My article, "Legal Fundamentals of Surrogate Decision Making" has just been published in Chest. Here is the abstract:
The four previous articles in this series have traced the history of patient autonomy and have identified its ethical and legal foundations. Patient autonomy is highly valued in the United States to the extent that the patient does not lose the right of self-determination when he or she loses the capacity to make health-care decisions for him or herself. The law has devised several tools to promote “prospective autonomy.” One mechanism is the instructional advance directive or living will. But most of us do not write such directives. Another mechanism is the proxy directive or durable power of attorney for health care, designating another person, a surrogate, to direct the course of our medical treatment upon our incapacity. But most of us do not do that either. Therefore, the most common mechanism by which our prospective autonomy is protected and promoted is through the informal selection of surrogates based on statutory priority lists. These “default” surrogates are the most numerous type of surrogate. This article explains the importance and legal fundamentals of surrogate decision making. It first describes five basic types of surrogates. The article then looks at the role of these surrogates and how they are supposed to make decisions on the patient’s behalf. Unfortunately, surrogate performance is often mediocre or poor. There are significant and persistent obstacles to good surrogate decision making. After explaining these problems, the article concludes by identifying several solutions.
The four previous articles in this series have traced the history of patient autonomy and have identified its ethical and legal foundations. Patient autonomy is highly valued in the United States to the extent that the patient does not lose the right of self-determination when he or she loses the capacity to make health-care decisions for him or herself. The law has devised several tools to promote “prospective autonomy.” One mechanism is the instructional advance directive or living will. But most of us do not write such directives. Another mechanism is the proxy directive or durable power of attorney for health care, designating another person, a surrogate, to direct the course of our medical treatment upon our incapacity. But most of us do not do that either. Therefore, the most common mechanism by which our prospective autonomy is protected and promoted is through the informal selection of surrogates based on statutory priority lists. These “default” surrogates are the most numerous type of surrogate. This article explains the importance and legal fundamentals of surrogate decision making. It first describes five basic types of surrogates. The article then looks at the role of these surrogates and how they are supposed to make decisions on the patient’s behalf. Unfortunately, surrogate performance is often mediocre or poor. There are significant and persistent obstacles to good surrogate decision making. After explaining these problems, the article concludes by identifying several solutions.
Pennsylvania's residents pay for health care.
contains a sulfite, sodium metabisulfite that some are allergic to and you have to watch for a few other drug interactions with anything that causes drowsiness and there’s a side effect of hallucinations and that side effect is higher with those who have Parkinson’s disease. 
the drug business with FICO selling software to companies such as PBM managers and now it gets interesting with analytics that are using mismatched data that has been spun and marketed, with FICO claiming they can predict medication adherence. How man PBMs are buying this and what will it do for access for patients? This is just one more example on how marketing today puts a wild spin on things and it goes on behind the scenes and denies due to parameters not being met, whatever they are.
was over-diagnosed when the x-ray was blown up to further investigate. That lead to a biopsy which was also messed up and if she would have gone for treatment for this tiny miniscule mass they found with radiation, she may not be here today at age 87 and this was about 3 years ago when all this occurred. 
s at all, but, it was good to have case history and see almost the exact same thing as what set off whistles and bells 3 years prior and again we stopped there once more and opted out for surgery. She’s still here today and again I can’t emphasize enough that each case is its own and we were and are lucky but I also understand that this is just her case and everyone needs to get all the information they can and make their own decisions. BD 
hear from their side, which if focused on reimbursements you might hear a different story but I’ll take the clinical side any day as we know all about the algorithms built for profit and it’s getting harder to do both with better clinical outcomes and at the same time apply fixes for the payments. Sure hospitals are getting to be a lot smarter with “running the business” but what are we here for, better outcomes or better financial management and you sometimes wonder about the financial side as hospitals are still going broke all over. BD 
don’t update frequently enough too. You just never know when the algos are going to bite. 
done some work in this area with projecting several different outcomes so they can move quickly in whatever direction they need. It is what it is today with intelligence and formulas. One health insurance company United recently hired the former US Assistant Attorney General from Minneapolis as a general counsel so that somewhat signals an area of preparedness on the part of big business here. 
