Get Published | Subscribe | About | Write for Our Blog    

Author Archive: Thaddeus Mason Pope, JD, PhD

About Thaddeus Mason Pope, JD, PhD

What does it mean to be dead? You’d think the answer to that question is binary. You are, or you are not dead. But the fact is every state in the United States determines death differently. And when it comes to brain death specifically, the subtle differences can have major consequences for doctors, patients, and their families. 

This was a challenge before COVID-19. The pandemic has underscored the already urgent need to reconcile these differences as soon as possible. I joined Jeff Segal, MD, JD on the Medical Liability Minute, to discuss brain death.


Full Article

To assist hospitals and health systems to implement a transparent and fair approach to allocate scarce medications to treat patients with COVID-19, the University of Pittsburgh Department of Critical Care Medicine has created a model hospital policy and allocation framework. 
Hospitals and health systems are welcome to adapt the policy for their specific needs. Click here to download a PDF version of the Model Hospital Policy for Fair Allocation of Medications to Treat COVID-19.
Since March 2020, the number of clinical trials to assess the efficacy of medications to treat COVID-19 has expanded rapidly. As the trials start to identify beneficial therapies, hospitals will face difficult choices about which patients should be treated when there is not enough medication to treat all patients with COVID-19.
Dr. Douglas White led a multidisciplinary team to develop a framework to fairly allocate scarce COVID-19 treatments. The team included diversity and inclusion experts, ethicists, economists, and medical specialists from the University of Pittsburgh, Harvard University, University of Denver, Boston College and MIT.
What are the important features of the model policy?
  1. An allocation team, not the treating clinicians, makes the allocation decisions. This promotes objectivity, avoids conflicts of commitment, and minimizes clinicians’ moral distress.
  2. The framework is designed to enhance medical benefit for communities, ensure meaningful access and individualized assessments for all patients, avoid discrimination, and mitigate disparities in outcomes due to social inequalities.
  3. The model policy uses a weighted lottery or categorical reserve system to fairly allocate drug supplies if there is insufficient supply to treat all eligible patients.
About Dr. Douglas White, MD, MAS
Dr. White is the UPMC Endowed Chair for Ethics in Critical Care Medicine and professor of Critical Care Medicine, Medicine, and Clinical and Translational Science in the Department of Critical Care Medicine at the University of Pittsburgh. Professor White is director of the CRISMA Program on Ethics and Decision Making in Critical Illness. He and his colleagues conduct scholarly work to understand and improve how medical decision are made for critically ill patients, many of whom are unable to made decisions for themselves. Dr. White is available for consultation on the policy by sending an email to douglas.white@pitt.edu.
References
White DB, Lo B. A Framework for Rationing Ventilators and Critical Care Beds During the COVID-19 Pandemic. JAMA. 2020 Mar 27.
DeJong C, Chen AH, Lo B. An Ethical Framework for Allocating Scarce Inpatient Medications for COVID-19 in the US. JAMA. 2020 May 15.
Pathak PA, Sönmez T, Unver MU, Yenmez MB. Leaving No Ethical Value Behind: Triage Protocol Design for Pandemic Rationing.
Daugherty Biddison EL, Gwon H, Schoch-Spana M, Cavalier R, White DB, Dawson T, Terry PB, London AJ, Regenberg A, Faden R, Toner ES. The community speaks: understanding ethical values in allocation of scarce lifesaving resources during disasters. Annals of the American Thoracic Society 2014;11:777-83.
Daugherty Biddison EL, Gwon HS, Schoch-Spana M, Regenberg AC, Juliano C, Faden RR, Toner ES. Scarce Resource Allocation During Disasters: A Mixed-Method Community Engagement Study. Chest 2018;153:187-95.

Full Article

Several United States jurisdictions (like Nevada) mandate continued organ-sustaining treatment AFTER determination of death when the individual is pregnant and there is some chance to later deliver the baby. This is not the case in the Australian Capi...

Full Article

The New Hampshire health care decisions act prohibits healthcare agents and surrogates from consenting to experimental therapy on behalf of an incapacitated patient. As in many states, this constraint on authority is listed with constraints on the abil...

Full Article

So, you’ve written an advance care directive. You’ve made it clear, you think, about the kinds of medical care you want should you get sick with Covid-19 or you’re in the midst of a medical crisis. Will your wishes be followed? 

Art Caplan and I talk with Cathy Wurzer at the End in Mind Project.


Full Article

Lamar Hankins has compiled both a good list of dementia directives and a good list of recommended elements of dementia directives. Many of these include provisions that direct stopping eating and drinking. In a recently completed invited book manuscri...

Full Article

I am delighted to have recently delivered complete manuscripts for a number of invited and planned publications. In addition, I list my articles and books that have already been published in 2020.

My key objective for June is completing "From Informed Consent to Shared Decision Making: Improving Patient Safety and Reducing Medical Liability Risk with Patient Decision Aids."

FORTHCOMING IN 2020

Is There a Right to Delay Determination of Death by Neurologic Criteria? JAMA NEUROLOGY (forthcoming 2020) (with Ariane Lewis, and Richard J. Bonnie).

Brain Death: Status Shift and Implications, AMA JOURNAL OF ETHICS (forthcoming 2020).

HASTENING DEATH BY VOLUNTARILY STOPPING EATING AND DRINKING: CLINICAL, ETHICAL, AND LEGAL DIMENSIONS (forthcoming Oxford University Press 2021) (with Timothy Quill, Paul Menzel, Judith Schwarz).

Jack Kevorkian, AMERICAN NATIONAL BIOGRAPHY (forthcoming 2020).

Medical Aid in Dying: Key Variations among U.S. State Laws, JOURNAL OF HEALTH & LIFE SCIENCES [AHLA] (forthcoming 2020).

Extrajudicial Resolution of Medical Futility Disputes: Key Factors in Establishing and Dismantling the Texas Advance Directives Act, in INTERNATIONAL PERSPECTIVES ON END OF LIFE REFORM: POLITICS, PERSUASION, AND PERSISTENCE (Cambridge University Press forthcoming 2021) (Ben White and Lindy Wilmott eds).

Medical Futility, in GUIDANCE FOR HEALTHCARE ETHICS COMMITTEES (2d ed. Cambridge University Press forthcoming 2020).

Video Advance Directives: Growth and Benefits of Audiovisual Recording, 73 SMU LAW REVIEW (forthcoming 2020).

ALREADY PUBLISHED IN 2020

Brain Death Testing: Time for National Uniformity, 20(6) AMERICAN JOURNAL OF BIOETHICS 1-3 (2020).

Making Medical Treatment Decisions for Unrepresented Patients in the ICU: An Official ATS/AGS Policy Statement, 201(10) AMERICAN JOURNAL OF RESPIRATORY & CRITICAL CARE MEDICINE 1182-1192 (2020) (with multi-professional committee).

Hospital Mergers and Conscience-Based Objections — Growing Threats to Access and Quality of Care, 382(15) NEW ENGLAND JOURNAL OF MEDICINE 1388-1389 (2020) (with Ian D. Wolfe).

It’s Time to Revise the Uniform Determination of Death Act, 172(2) ANNALS OF INTERNAL MEDICINE 143-144 (2020) (with Ariane Lewis and Richard Bonnie).

Revising the Uniform Determination of Death Act: Response to Miller and Nair-Collins, HASTINGS BIOETHICS FORUM (January 29, 2020) (with Ariane Lewis and Richard J. Bonnie).

THE RIGHT TO DIE: THE LAW OF END-OF-LIFE DECISIONMAKING (3d ed. Wolters Kluwer Law & Business) (with Alan Meisel & Kathy L. Cerminara) (2020).


Full Article

Last Monday, the Governor of Oklahoma signed H.B 2588, which limits the power of guardians to authorize DNR orders without specific court approval.  In response to the high profile debacle of guardian Rebecca Fierle, Florida enacted similar legis...

Full Article

Scores of legislative bills and a dozen lawsuits have questioned whether the Texas Advance Directives Act affords adequate procedural due process. One such case is now pending before the Texas Court of Appeal.  But a new lawsuit alleges that a p...

Full Article

I have written a lot about "bad" surrogates, those who make treatment decisions for incapacitated patients that those patients would not have made for themselves. Therefore, it was a delight to see this movie scene depicting a strong and faithful heal...

Full Article