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. 

Delaware - Proposed MOLST Regulations

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

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 safeguards lean one way: to prevent erroneous withdrawal/withholding.  Few or no safeguards are directed at preventing erroneous continuation of treatment.

Wrong Medicine Doctors, Patients, and Futile Treatment

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 copy on Monday.  And while the book is only 216 pages, I have not yet had a chance to read it.  Here is a description from the publisher, Johns Hopkins University Press:

The authors examine the ethics of cases in which medical treatment is offered—or mandated—even if a patient lacks the capacity to appreciate its benefit or if the treatment will still leave a patient totally dependent on intensive medical care.



In exploring these timely issues Schneiderman and Jecker reexamine the doctor-patient relationship and call for a restoration of common sense and reality to what we expect from medicine. They discuss economic, historical, and demographic factors that affect medical care and offer clear definitions of what constitutes futile medical treatment. And they address such topics as the limits on unwanted treatment, the shift from the "Age of Physician Paternalism" to the "Age of Patient Autonomy," health care rationing, and the adoption of new ethical standards.

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 health.

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" requirement.

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.