What Is Medical

Delaware End-of-Life Coalition

The Delaware End-of-Life Coalition was featured in the state's main newspaper today. From the article:

The Delaware End-of-Life Coalition aims to increase awareness of hospice, palliative and other end-of-life services among patients by educating more doctors and other health professionals.

The coalition, which was formed 10 years ago, has created a number of initiatives to address issues surrounding end of life, including training programs for health professionals so they are better equipped to discuss end-of-life care with patients and their loved ones. It also spearheaded an effort to get more Delawareans to fill out advance directives.

Medical Futility Law - International Survey

Chad Ball and colleagues recently reported, in JOURNAL OF TRAUMA, on a recent end-of-life survey distributed to over 400 physicians in the United States, Canada, South Africa, Europe, Asia, and Australia. One of the questions was

Does your local government body (country/state/province/county) have a medical futility law stating that if continued care of a given patient is "medically futile," then the clinician may de-escalate care, regardless of what the family member requests? YES NO

The authors report that 14-38% of respondents indicated that they "benefit from a medical futility law allowing them to proceed with different end-of-life care than desired by a patient's family." They also noted that "U.S. clinicians were much more reluctant . . . [which] may result from a complex interaction between the Western hemisphere's heavy emphasis on patient autonomy , litigious concerns, . . . ."

Palliative Care and the "Battered Patient Syndrome"

Upon being called in (too late) an Australian palliative care provider stated: "We can then see very clearly they have been battered and pushed around, beaten until they lose sight of what they want - they suffer what has been called the battered patient syndrome." (Sydney Morning Herald, 2003)

Another provider, more recently describes what he also calls – shockingly – "battered patient syndrome" - Once you've had five, 10, 50 tests you can become physically battered." (Sydney Morning Herald, 2010)

Minimizing Autonomy Errors when Stopping Life Support

It has long been recognized that errors will be made when it comes to stopping life support. On the one hand, some patients will have life support stopped even though they still wanted it. This might result from, among other things: (a) an error in prognosis, (b) an error in determining the patient's preferences, or (c) a failure to follow the patient's preferences. On the other hand, some patients will have life support continued even though they did not want it. This might result from, among other things: (a) an error in prognosis, (b) an error in determining the patient's preferences, or (c) a failure to follow the patient's preferences.

It struck me in Baltimore, on Tuesday, that amending the law to permit unilateral refusal probably does raise at lease the "risk" of erroneous stopping of life support. But such an acknowledgment is not fatal to the effort. First, significant efforts can and should be made to implement safeguards to minimize that risk. Second, the risk of erroneous stopping is surely significantly outweighed by the benefits of reducing erroneous prolongation. But for the latter argument to have persuasive force, the latter type of error must be perceived as serious as the former type of error.

Pulling the Life Support Plug Before the New Year to Escape the Death Tax

Last year at this time, the 2010 federal estate tax provided an incentive for surrogates to keep wealthy patients alive past December 31, 2009. This month, the incentive is the opposite. If the patient dies on or before December 31, 2010, the estate can escape federal estate taxes. Therefore, there is arguably an incentive for surrogates to hasten death. Of course, this may very well be with the wishes and blessing of the patient herself.

Sidney Morning Herald - "The End"

The Sidney Morning Herald just posted an interactive multimedia feature, referred to as a "documentary," comprised of articles and videos on the end of life, on topics from costs, to treatment options, to palliative care. 