» Health Care Where the World Finds Bioethics Thu, 23 Oct 2014 21:19:35 +0000 en-US hourly 1 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 Texas Medical Association Defends Advance Directives Act Sun, 12 Oct 2014 07:30:00 +0000 Konni Burton is running for the Texas State Senate as a Tea Party candidate.  She recently took a position on the end-of-life medical disputes.

Burton sent a campaign mailer that stated: “As State Senator, Konni will fight to protect the elderly and disabled patients from doctors who want to administer life-ending procedures.”  (Star Telegram)  This is an attack on Texas Health & Safety Code 166.046, the so-called Texas "medical futility law."

A letter from the Texas Medical Association Political Action Committee attacks Burton for her opposition to the 1999 law.  
  • "Do you know one single doctor who proposes to do such a thing? In my house, we would call that murder."
  •  "By this statement alone, Burton proves she is totally out of touch with the reality of medical care."
  • "Burton has demonstrated repeatedly that she is an enemy of the physicians of Texas."

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Lucas Moore: 23-week 520-gram Baby Survives Sat, 11 Oct 2014 08:30:00 +0000 Lucas Moore was born prematurely at 23 weeks weighing 520 grams, just 0.7 of an ounce over the hospital’s 500 gram cut-off point for intervention. (Telegraph)

With severe health problems – including a bleed on the brain and a hole in his heart – Lucas’s chances seemed dire, and doctors warned there was a high chance of him suffering disabilities as a result.  

But Lucas defied predictions and has now celebrated his first birthday.  The Daily Mail suggests that the case will fuel the debate over guidelines governing whether hospitals try to save the lives of extremely premature babies.

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Responding to Ebola: Questions about Resuscitation Fri, 10 Oct 2014 14:54:00 +0000 Joseph J. Fins]]> 0 Racial Disparities in Outcomes after Heart Attack Were Eliminated by Free Prescriptions Fri, 10 Oct 2014 13:22:21 +0000 Continue reading ]]> 0 Yes, Obamacare is a Success Fri, 10 Oct 2014 10:10:55 +0000 0 The Law and Ethics of Dementia Fri, 10 Oct 2014 08:30:00 +0000 Just published:  The Law and Ethics of Dementia, edited by: Charles Foster, Jonathan Herring, Israel Doron

Dementia is a topic of enormous human, medical, economic, legal and ethical importance. Its importance grows as more of us live
longer. The legal and ethical problems it raises are complex, intertwined and under-discussed. This book brings together contributions from clinicians, lawyers and ethicists - all of them world leaders in the field of dementia - and is a comprehensive, scholarly yet accessible library of all the main (and many of the fringe) perspectives. 

It begins with the medical facts: what is dementia? Who gets it? What are the current and future therapeutic and palliative options? What are the main challenges for medical and nursing care? The story is then taken up by the ethicists, who grapple with questions such as: is it legitimate to lie to dementia patients if that is a kind thing to do? Who is the person whose memory, preferences and personality have all been transformed by their disease? Should any constraints be placed on the sexual activity of patients? Are GPS tracking devices an unpardonable interference with the patient's freedom? These issues, and many more, are then examined through legal lenses. The book closes with accounts from dementia sufferers and their carers. It is the first and only book of its kind, and the authoritative text.

The book is divided into five main sections:
  1. Medical Fundamentals
  2. Ethical Perspectives
  3. Legal Perspectives
  4. Social Aspects
  5. Patient & Carer Perspectives

Twelve of the 44 chapters are in the legal section:
23. A Legal Overview Mary Donnelly
24. Assessing Capacity Lesley King and Hugh Series
25. Best Interests and Dementia Jonathan Herring
26. Proxy Decision-Making: A Legal Perspective Winsor C Schmidt
27. Being and Being Lost: Personal Identity and Dementia Jesse Wall
28. Dementia, Autonomy and Guardianship for the Old Margaret Isabel Hall
29. Restriction of Liberty Michael Schindler and Yael Waksman
30. Research on Patients with Dementia Phil Bielby
31. Dementia and Carers: Relationality and Informal Carers’ Experiences Rosie Harding
32. End-of-Life Care Ofra G Golan
33. Health Care Resource Allocation Issues in Dementia Keith Syrett
34. The Use of New Technologies in the Managementof Dementia Patients Karen Eltis

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George Watson – End-of-Life Pathway without Consultation Fri, 10 Oct 2014 06:00:00 +0000 0 Lawsuit Against U.N. on the Spread of Cholera Epidemic in Haiti Advances Thu, 09 Oct 2014 22:30:41 +0000 0 “I, Transhumanist” Thu, 09 Oct 2014 21:10:42 +0000 Read More »]]> 0 Fever Pitch Thu, 09 Oct 2014 11:42:35 +0000 ]]> 0 BMA Updates "Decisions Relating to Cardiopulmonary Resuscitation" Thu, 09 Oct 2014 08:00:00 +0000 On Tuesday, the British Medical Association, in conjunction with Resuscitation Council (UK) and the Royal College of Nursing, published a new guidance, a revised edition of Decisions Relating to Cardiopulmonary Resuscitation.

The guidelines identify the key ethical and legal issues that should inform all CPR decisions. Key points emphasized in the new guidance include:

  • The value of making anticipatory decisions about CPR as an integral part of good clinical practice
  • The importance of involving people (or their representatives if they are unable to make decisions for themselves) in the decision-making process
  • That when CPR has no realistic chance of success it is important to make decisions that are in the best interest of the patient, and not to delay a decision because a person is not well enough to have it explained to them or because their family or other representatives are not available
  • The importance of careful documentation and effective communication of decisions about CPR.

The guidance also warns against adopting the ‘default position’ of providing CPR, as this potentially denies patients the opportunity to refuse treatment they may not want or that, for many, may not offer overall benefit.  BMA medical ethics chair John Chisholm said: "It is our primary role to benefit patients and, when treatment can no longer achieve this, it is right to avoid invasive and burdensome interventions that will not be successful."

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Dolan Press Release on Postponing Jahi McMath Hearing Thu, 09 Oct 2014 02:49:00 +0000 The following is an unedited press release issued by Christopher Dolan, McMath family attorney.  I have posted a copy of the referenced documents here.

Christopher Dolan, McMath family attorney, has asked Alameda County Superior Court Judge Emillo Grillo to postpone tomorrow’s hearing regarding Jahi McMath’s status as brain dead so that the team of international brain death experts presented by McMath’s attorneys can have time to read and react to a new statement issued by Dr. Paul Fischer, the physician who originally testified as to Jahi’s brain death. 

This comes following yesterday’s re-appointment of Dr. Fischer as a court consultant by Judge Grillo. McMath’s attorneys have objected to Dr. Fischer’s appointment saying that Fischer had a conflict of interest, and a legal bias, as it is his original determination which is being examined in light of the new facts. No decision on the objection to Dr. Fischer has been issued.

Fischer, immediately upon re-appointment by the court issued a letter supporting his earlier determination stating that the fact that the brain had not liquified, Jahi had started her period (menarche), the evidence that there was cerebral blood flow, the recorded movements of Jahi’s body in response to commands, and the presence of electrical activity in her brain as recorded by EEG had no effect on his opinion.

Despite the sworn declarations of Dr. Calixto Machado, who’s CV demonstrates he is international recognized as a Board Certified expert on brain death; Dr. Alan Shewmon, a former Chief of Neurology at UCLA-Olive Medical Center who’s CV details vast experience as an expert on pediatrics and brain death in children; Dr. Charles Prestigiacomo who’s CV, shows his expertise in brain injury as a Board Certified Neurologic surgeon and Chair of Department of Neurosurgery at Rutgers University; Dr Ivan Mikolaenko, who’s CV details his expertise in brain injury as a Johns Hopkins trained Neurointensiveist/Neurological Consultant; and Dr. Phil DeFina, who’s CV demonstrates his education and experience as the Chief Scientific Officer of the International Brain Research Foundation, Dr. Fischer has indicated that none of the information provided by these experts, who all swear that Jahi McMath is not brain dead, has any effect on his prior opinion.

McMath’s lawyer, Christopher Dolan, asked to have tomorrow’s hearing taken off calendar and be rescheduled for the near future stating “we want to address any concerns that Dr. Fischer has in an effort to demonstrate that, with an open and transparent dialogue between healthcare professionals, only one conclusion can remain: that Jahi McMath is not brain dead.”  

Dolan said “I can understand what a difficult place Dr. Fischer finds himself in as he is the doctor who originally diagnosed Jahi as brain dead. We are not seeking to fault Dr. Fischer’s original exam. Experts say that Jahi’s brain swelling would have given the impression of brain death at that time. What we do want to do is to bring all the evidence forward to be looked at critically, and not defensively, as this is an important medical and legal debate which goes far beyond Jahi. In that regard, in the past, I had approached Dr. Fischer to share this information with him. He did not return my communications. So it is just within the last 24 hours that I have learned of Dr. Fischer’s concerns. To avoid this lapse in communication in the future, today I have requested that the Court permit all of the doctors to conference together as this is an area of science and medicine, with many world class scholars and practitioners involved.”  

Dolan said “We would like to take this out of the arena of adversarial proceedings and into an area of open dialogue and discussion between health care professionals. I’m a lawyer, not a doctor, it would be nice if the doctors could work as doctors without lawyers involved.”

Children’s Hospital has objected to Dolan’s request. In response to Children’ s Hospital’s objection Dolan stated “the McMath family hopes that a way can be found to have the medical community, including Dr. Fischer, productively and thoughtfully engage with Drs. Machado, Shewmon, Mikolaenko, Prestigiacomo, DeFina and Labkovsky and others who have sworn that she is not brain dead. These world class physicians, in saying that Jahi is not brain dead, do not do so lightly, Indeed, Dr. Machado is a staunch defender of the concept of brain death he just believes, unequivocally, in this case, Jahi is not brain dead.”

Dolan said, “the stakes are so high Jahi’s request to be restored to the status of a living person should not be determined technically by the choice of one test over another but, instead, based on well accepted medical principals and Jahi’s presentation which is consistent with a person who is not brain dead. To make sure that the Court has all information, including that which Dr. Fischer says is lacking, we are postponing tomorrow hearing and we will be approaching the court for a further hearing date in the near future.”

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Hamline University Health Law Institute – Annual Report Wed, 08 Oct 2014 23:02:00 +0000 0 The Bioethics Commission’s Work on Incidental and Secondary Findings and the Applications for Neuroscience Wed, 08 Oct 2014 16:39:38 +0000 0 New York City’s Innovative Approach to Helping Unaccompanied Minors Wed, 08 Oct 2014 14:54:00 +0000 Chelsea Jack]]> 0 American Public Ready to Abandon the Dead Donor Rule Wed, 08 Oct 2014 10:00:00 +0000 0 Medical Futility & Physician Moral Distress Wed, 08 Oct 2014 08:00:00 +0000 0 Jahi McMath Case Unites Tue, 07 Oct 2014 23:34:00 +0000 0 Don’t Blame Obamacare for Health Insurance Turnover Tue, 07 Oct 2014 13:08:41 +0000 Continue reading ]]> 0 New York Times: Expanding the Right to Die Tue, 07 Oct 2014 01:09:00 +0000 0