smart.  Tucker has two decades of experience in moving a multidimensional advocacy agenda forward for a social change movement.  Her work involved state and federal impact litigation as well as state and federal legislative work. She is known for creative aggressive advocacy and achieving outstanding results. Selecting her as Executive Director, positions DRLC to be a leader in the Disability community.

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Memorial to Lives Unworthy of Life Sun, 07 Sep 2014 06:00:48 +0000 Read More »]]> 0 AARP Oddly Excludes Right to Die Groups Sat, 06 Sep 2014 14:17:00 +0000 0 Creating a “New Race,” a New Problem…or Both? Sat, 06 Sep 2014 13:26:42 +0000 Read More »]]> 0 Maine DHHS Cannot Authorize DNR on Baby Aleah Peaslee without Mother Virginia Trask’s Consent Sat, 06 Sep 2014 11:26:00 +0000 Virginia Trask originally agreed to a DNR order on her brain-damaged daughter, Aleah Peaslee.  But after the baby improved somewhat, Trask changed her mind. But, by then, Trask was no longer in charge of her daughter.  State child welfare officials consented to the DNR order. Trask is now fighting to reverse that order. The Maine Supreme Judicial Court hears arguments on September 23 (In re A.P., Ken-14-192).

Trask argues that the court may allow the Department of Health & Human Services to authorize a DNR order only if the parent's parental rights have been terminated.  The Department argues that it has the authority to consent to a "do-not-resuscitate" order for any child in its custody, if it is in the child's best interest to do so.

In short, a core question at issue is whether temporary substitute decision makers have the right to consent to a DNR order for a child.  Generally, the answer is "no."  These decision makers cannot consent to stopping life-sustaining treatment until parental rights are permanently terminated.  
  • D.K. v. Commonwealth, 221 S.W.3d 382, 384 (Ky. Ct. App. 2007).
  • In re Matthew W., 903 A.2d 333, 335 (Me. 2006). 
  • In re Smith, 133 P.3d 924, 929‐30 (Or. Ct. App. 2006). 
  • In re Stein, 821 N.E.2d 1008 (Ohio 2004).
  • In re Tabatha R., 564 N.W.2d 598, 605 (Neb. 1997).

Most recently, attorneys for the mother of Issac Lopez tried to argue that withdrawing physiological support without consent violated parental rights.  That argument failed, because Issac was already dead and his death terminated parental rights.  But since Aleah is still alive, the argument should be successful.

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5th International Conference on Advance Care Planning & End-of-Life Care Sat, 06 Sep 2014 07:30:00 +0000 0 IOM Committee on Approaching Death: Addressing Key End of Life Issues Report Release Sat, 06 Sep 2014 00:53:00 +0000 0 New Educational Modules on Vulnerable Populations Fri, 05 Sep 2014 16:00:35 +0000 0 Red Robin, Red Robin, Please Clog My Arteries! Fri, 05 Sep 2014 12:44:17 +0000 Continue reading ]]> 0 The Farewell Party (film) Fri, 05 Sep 2014 08:00:00 +0000 "The Farewell Party" centers on a group of Jerusalem retirement-home residents who create a euthanasia machine to put a dying friend out of his misery — and then face a moral dilemma when others come seeking the same service.

Co-director Carol Maymon said the seed of the film was the death of her ex-boyfriend’s elderly grandmother.  "We felt like death released her from pain and suffering — but then the paramedics came into the house and tried to resuscitate her for half an hour. . .  They were fighting for her life like she was 16 years old. It was so absurd, and from this absurd moment the idea came. . . .  There was a funny moment when her son told the paramedics: 'If you wake her up, you are taking her with you.'"

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Is an RCT of an Ebola drug ethical? Fri, 05 Sep 2014 03:25:13 +0000 Read More »]]> 0 Patients Killing Doctors Thu, 04 Sep 2014 19:06:00 +0000 0 FDA Proposal for Regulating Laboratory Diagnostics Could Improve Patient Care Thu, 04 Sep 2014 14:54:00 +0000 Rachel Sachs]]> 0 Moderate Politicans: No Reason to Run for Office Thu, 04 Sep 2014 12:35:27 +0000 Continue reading ]]> 0 Legal Briefing: Brain Death and Total Brain Failure Thu, 04 Sep 2014 08:30:00 +0000 My latest legal briefing is now available: "Legal Briefing: Brain Death and Total Brain Failure"  Journal of Clinical Ethics 25, no. 3 (Fall 2014): 245-57.  Here is the abstract:

This issue’s “Legal Briefing” column covers recent legal developments involving total brain failure. Death determined by neurological criteria (DDNC) or “brain death” has been legally established for decades in the United States. But recent conflicts between families and hospitals have created some uncertainty. Clinicians are increasingly unsure about the scope of their legal and ethical treatment duties when families object to the withdrawal of physiological support after DDNC. This issue of JCE includes a thorough analysis of one institution’s ethics consults illustrating this uncertainty. This experience is not unique. Hospitals across the country are seeing more DDNC disputes. 

Because of the similarity to medical futility disputes, some court cases on this topic were reviewed in a prior “Legal Briefing” column. But a more systematic review is now warranted. I categorize recent legal developments into the following nine categories:
1.   History of Determining Death by Neurological Criteria
2.   Legal Status of Determining Death by Neurological Criteria
3.   Legal Duties to Accommodate Family Objections
4.   Protocols for Determining Death by Neurological Criteria
5.   Court Cases Seeking Physiological Support after DDNC
6.   Court Cases Seeking Damages for Intentionally Premature DDNC
7.   Court Cases Seeking Damages for Negligently Premature DDNC
8.   Court Cases Seeking Damages for Emotional Distress
9.   Pregnancy Limitations on DDNC

In the same issue, check out "Family Members’ Requests to Extend Physiologic Support after Declaration of Brain Death: A Case Series Analysis and Proposed Guidelines for Clinical Management."

We describe and analyze 13 cases handled by our ethics consultation service (ECS) in which families requested continuation of physiological support for loved ones after death by neurological criteria (DNC) had been declared. These ethics consultations took place between 2005 and 2013. Patients’ ages ranged from 14 to 85. Continued mechanical ventilation was the focal intervention sought by all families. The ECS’s advice and recommendations generally promoted “reasonable accommodation” of the requests, balancing compassion for grieving families with other ethical and moral concerns such as stewardship of resources, professional integrity, and moral distress. In cases we characterized as finite-goal accommodation, a “reasonable accommodation” strategy proved effective in balancing stakeholders’ interests and goals, enabling steady progress toward resolution. When a family objected outright to a declaration of DNC and asked for an indefinite accommodation, the “reasonable accommodation” approach offered clinicians little practical direction, and resolution required definitive action by either the family or the clinical team. Based on our analysis and reflections on these 13 cases, we propose ethically justified and practical guidelines to assist healthcare professionals, administrators, and ECSs faced with similar cases.

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CRISIS ETHICS: Hope for the best, prepare for the worst Thu, 04 Sep 2014 05:52:57 +0000 by Craig Klugman, Ph.D.

An Ebola epidemic rages through Western Africa. Civil unrest and terrorist turmoil rocks Syria/Iraq, Libya, Israel/Gaza, and Ferguson, Missouri. A 6.1 earthquake damages Napa and shakes the entire San Francisco Bay Area. All of these events are examples of crisis—a catastrophic disaster (natural or human-made) that disrupts the regular operating of a region.

In terms of health, a crisis is a “state of being that indicates a substantial change in health care operations and the level of care than can be delivered in a public health emergency, justified by specific circumstances” (IOM, Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response 2012).

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A Distinction for the Debate over Brain-Death Thu, 04 Sep 2014 02:09:27 +0000 0 Physician Aid in Dying Through Legislation: The Vermont Experience Wed, 03 Sep 2014 20:08:00 +0000 In Minneapolis, on Friday, September 12, the University of Minnesota Center for Bioethics hosts Vermont Senator Claire Ayer.  She will present “Physician Aid in Dying Through Legislation: The Vermont Experience.”

In 2013, Vermont became the first eastern state to allow for Physician Aid in Dying (PAD). Of equal or perhaps greater significance, Vermont also became the first state in the country to enact PAD through the legislative process. 

Senator Ayer, chairwoman of the Senate Health and Welfare Committee, spearheaded the measure’s passage. In so doing, she and others overcame numerous procedural and substantive challenges from her peers, the press, and the public. Interestingly, challenges came from both those who wanted more governmental protections and oversight and from those who opposed any government involvement in the doctor patient relationship. The final measure was signed by the Governor on May 20, 2013 and managed to address, at least in part, both concerns.

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Responding to Ebola: Fostering Transparency and Inclusivity Wed, 03 Sep 2014 14:54:00 +0000 Keymanthri Moodley]]> 0 Who cares about the well-being of women who have abortions? Wed, 03 Sep 2014 12:35:20 +0000 Read More »]]> 0 Something I Have in Common with Beethoven Wed, 03 Sep 2014 12:10:05 +0000 Continue reading ]]> 0 Right to Die Conference – Sept. 17-21 in Chicago Wed, 03 Sep 2014 08:00:00 +0000 0 Big Data Peeps At Your Medical Records To Find Drug Problems Tue, 02 Sep 2014 23:57:34 +0000 0 Holding Institutions Responsible for Research Misconduct: the recent case of a death of stem cell scientist Tue, 02 Sep 2014 09:09:11 +0000 0 Overemphasis on Errors of Unwanted Death Exacerabate Errors of Unwanted Life Tue, 02 Sep 2014 08:00:00 +0000 0 Is [Your Favorite Politician Here] Narcissistic Enough to Be a Good President? Mon, 01 Sep 2014 15:09:35 +0000 Continue reading ]]> 0 2014 United States Health Freedom Congress (Minnesota) Mon, 01 Sep 2014 13:34:00 +0000 Come to Hamline University on September 26 and 27 for the 2014 Health Freedom Congress.

The 2014 United States Health Freedom Congress is the 9th national health freedom gathering hosted by NHFC.  This Congress will bring together over 40 health freedom organizations and their leaders from across the nation and numerous other leaders and general participants. Attendees will join and work together for two days. 

The first day, September 26, Voting Members of the Congress will reconvene the Congress formal circle for a limited time in the morning. This will be followed by a full day of activities with General Participants and Voting Members working closely together to discern ways to strengthen the health freedom movement. The daytime work will be followed by an evening workshop on social media entitled “Health Freedom Going Live.”

The second day, September 27, attendees will resume their work from 9:00am - 2:00pm. At 2:00pm the Health Freedom Congress will convene and participate in wrap-up. The Health Freedom Awards Banquet and Keynote speech by Barbara Loe Fisher will begin at 6:30pm Saturday evening.

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California Law on Therapeutic Obstinacy & Non-Beneficial Treatment (Video) Mon, 01 Sep 2014 12:45:00 +0000 0 What Is Driving Our Health Care? Sun, 31 Aug 2014 18:26:38 +0000 Read More »]]> 0 Final Exit Network – 10 Year Anniversary Sun, 31 Aug 2014 09:00:00 +0000 0