AARP Report on POLST - MOLST

Coinciding with Delaware's introduction of MOLST regulations is a new 64-page report from AARP's Public Policy Institute titled "Improving Advanced Illness Care: The Evolution of State POLST Programs."  It iswritten by Naomi Karp and Charles Sabatino.POLST development usually involves statewide collaboration among a diverse array of stakeholders, including the medical community, hospitals, nursing homes, state health and EMS departments, disability and aging advocacy groups, and the bar.  This report describes the elements of what has helped or hindered efforts, so that new initiatives don’t have to reinvent the wheel.&nb...

Delaware - Proposed MOLST Regulations

Delaware has promulgated proposed regulations to authorize use of MOLST.  The notice and comment period runs through the end of M...

Barney Frank: "Don't Force End-of-Life Care on People"

Barney Frank on MSNBC:  "I think it's time for us to say that if people at the end of their lives want to simply say, okay, this is it, this is not a meaningful existence.  I'm not talking about assisted suicide, I'm talking about the Schiavo case sort of situation where you don't force care on people who don't want it, and guardians don't want them to have it. we spend an awful lot of medicaid on the end of life. and this is not death panels, this is not the government telling you don't get anymore. this is the government not telling you, you have to get this medical care whether you want it or not."  (Hat Tip: NDY)  Rep. Frank is right.  The system is structured to systematically force care on people who do not want it.  All the legal...

Wrong Medicine Doctors, Patients, and Futile Treatment

Normal 0 MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman";} Larry Schneiderman and Nancy Jecker have published the second edition (ISBN 9780801863721) of their popular 1995 Wrong Medicine.  The 2010 edition has clearly been updated, as I was pleased to see myself cited.  I just got a...

Centre for Medical Humanities at Durham

The Centre for Medical Humanities at Durham University has a great blog, giving notice of medical humanities events but also offering reflections on the relationship between medicine and broader concepts of heal...

Second Hearing on H.B. 3520 to Amend Texas "Futility" Law

Here is a link to a video of (part of) yesterday's hearing on H.B. 3520.  Actually, it was on the committee substitute to H.B. 3520, which focuses more on the due process procedures than on a straight "treat 'til transfer" requireme...

Appellate Oral Argument on Right to Unilaterally Withdraw

Oral arguments in Rasouli v. Sunnybrook Health Sciences Center (Ontario Court of Appeal No. C53442) are scheduled for May 18th.   On March 9th, the Ontario Superior Court of Justice issued the ruling that is being appealed.  It held that providers do not have a right to unilaterally withdraw.  They must either secure the consent of the surrogate or use the CCB.&nb...

Mr. C. v. John Radcliffe Hospital

It is one thing to unilaterally stop life-sustaining medical treatment.  It is quite another to do so in an insensitive, secretive, or otherwise outrageous manner.  Almost all the successful United States lawsuits against healthcare providers for unilateral withdrawal were based on a tort theory of outrage or intentional infliction of emotional distress.  Similarly condemning non-transparent, non-consensual stopping of life support is a recent case from the John Radcliffe Hospital in Oxford, England.  Mr C, had his life support machine turned off after a ‘do not attempt resuscitation’ note was made in his medical...

New York Bills to Promote Advance Directives

Taking a lead from recent legislation aimed at increasing organ donation rates by using people's contact with the DMV, several new New York bills aim at increasing advance directive completion rates in the same way.  One New York bill (SB 2350) would require the DMV to include health proxy forms with driver and vehicle registration renewal mailings.  Another (A.B. 4901) provides a space right on the drivers license for the proxy's contact information.  I really like this second bill.  Several states already operate "next-of-kin registries," including Colorado, Florida, Illinois, Indiana, Ohio.  In my neighborhood, Delaware...

Sweiss v. Alberta Health Services

Blogging the DW case the other day reminded me that I never blogged the similar Sweiss v. Alberta Health Services case from a few months ago.  In that case the patient, Samir Sweiss, “wished that all Islamic law be followed.”  He had significant health problems (ischemic cardiomyopathy, hypertension, Type II diabetes, COPD, and other issues) that resulted in nearly 100 hospital admissions.  Mr. Sweiss then had a 40-minute arrest that left him in an even worse state.  The neurologist determined he had a zero percent chance of recovery.  Mr. Sweiss’s providers entered a DNR order and informed the family that they were going to discontinue ventilation support.   The family disagreed and obtained a temporary injunction...

56th Anniversary of Einstein's Death

Yesterday marked the 56th anniversary of Albert Einstein's Death.  He died in Princeton, New Jersey on April 18, 1955.  The immediate cause was a ruptured abdominal aneurysm.  Einstein had been admitted about a month earlier.  But he refused surgery, saying: "I want to go when I want. It is tasteless to prolong life artificially. I have done my share, it is time to go. I will do it elegantl...

The case for rationing healthcare

My law school Health Law professor, Gregg Bloche, has a great opinion piece in the LA Times titled "The case for rationing healthcare."  He uses a medical futility scenario as a bridge into the broader iss...

Resolving Medical Futility Disputes

A brief article titled "Resolving Medical Futility Disputes" that I co-authored with Donna Casey, the nurse manager of the Wilmington Hospital ICU and the co-chair of the Christiana Care Health System ethics committee, has been published in latest newsletter of the Delaware Nurses Associati...

CCB Ruling in the Desmond Watson Case

I blogged, last month, about the CCB's ruling in the Desmond Watson case.  But that was based on a newspaper story.  I finally read the CCB's written opinion that Mark Handelman was kind enough to send me.  This case, like some other recent CCB cases that I have discussed, illustrates the limits of surrogate selection as a mechanism for resolving intractable futility disputes.     The Physician First, it is noteworthy that the physician pushed this case through the dispute resolution process even though he rotated onto this patient's case in only one out of every five weeks.  The physician who brought the Form G application noted that the patient: Had been an inpatient for almost 14 continuous months. Suffered severe dementia, was bedridden...

USC - "No Matter What - Fight On"

I wonder if this advertising campaign at the University of Southern California increases futility disput...

Risk of Hastening Death vs. Risk of Prolonging Dying

The one thing from Tuesday's hearing that surprised me most was the failure of witnesses testifying both for and against H.B. 3520 to present "compelling evidence" to support their positions.  Yes, the personal stories (from both families and physicians) were compelling.  They help the legislators and the public better understand what is at stake.  But what was absent was any notion of scale or scope.  One key way in which to frame the issue is in terms of weighing (a) the risks of inappropriate prolongation of dying against the risks of (b) inappropriate hastening death.  Risks of Inappropriate Hastening of DeathThis is the risk that has received almost all the focus for decades.  Almost all the safeguards in state laws are directed at mitigating this risk.  And...

More on the H.B. 3520 Hearing and the Texas "Futility" Law

I left Austin on Wednesday with a lot of ideas about TADA that I did not include in either my written or oral testimony.  I hope to summarize, even if just preliminarily, many of those thoughts here.Procedural Due ProcessRepresentative Gonzalez seemed to think that a good way to address concerns with Section166.046 would be to improve the procedural due process protections.  I agree.  Sufficiently fair procedures would minimize the risk of error.  Admittedly, due to the limits of prognostication, errors would still be made.  But, dislike it as we may, we must be prepared to accept some level of such risk in all tribunals.Compromise on the Length of Transfer PeriodRepresentative Naishtat asked several witnesses about a compromise position concerning the length...

H.B. 3520 - 2d hearing on Wednesday

The Human Services Committee of the Texas House of Representatives has formed a Subcommittee on End of Life Issues.  That Subcommittee is holding a second hearing on H.B. 3520 on Wednesday, April ...

Hearing on H.B. 3520 to Amend the Texas "Futility" Law

I am glad that I made the trip down to Austin yesterday to testify on H.B. 3520.  I have posted a copy of my written testimony here.  But I hasten to add that listening to the other witnesses and speaking to stakeholders in the hallways gave me a fuller appreciation of some issues.  (That is why I am glad I came.)  Therefore, the written testimony that I prepared prior to the hearing does not now fully reflect my current view on H.B. 3520.  I hope to pull together my notes and post about that on the flight back to Philadelphia today.  The video of the hearing is available here.  My testimony starts at about 4:23:00 and appears to last over 30 minutes.  I thought it just seemed to last a long time.  &nb...

Dispute Resolution Mechanisms: Manitoba - O, Ontario -2?

Manitoba recently rejected a proposal to adopt a tribunal like Ontario’s Consent and Capacity Board.  Manitoba is going to focus exclusively on preventing intractable futility disputes instead of on resolving them once they obtain.  But over in Ontario, some providers are pushing for even more dispute resolution options than they already have.   Ontario providers already frequently (though not always, especially when the patient’s religion calls for continued life support) successfully use the CCB to resolve medical futility disputes.  Last month, the Rasouli case held that Ontario providers must use the CCB to resolve these cases.  Providers are appealing that decision in hopes that they...

End-of-life - Steer or be dragged along

We have been, and will continue seeing, many media stories about advance care planning.  This Saturday is National Healthcare Decisions Day.  I especially like the title of this article by Clay Evans in Boulder, Colorado's Daily Camera:  "End-of-life - Steer or be dragged alon...

Pena v. Meeker - Oral Argument on April 15th

Next Friday, April 15th, the U.S. Court of Appeals for the Ninth Circuit will hear oral arguments in Pena v. Meeker.  Van Pena was fired for allegedly writing a unilateral DNR order on the grounds that it was medically ineffective and non-beneficial.  Pena argues that since the DNR order was appropriate, this ground for dismissal is clearly pretextual.  The actual basis for dismissal, argues Pena, was retaliation in violation of civil rights.   Pena lost after a jury trial in November 2009.  But one ground of appeal is that the trial court did not permit him to adequately present his medical futility argument to the jury.  I posted a copy of the plaintiff's trial brief he...

April 12th Hearing on H.B. 3520 to Amend the Texas Advance Directives Act

On Tuesday, April 11, 2011, the Human Services Committee of the Texas House of Representatives will hold a public hearing  on the Patient and Family Treatment Choice Rights Act of 2011, H.B. 3520.  I will be there.  I somewhat anticipated that I might participate in this session’s review of the law (there were numerous bills and hearings in the 2007 and 2009 sessions).  Here is a picture of me in front of the Texas Capitol, in June, when I was in town for the annual ASLME Health Law Professors Conference. &nb...

Ziv Magen v. Gold Coast Hospital

Ziv Magen refused to consent to withdrawing life-sustaining treatment from his 39-year-old wife Maiko.  He said he had been "ready to let her go" but not until he was sure everything possible had been done to save her.  (Courier Mail)  He was told that his wife had only a 5 per cent chance of survival at best. "But even if she has only a 1 per cent chance of survival, does it give them the right to take that chance away from her?" he said.   Gold Coast Health Service District executive director Dr Brian Bell said the decision to stop treatment was made by doctors "on clinical grounds and no othe...

Baby RB - Mother explains why she fought to let her son die

In November 2009, I blogged (here, here, and here, and here) about the very high profile Baby RB medical futility case in the British courts.  This was a case in which the mother supported withdrawing life support but the father did not.  Today, the mother, Kelly Bickell, talked to BBC Radio 5 about her decision.  I posted a copy of the High Court's opinion he...

Medical Futility at the End of Life: Legal, Ethical, and Practical Considerations for Nurses

On this Thursday afternoon, I am presenting Medical Futility at the End of Life: Legal, Ethical, and Practical Considerations for Nurses, at the Delaware Nurses Association Spring DNA/APN Conferen...

Future of Rights of Conscience in Health Care: Legal and Ethical Perspectives

In February 2010, BYU Law held a conference titled "Future of Rights of Conscience in Health Care: Legal and Ethical Perspectives."  While draft articles have been available on the BYU site, the final articles were just published in the Ave Maria Law Review.  Here is the table of contents:9 Ave Maria L. Rev. 1 -- PROTECTION OF HEALTH-CARE PROVIDERS' RIGHTS OF CONSCIENCE IN AMERICAN LAW: PRESENT, PAST, AND FUTURE Lynn D. Ward9 Ave Maria L. Rev. 47 -- REFUSALS OF CONSCIENCE: WHAT ARE THEY AND WHEN SHOULD THEY BE ACCOMMODATED? Kent Greenawalt9 Ave Maria L. Rev. 67 -- INDIVIDUAL RIGHTS VS. INSTITUTIONAL IDENTITY: THE RELATIONAL DIMENSION OF CONSCIENCE IN HEALTH CARE Robert K. Vischer9 Ave Maria L. Rev. 81 -- CONSCIENTIOUS OBJECTION IN CLINICAL PRACTICE: NOTICE,...

Legal Briefing: Healthcare Ethics Committees

My latest "Legal Briefing” column, "Healthcare Ethics Committees" was just published  in The Journal of Clinical Ethics 22, no. 1 (Spring 2011): 74-93.  This article covers recent legal developments involving institutional healthcare ethics committees. This topic has been the subject of recent articles in JCE. Healthcare ethics committees have also recently been the subject of significant public policy attention. Disturbingly, Bobby Schindler and others have described ethics committees as “death panels.” But most of the recent attention has been positive. Over the past several months, legislatures and courts...

Conscience Clauses and Conscientious Objection

While the print version was released a few weeks ago, the online version of my brief look at the legal aspects of provider conscientious objection was posted in the Winter 2011 Lahey Clinic Medical Ethics Journal.  I did a more comprehensive review in 21(2) Journal of Clinical Ethi...

Asking Kidney Patients to Forgo a Free Lifeline

For many years, a significant portion of patients receiving dialysis have decided to voluntary forgo further dialysis.  But, as reported in today's New York Times, kidney specialists are increasingly pushing doctors to be more forthright with elderly people who have other serious medical conditions, to tell the patients that even though they are entitled to dialysis, they may want to decline such treatment and enter a hospice instead. &nb...