Saturday, February 13, 2016

Horse Euthanasia: Equine End-of-Life Dispute Parallels Human Conflicts

Dan Buck Soules used to own Knotty.  But he eventually sold Knotty with the arrangement that he could buy it back.  

But in 2013, Lisa Bosse, the buyer advised Soules that Knotty was sick. Knotty had trouble getting up and would need to be put down. 

Soules disagreed vehemently. Through his research, he determined that Knotty probably has Lyme disease. It's fairly common in horses, and it's treatable.  So, Soules sued to regain ownership.  Both parties claimed to act in Knotty's best interests.  The parties eventually agreed to treat Knotty for Lyme disease and vitamin deficiency.  

But Knotty's health continued to decline. He developed a new condition that required the removal of an eye. A veterinarian temporarily overseeing Knotty's treatment recommended that he be euthanized after concluding he wouldn't be able to tolerate the anesthesia necessary for the surgery.  In January 2014, a trial court revoked an earlier injunction prohibiting euthanasia, after a neutral veterinarian agreed to by both parties concluded that Knotty was at risk of a "catastrophic fall."

The dispute over Knotty continued and was finally heard this week by the Maine Supreme Judicial Court.  

Tuesday, February 9, 2016

In Texas, A Hospital Ethics Panel - Not the Patient or Family - Decides Whether to End Care

A new story in the Houston Press covers the operation of dispute resolution procedures in the Texas Advance Directives Act.

I cover this in more detail in a forthcoming long article in 16(1) QUT Law Review.

Monday, February 8, 2016

Living, Dying, and the Problem with Hope

In this 20-minute TEDx talk Dr. Leslie Blackhall, Head of Palliative Care at the University of Virginia, identifies misplaced "hope" as a key cause of non-beneficial medical interventions.  

Blackhall argues that accepting dying as a part of life allows us to achieve a fuller and richer life with the days that we live.

Sunday, February 7, 2016

"That Dragon, Cancer" - A Journey of Hope in the Shadow of Death [EOL in Art 199]

“That Dragon, Cancer” is a new video game about Joel Green, a terminally ill 5-year-old, and his parents.  It sounds more (meaningfully) sad than fun.  For example, the game withholds some control from the player as an attempt to convey feelings of helplessness and despair. 

“That Dragon, Cancer” mixes animation and magical realism to convey the Greens’ emotional state during Joel’s illness. There is one dragon, but much of the game consists of re-enactments of mundanities like phone messages and hospital visits.  Water fills a room as a doctor says there are no more treatments for Joel’s cancer.   (HT: NYT)

Saturday, February 6, 2016

Room for Death [EOL in Art 198]

A new study in Social Science and Medicine, researchers report on data from a project teaming artists and craftspeople together to create prototypes of space for difficult conversations in end-of-life settings. 

These prototypes were presented in a museum exhibition, "Room for Death", in Stockholm in 2012. Palliative care researchers contributed a question to the public viewing the exhibition, to explore their reflections: "How would you like it to be around you when you are dying?" 

Responses were categorized in the following inductively-derived categories: 

  1. The familiar death
  2. The 'larger-than life' death
  3. The lone death
  4. The mediated death
  5. The calm and peaceful death
  6. The sensuous death
  7. The 'green' death
  8. The distanced death. 
This project can be seen as an example of innovative endeavors to promote public awareness of issues related to death and dying, within the framework of health-promoting palliative care.

Friday, February 5, 2016

CANHR v. Chapman - Final Judgment on 1418.8 IDT Process

In June 2015, the Alameda Superior Court issued an Order striking down much of California Health & Safety Code 1418.8.  

This section outlines the IDT process that long-term care facilities have long used to make medical decisions for incapacitated patients without available legally authorized surrogates.  

Last week, the court issued its final Judgment in the case.  That Judgment provides:
  • The use of Health & Safety Code 1418.8 is prohibited to the extent that it does not require that the resident be adequately notified in writing.
  • The use of Health & Safety Code 1418.8 is prohibited for the administration of anti-psychotic drugs except in emergency situations.
  • The use of Health & Safety Code 1418.8 is prohibited to make end of life decisions regarding the withholding or withdrawal of life-sustaining treatment for residents, except to the extent consistent with the resident's advance directive or known wishes.
  • The use of Health & Safety Code 1418.8 may be used to provide or initiate hospice or comfort care.

Thursday, February 4, 2016

Comments on the New ATS/AACN/ACCP/ESICM/SCCM Statement: Responding to Requests for Potentially Inappropriate Therapies in the ICU

In the late January MEDICAL ETHICS ADVISOR, Baylor College of Medicine Professor Janet Malek comments on the new "Official ATS / AACN / ACCP / ESICM / SCCM Statement: Responding to requests for potentially inappropriate therapies in the ICU."

"While this may allow for more semantically coherent dialogue on this topic, it does not give additional guidance about which treatments should not be offered by providers."

Instead, Malek says it raises a new set of questions: 
  • What interventions are inappropriate? 
  • Under what circumstances are they inappropriate? 
  • Why are they considered to be inappropriate? 
  • Who determines whether they are inappropriate?

"The approach advocated by the policy only answers the last of these questions." The policy statement  proposes a process-oriented, step-wise approach involving a second opinion, hospital review, and facilitation of transfer to another institution before permitting life-sustaining treatment to be withheld. "The process therefore draws on a progressively wider set of opinions about whether an intervention is inappropriate, without defining the concept itself."

Can Our Minds Live Forever?

Can you freeze your brains and preserve the pattern of information that represents you—your thoughts, memories and personality—your self

A story in Scientific American reports on a company that is trying.  It has started with rabbit brains.

Wednesday, February 3, 2016

When Is CPR Futile?

Here in the February 2016 AMDA newspaper CARING FOR THE AGES, is a reasonable and informed analysis of when CPR may or should be refused in the long-term care setting.

Tuesday, February 2, 2016

Founding Father Thomas Paine on Medical Futility and Brain Death

Thomas Paine wrote The American Crisis during the American Revolution,  in 1778.  But he makes an interesting observation about medical futility:

"To argue with a man who has renounced the use and authority of reason . . . is like administering medicine to the dead . . . ."

This was, like much of Paine's writing, powerful rhetoric in 1778.  But the metaphor does not seem quite as cogent, today.  Many have advanced strong arguments that administering medicine to "the dead" may have some value.  "Death" in 2016 is a far fuzzier concept in 2016 than it was in 1778.

Monday, February 1, 2016

Boston's Fine Arts Museum Offers Doctors Time for Reflection [EOL in Art 197]

Doctors and nurses at Boston’s Brigham and Women’s Hospital are honing their communication and teamwork skills in an unexpected environment: an art museum.

Sunday, January 31, 2016

Jahi McMath - Update on the Malpractice Litigation

On Friday, January 29,  the Alameda County Superior Court held a brief hearing on the medical defendants' demurrers to the McMath family's first amended medical malpractice complaint.  

As he indicated in prior rulings on similar motions, Judge Freedman said that he is disinclined to agree with defense on the collateral estoppel issue "at this point."  He took  the matter under advisement and will issue his ruling shortly.  Perhaps foreseeing that their demurrers probably will be denied, the defendants filed requests for certification for appeal.  

Again, all the briefing at this stage is wholly procedural.  The question is whether the McMath family may even ( at all) litigate the life/death question given that they already had the opportunity to litigate that before other judges in January 2014 and October 2014.  Only once the McMath family gets past this procedural challenge, will they be required to actually provide proof/evidence of life.