Wednesday, September 17, 2014

Prevalence of Non-Beneficial ICU Treatment

The Ventura County Star has a new story and a poll on medical futility.  In addition to recounting the widely discussed UCLA research, health care reporter Tom Kisken interviews clinicians at other Southern California hospitals.

"I think it happens at every hospital in the United States." -- Dr. Hannah Grossman, chief medical officer at Los Robles Hospital & Medical Center in Thousand Oaks.

"I wouldn't say it happens every day. . . .  I would say we might have one or two patients a week where it might be futile." -- Dr. David Fishman, director of the intensive care unit at Ventura County Medical Center in Ventura. 

"Medical technology allows us to extend life. . . .  Sometimes it can extend death." -- Ron Hyrchuk, director of spiritual care services and a member of the bioethics committee at Simi Valley Hospital

International Resource Library on Adult Guardianship

The 3rd World Congress on Adult Guardianship recently convened in Washington, DC. One of the goals of this Congress was to form an online International Resource Library on Adult Guardianship.  That resource is now available here.

The organizers are also looking for more submissions, including papers, brochures, manuals, handbooks and more, are welcome if they would be of help to others.  Submissions may be made by emailing info@nationalguardianshipnetwork.org with the subject line “resource library.” Please provide, in English, a description regarding the document(s) you send, so that they can name and categorize them. 


Tuesday, September 16, 2014

Emotional, Religious Reasons to Keep Grandson in PVS on Life Support

This sad story in the Chicago Tribune powerfully illustrates why one grandmother could not consent to comfort care only for her grandson.  

The grandmother's daughter had been shot by a gang member while still pregnant.  "To Jefferson, the baby looked just like her daughter — her face, her color, her hands. But doctors told her [the baby] would remain in a persistent vegetative state, unable to see, hear or breathe on his own."  Clinicians "urged her to remove him from life support, telling her his condition would never improve." 

The grandmother "set the date to pull the plug — Oct. 20, 2011, what would have been her daughter's 18th birthday.  But she had a change of heart as she entered Advocate Christ Medical Center that day.  

"I couldn't see turning the machine off on him . . ..   Who am I to judge whether he lives or dies, OK?  I think at (the hospital) a lot of them were kind of disappointed with me because they thought actually I was
going to turn the machine off. . . .  But my faith didn't allow me to do it."

CALL FOR PAPERS Aging, Law, & Society Critical Research Network

CALL FOR PAPERS
Aging, Law, & Society Critical Research Network

Law and Society Association Annual Meeting
Seattle, May 28 – May 31, 2015

The Aging, Law, and Society Critical Research Network (CRN) invites scholars to participate in a multi-event workshop sponsored by the CRN as part of the Law and Society Association’s 2014 Annual Meeting.  The Aging, Law & Society CRN brings together scholars from across disciplines to share research and ideas about the relationship between law and aging, including how the law responds the needs of persons as they age and how law shapes the aging experience.


At this year’s meeting, the CRN will sponsor two primary types of panels at the annual meeting:  (1) themed panel presentations on topics selected by the programming committee; and (2) workshops in which scholars present works-in-progress and receive commentary from an assigned discussant.

Accordingly, the CRN encourages paper proposals on a broad range of issues related to law and aging.  However, we especially encourage proposals on the following topics:

·         Comparative approaches to elder law and old age policy;
·         The interaction between elder law and labor and employment law;
·         Creative and empirical methodologies for studying law and aging;
·         The conference theme:  law’s promises and law’s pathos in domestic and transnational contexts.

In addition to paper proposals, we also welcome:
·         Ideas and proposals for themed panels:  In particular, please email Nina Kohn at nakohn@law.syr.edu if you are already planning a panel that you would like to have featured as part of the Aging, Law, and Society CRN; and
·         Volunteers to serve as commentators on works-in-progress. 

If you would like to present a paper as part of a the CRN’s programming, please send a 400-500 word abstract, with your name, full contact information, and a paper title to both Nina Kohn (nakohn@law.syr.edu) and Nancy Knauer (nknauer@temple.edu).   Please indicate the stage at which the paper will be, or is expected to be, in May of 2014.  If you wish to present a paper showcasing a research methodology, please send additional copies to Israel Doron (idoron@univ.haifa.ac.il) and Daphna Hacker (dafna@post.tau.ac.il).


Please submit all proposals for paper presentations by no later than October 1, 2014.   Earlier submissions are highly encouraged and will be given priority. 

Minnesota Maintains 100 Percent Rate for Advance Care Planning

In study after study after study, researchers bemoan persistently mediocre rates of advance care planning.  

So, I was delighted to hear the Medical Director or Honoring Choices Minnesota, Ken Gephart, announce at a recent conference that the "effective" completion rate of advance care planning in Minnesota is 100%.

What he meant is that medical treatment decisions have been made for every Minnesotan (and every other American too) should they become incapacitated.  The problem is that most of those decisions were not made by the patients themselves.  And in many cases they are not the same treatment decisions that those patients would have made for themselves.  

In short, failure to make any affirmative choice is still a choice.  It is a choice for the default option: continued aggressive treatment.    

Vincent Lambert - Treatment Pending European Court of Human Rights

The slow and cumbersome nature of litigation often means that the status quo is preserved for a long time, until judgment.  In the context of end-of-life medical treatment, this usually means that the patient's biological existence is perpetuated for months or even years unless or until the court says that physiological support can stop.  

The family of Vincent Lambert is fighting about his proper treatment pending a ruling from the European Court of Human Rights either affirming or reversing the French Council of State.

Monday, September 15, 2014

Law and Bioethics Career Panel


Bad Medical Language: "Failure to Die" & "GOMER"

Brian Goldman recently published The Secret Language of Doctors.  In 330 pages, Goldman exposes the clandestine phrases that doctors use to describe patients, situations and even colleagues they detest. This book reveals modern medical culture at its best and all too often at its worst.

Specifically, chapter five is titled "Failure to Die."  This tragic term and the related term "GOMER" is discussed in a brief promotional video that Goldman produced.