Wednesday, April 16, 2014

7th Annual National Healthcare Decisions Day

IT’S HERE!  Today is the 7th Annual National Healthcare Decisions Day! 

ACTIVITIES/RESOURCES:  Even if you have your own resources, please also direct patients, residents, clients, and the public to the resources at:  There are free resources that people can care with loved ones throughout the country.

FREE WEBINAR TODAY: at 3:00pm eastern, please join me, Ellen Goodman and others for an NHDD webinar.  Register at:

LEAD BY EXAMPLE: As always, please encourage others by your example.  Here’s a simple message you can send/post to your family and friends tomorrow:

Today is National Healthcare Decisions Day.  I have had a talk about advance care planning with my loved ones.  Have you?  Free information, forms, tools, and an incredible video are at:  Do it today.

SPREAD THE WORD FURTHER: Please share NHDD information with your members/contacts/colleagues by forwarding this email or a link to or NHDD on Facebook or Twitter or LinkedIn 

JOIN US:  If you are receiving this email second-hand (or have not previously confirmed participation), please let us know who you are by completing the short participant confirmation here:

DON’T FORGET THE REST OF THE YEAR:  NHDD is our rallying day, but advance care planning is important throughout the year.  Continue to use the NHDD resources and always be on the lookout for activities to make NHDD even better.   

Tuesday, April 15, 2014

International Conference on End of Life: Law, Ethics, Policy and Practice - ABSTRACT DEADLINE

From August 13-15  2014, the Queensland University of Technology in Brisbane, Australia will be hosting the International Conference on End of Life: Law, Ethics, Policy and Practice.  The call for abstracts closes Wednesday, April 30.

ICEL 2014 will provide a global forum at which health law scholars, bioethicists, legal and health practitioners, and health law and bioethics institutions can meet to discuss and present on law, ethics, policy and practice relating to the end of life. Abstracts on the conference’s four sub-themes are particularly welcome:
  • Withholding and withdrawal of potentially life-sustaining treatment (e.g. advance care planning, futile treatment)
  • Palliative care and terminal sedation
  • Euthanasia and assisted suicide
  • Determination of death and organ and tissue donation

Here are some highlights:
  • Debate on ethics of euthanasia and assisted suicide -- Professor Peter Singer, Princeton University & Assistant Professor Charles Camosy, Fordham University
  • How we die -- Dr Peter Saul, John Hunter Hospital & Professor Michael Ashby, Royal Hobart Hospital and Southern Tasmania Health Organisation (THO)
  • Withholding and withdrawing life-sustaining treatment -- Professor Jocelyn Downie, Dalhousie University
  • Panel sessions: Comparative flash points in end of life law, ethics and policy
  • Terminal sedation -- Professor Shelia McLean, Glasgow University
  • Determination of death -- Dr Dale Gardiner, Nottingham University Hospitals
  • Assisted death practice: Research from around the world

Monday, April 14, 2014

The Changing Legal Climate for Physician Aid in Dying

Posted today and available for free from JAMA:  "The Changing Legal Climate for Physician Aid in Dying."

A summary of the trend toward legalization that I prepared with David Orentlicher and Ben Rich.

Saturday, April 12, 2014

Very Preterm Baby Beats the Odds and Survives

Radiolab has a compelling audio story (based on earlier newspaper stories by the parents) about the medical journey navigated by the parents of a newborn infant born at 23 weeks, 6 days.  

At one point, an operation was required.  But he surgeon initially refused to operate on the preterm infant, because surgery was "futile."  But despite the odds, the baby survived - not just surgery but also the NICU stay.

Honoring Choices Across Cultures: End of Life & Advanced Care Planning

On Wednesday, May 7, the University of Minnesota will host a one-day conference:  "Honoring Choices Across Cultures: End of Life & Advanced Care Planning."

High quality advanced care planning and end of life care is essential to ensuring that patients do not receive unwanted care in their last days, weeks, and months of life. As our population ages and health care spending grows, this issue becomes more and more pressing. Health disparities exist between majority culture and minority cultures in many areas, including advanced care planning and end of life care. Discussions around these topics can be difficult in the best of circumstances, and language or cultural barriers can lead to poor quality or even damaging conversations that cause harm to patients or the provider/patient relationship. This course aims to address this challenging area of medicine.

This one-day conference will include didactic lectures in the morning. The afternoon will include small-group simulated patient encounters with live standardized patients, as well as small-group tabletop scenarios. The simulated patient encounters will allow learners to each be the provider leading  discussion with a patient or family member, followed by a small-group debrief led by a faculty expert.  Tabletop exercises will include discussions of common clinical scenarios facilitated by a faculty expert.

Upon completion of this educational activity, participants should be better able to:

  • Develop a framework for leading discussions with patients and families about advanced care planning and end-of-life care 
  • Review evidenced-based methods for cross-cultural bargaining and discussion 
  • Apply skills learned in didactic sessions to live simulated patient encounters 
  • Comfortably address advance care planning and end-of-life care when a language or cultural barrier exists.

7:30 – 8:00 
Registration and Continental Breakfast
8:00 – 8:15 
Welcome and Introduction to health disparities in Advance Care Planning - Brett Hendel-Paterson, MD, CTropMed
8:15 – 8:45 
Panel Discussion about cross-cultural approaches to advance care planning - Miguel Ruiz, MD; Mohamed Hagi-Aden, MD, Channy Som, (Interpreter)
8:45 – 9:30 
Advance Care Planning – Definitions and Best Practices - Drew Rosielle,MD FAAHPM
9:30 - 9:45 
9:45 – 10:15 
Introduction to Cross-Cultural Communication - Pat Walker, MD, DTM&H, FASTMH
10:15 – 10:45 
Cross-cultural bargaining and discussions of end-of-life care - Kathie Culhane-Pera, MD
10:45 – 11:15 
End of Life Care and Advance Care Planning – a practical framework for working across
cultures - Miguel Ruiz,MD
11:15AM – 12:00
12:00 – 1:00 
1:00 – 2:30 
Afternoon Session A*
1.) Sim-Center Cases
2.) Tabletop exercises (5-6 cases)
2:30 – 2:45 
Break and transition next group
2:45 – 4:15 
Afternoon Session B*
1.) Sim-Center Cases (3 cases)
2.) Tabletop exercises (5-6 cases)
4:30 – 5:00 
Group Debrief - Brett Hendel-Paterson, MD; Patricia Walker, MD

The Sim Center Cases will include three cases with professional standardized patients and debriefing led by an experienced teacher in palliative care or primary care. The cases will include one inpatient case, one clinic-based case, and one home-based case. Each participant will have the opportunity to be the lead provider for at least one case, and be an active observer in one or two other cases.

Tabletop Exercises will include small-group discussions of some common scenarios that arise in inpatient or outpatient medicine around advanced care planning and end-of-life care. Groups will be facilitated by a faculty expert in palliative care or primary care.

Friday, April 11, 2014

Terri Schiavo Life & Hope Network WRONG to Defend the Dead?

The Terri Schiavo Life & Hope Network is a Pennsylvania-based nonprofit that works to "protect the lives of the medically vulnerable from the threat of imposed death."

Earlier this year, the Network helped the family of Jahi McMath by "assembl[ing] a team of advocates that located a facility to provide the care Jahi needed."  More recently, the Network honored the family in its award gala.

I wonder if devoting resources to litigate this case and to provide mechanical interventions for Jahi McMath's body was prudent for the Life & Hope Network.  After all, it is one thing to protect vulnerable adults from coercion, manipulation, bias, and conflict of interest that might hasten death.  It is quite another to defend the dead themselves.  Some donors may feel that the Jahi McMath case falls outside the appropriate scope of the organization's mission.

Thursday, April 10, 2014

National Healthcare Decisions Day - Minnesota

Health Care Decisions and the "F" Word: Counseling Clients about Medical Futility

Health Care Decisions and the "F" Word: Counseling Clients about Medical Futility

Date: Wednesday, April 23, 2014
Format: Live Webinar
Duration: 90 minutes
Register here

The American Bar Association Commission on Law and Aging, Senior Lawyers Division and Center for Professional Development
1:00 PM-2:30 PM Eastern
12:00 PM-1:30 PM Central
11:00 AM-12:30 PM Mountain
10:00 AM-11:30 AM Pacific

Program Description

Recent cases involving brain dead patients and resulting disputes over continuing organ-sustaining treatments have reignited debate over the appropriate use of medical technologies.  The family of Jahi McMath in Oakland, CA, fought to keep their daughter connected to a ventilator, while a hospital in Fort Worth, TX, sought to keep Marlise Muñoz, fourteen weeks pregnant, on a ventilator over the objection of her husband and family.  For terminally ill patients who are not brain dead, a family's desire to "do everything possible" sometimes leads to insisting on medical interventions that medical professionals may deem inappropriate or "futile."  


  • Provide you with an understanding of the range of policy and practice issues concerning medical futility
  • Enable you to be accurate and supportive in counseling clients on these issues in the context of advance planning
  • Enable you to be more effective in counseling and dispute resolution when conflicts arise in end-of-life decision-making concerning the limits of care
  • The focus is not on litigation. 

Program Faculty

  • Robert L. Fine, MD, FACP, FAAHPM, Clinical Director, Office of Clinical Ethics and Palliative Care, Baylor Health Care System, Dallas, TX
  • Bernard "Bud" Hammes, Ph.D, Director of Medical Humanities, Gundersen Lutheran Medical Foundation, La Crosse, WI
  • Thaddeus Mason Pope, JD, PhD, Director, Health Law Institute & Associate Professor of Law, Hamline University School of Law, St. Paul, MN
  • Charles P. Sabatino, JD (Moderator), Director, ABA Commission on Law and Aging, Washington, DC