Wednesday, May 27, 2015

Brain Death Conference - Milwaukee

On Tuesday June 2,  the Medical College of Wisconsin Center for Bioethics and Medical Humanities will host a day-long conference exploring issues surrounding brain death:  "Death by Brain Criteria."  

Father at Mt. Sinai [EOL in Art 17]

Max Ferguson's "My Father at Mt. Sinai" depicts his dad on a hospital bed, with a tube under his nose. The curtain in the foreground is a tallit (a Jewish prayer shawl).  I like that dad is mid-speech and engaged with the viewer.

Tuesday, May 26, 2015

End-of-Life Care Is Getting Worse

Joan Teno's new report in The Journal of Palliative Medicine confirms that there are still large gaps between the kind of care that patients and families want and the care they actually receive. 

Teno and her coauthors compared two surveys, one conducted in 2000, and the second carried out between 2011 and 2013. Each of the studies asked individuals about the care received by elderly loved ones at the end of life.  

Despite all the effort put into improving end-of-life care in recent years, there was a marked decline in satisfaction between the first survey and the second. While 56.7% of respondents in 2000 said that the care their loved one received was “excellent,” only 47% could say the same in the 2011-2013 study.

Teno rightly observes: “People are less satisfied with care at the close of life, and I think it’s now urgent for us to start thinking about what interventions we can do to improve care at the end of life.

Death Carts [EOL in Art 16]

The death cart is an object that was used in acts of corporal penance performed by the Hermanos de la Fraternidad Piadosa de Nuestro Padre Jesús Nazareno. The Brotherhoods were secretive, lay-religious fraternal organizations that served the spiritual needs of Hispanic Roman Catholics in northern New Mexico and southern Colorado in the 19th and early 20th centuries. 

Public processions reenacted the sorrow and suffering of Christ’s final days.  The female Angel of Death, Doña Sebastiana, serves as a reminder of human mortality and the importance of preparing for a good death through prayer and virtuous deeds. 

Monday, May 25, 2015

Another California Lawsuit for Following the Wrong Surrogate

A few days ago, Bart F. Sullivan filed a lawsuit in Orange County Superior Court (California) against Park Vista at Morningside and Placentia Linda Hospital.  His 92-year-old mother, Clara, died there in May 2014.  Sullivan's legal theories include: abuse of an elder person, negligent wrongful death, medical malpractice, infliction of emotional distress, and fraud.

Most interesting is a claim that the nursing home and hospital lacked a good faith belief in the validity of Clara Sullivan's DNR order.  From the complaint: "Clara Sullivan’s daughter Gail Mitsch had signed a “Do Not Resuscitate” form for Clara . . . a form not only without Plaintiff’s signature (as Plaintiff shared POA for Health care, Exhibit “X” ), but contradicting Clara’s Health Care Directive. . . .  Clara Sullivan on many occasions has expressed her desire for optimal medical treatment."

This sounds a little like the Noval lawsuit in which the hospital proceeded on the basis of the consent of some of the patient's family but without the consent of the duly authorize agent.

Louise Vernet on Her Death Bed [EOL in Art 15]

Paul Delaroche created a convincing and transcendent image of his dead wife in "Louise Vernet on her Death Bed" (1845, graphite on slightly textured, moderately thick, cream wove paper).

Louise lays blissfully in profile, as both her mouth and right eye remain slightly open. Her elevated head rests on two pillows, as locks of her hair fall vertically to her shoulder and drape diagonally across her bosom. Delaroche carefully defined each curl, delineating individual hairs and shimmering highlights, in Louise's palpable coiffure. Her pale skin and her lifeless body indicate that she is deceased. 

Rather than present the sordid details of death by fever, Delaroche conveyed Christian triumph over death, as a halo emerges from the dark background to encircle his wife's beautiful head. This drawing is an angelic effigy.

Sunday, May 24, 2015

Texas Advance Directives Act - House Debate Today

Today, the Texas House is set to consider legislation to re-evaluate the state’s health commission. The Texas Tribune notes that a number of amendments could set the stage for a fiery debate over the futility provisions in the Texas Advance Directives Act.

Republican lawmakers have filed amendments to Senate Bill 200 that would limit medical professionals’ abilities to override patients' advance directives or their families’ wishes to continue life-sustaining treatment.

The fight over end-of-life care has been a perennial one at the Legislature as lawmakers have struggled to decide whether families or medical professionals should make the final decision to end life-sustaining treatment for a terminally ill patient.

Texas law allows physicians to discontinue treatment they deem unnecessary. But if a physician’s decision to halt treatment is at odds with patients' advance directives — or if their families or surrogates disagree — patients or their families have 10 days to find an alternative medical provider.

They can also appeal the doctor’s decision to a hospital ethics committee.

Some lawmakers want to prohibit physicians from discontinuing care against a family’s wishes, while others want to give patients and their surrogates more discretion but preserve a physician’s ability to make a medical judgment to end treatment.

The pre-filed amendments would give more weight to a family’s wishes over physicians' recommendations.

One pre-filed amendment by Republican state Rep. Bryan Hughes of Mineola would direct the state’s executive health commissioner to develop rules that would prohibit a health care facility or hospital ethics committee from ending life-sustaining treatment based on the “lesser value” the health care facility may place on an elderly, disabled or terminally ill patient versus a young patient who is not disabled or terminally ill.

Hughes said Republicans were pushing the end-of-life measures as amendments to the health agency bill, also known as a Sunset bill, after they were unable to pass them on the House floor.

"Sunset bills have always been vehicles for legislation whether from the left or from the right," Hughes said, adding that the bills were fair game despite the "controversy and concern" surrounding end-of-life issues.

Another amendment by Republican state Rep. James Frank of Wichita Falls would extend from 10 days to 21 days the time families have to find an alternative medical provider to continue life-sustaining treatment their current physician has deemed unnecessary.

Meanwhile, state Rep. Jonathan Stickland, R-Bedford, filed an amendment to prohibit abortions on the basis of fetal abnormalities. In its 20-week abortion ban, the state carved out an exception for abortions in cases of a "severe fetal abnormality," but some conservatives are looking to remove that.

This wouldn’t be the first time a debate over a social issue has come during consideration of a state agency review. An April debate on legislation to reform the Department of State Health Services morphed into a fight over abortion, and the bill was pulled down after a pair of anti-abortion amendments, including one repealing the fetal abnormality exception, were tacked onto the bill over the author’s objections.

Woman Praying at a Deathbed [EOL in Art 14]

Benjamin Vautier's 1864 pencil drawing "Woman Praying at a Deathbed" includes an open Bible on the table and a rosary on the floor.  These suggest a devout life and the promise of salvation after death.