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Blog Posts (1888)

May 17, 2015

History of Cardiac Arrest and Its Effect on Contemporary Medicine (video)

Recently, at the MacLean Center's end-of-life series, Daniel Brauner offered a compelling history of cardiac arrest and its effect on contemporary medicine.  
May 17, 2015

Death Will Come for You [EOL in Art 7]

Edvard Munch painted "By the Deathbed in 1895. Here the focus is not so much on the person who has died, but rather on those who have come to grieve him. While the first four mourners from the left are focused on the person who has died, the fifth mou...
May 16, 2015

Minnesota Case: Final Exit Network Found Guilty of a Crime for Mere Speech

A 12-member Minnesota jury found Final Exit Network, Inc. guilty of "assisting" in a suicide and interfering with the scene of a death so as to mislead the coroner.  Judge Christian Wilton set the sentencing hearing to take place on August 24. The...
May 16, 2015

An Official ATS/AACN/ACCP/ESICM/SCCM Policy Statement: Responding to Requests for Potentially Inappropriate Treatments in Intensive Care Unit

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.

May 16, 2015

Ignoring the Approach of Death [EOL in Art 6]

Gustav Klimt painted "Death and Life" in 1916.  The allegorical figure of death is portrayed as a robed skeleton, holding a stick, approaching a family that is grouped together.  The family is filled with life, and they portray the full rang...
May 15, 2015

Baby Samuel - Court Vacates DNR over Mom's Objections

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.

May 15, 2015

Last Portrait of Mother [EOL in Art 5]

In 2010, Daphne Todd won the UK's leading prize for portraiture.  She painted her 100-year-old mother Annie after she died.  The undertaker allowed her to spend three days in the funeral parlor cool room painting her mother's body, which can...
May 14, 2015

Engaging Parents and Children Throughout Pediatric Research: A New Report from the Nuffield Council on Bioethics

Today the Nuffield Council on Bioethics (Nuffield Council), an independent bioethics advisory body in the United Kingdom, released Children and Clinical Research: Ethical Issues. The report marks the culmination of a two-year inquiry, during which the Nuffield Council received input from over 500 stakeholders – including the U.S. Presidential Commission for the Study of Bioethical […]
May 14, 2015

What Physicians Could Learn from Accountants and Veterinarians

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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May 14, 2015

Assisted Suicide: Death with Dignity or Legalized Killing

A debate in Saint Paul, MN on May 26.