Monday, November 24, 2014

Stop Unwanted Medical Treatment

Healthcare providers regularly ignore end-of-life wishes or give patients insufficient information to make medical decisions.  Check out Compassion & Choices campaign to stop unwanted medical treatment. 

Saturday, November 22, 2014

Mary Welch Charged with Medical Child Abuse for Obtaining Unnecessary Treatment

A 50-page arrest warrant for Mary Anna Welch accuses her of deceiving doctors into performing needless invasive surgeries on her son, Duke. 

She's charged with child endangerment.  (NBC NewsABC News)

Friday, November 21, 2014

Brain in a Jar - Sufficient Reason to Keep Me Alive

I share this treatment preference expressed by Atul Gawande at a recent Oregon Public Broadcasting book event.

"If I'm a brain in jar and I have some sort of sensory devices hooked up to me that allow me to speak, to think, to hear, to talk and to connect with other people, then keep me alive."

Thursday, November 20, 2014

Resolving Medical Futility Disputes - Alberta follows Ontario in Chalifoux v. Alberta Health Services

This month, the Court of Queen's Bench of Alberta released an eleven-page opinion in Chalifoux v. Alberta Health Services.  This is a rather typical medical futility case resolved in a typical fashion.

The Patient
Ava Alayla Chalifoux-Campiou was born in May 2014 with thanatophotic dysplasia.  This condition prevents her chest from being able to grow to accommodate her lungs.  Sun Hudson, the subject of one of the most high-profile U.S. futility cases, had the same genetic condition.

The Clinicians
The treating clinicians unanimously agreed that it was in Ava's best interests to have comfort measures only.  They, the facility ethicist, and even the mother's independent expert all agreed it was "ethically inappropriate" to continue intensive care interventions, because:  
  • Ava's condition was "terminal" with "no known cure"  
  • ICU interventions were "painful and distressing" 
  • ICU interventions placed Ava at risk of "distressing complications"  

Unable to reach consensus in family conferences, Ava's treating clinicians sent her mother a letter advising that they would remove Ava from mechanical ventilation 48 hours later.

The Mother
Ava's mother sought an injunction to prevent the clinicians from removing mechanical ventilation.  But she did not explain why she thought it was in Ava's best interests to be maintained on mechanical ventilation.

The Court
The Court determined that Ava's mother was unable to appreciate Ava's best interests, because:
  • she was not very involved with Ava's care
  • she was not well engaged with the medical team  
  • she had other personal circumstances that impeded her ability to make a decision   

In short, the Court held that the "ability" of Ava's mother "to make decisions that are in Ava's best interests" was "compromised."  

Notably, the Court specifically refused to hold that "physicians do not require the consent of the family or the approval of a Court."  Instead, much like the Ontario CCB, the Court found that Ava's parents were not acting consistent with the applicable standards for substitute decision makers.  The court provided the authorization that it held Ava's mother should have provided.    

Wednesday, November 19, 2014

Martha Perez - Texas Family Charges Organs Procured BEFORE Death

I recently summarized a few cases in which a patient was either negligently or intentionally declared dead prematurely.  

But this recent case reported by Fox News in Dallas Fort Worth indicates misunderstanding by the family rather than error by the clinicians.  

26-year-old Martha Perez dies from injuries sustained in an car wreck involving a suspected drunk driver.  Perez was a registered organ donor and doctors told the family they were prepared to harvest the organs for donations.

The family objected: “But she still has heart and lung functions,” said family member Juan Martinez.  Unfortunately, this statement indicates that the family does not understand that these cardiopulmonary functions are compatible with legal death in Texas.  They can be artificially sustained even after death is determined (on neurological criteria).   

On the other hand, the family also alleges: “They took her off the life support and she was still breathing.”  If that is true, then the determination of death must have been wrong.  A person breathing on their own (without ventilation support) cannot be dead under either cardiopulmonary or neurological criteria.

Tuesday, November 18, 2014

Texas Legislature to Address Marlise Munoz Dead Pregnant Situation

Yesterday, on Inside Texas Politics, Texas Representative Matt Krause said he is preparing legislation for the 2015 session that will address the situation in which a pregnant woman is on life support.  

Removing life support from a pregnant woman is currently not allowed.  But if the woman is dead, like Marlise Munoz was, then stopping "life sustaining treatment" is not prohibited.  Krause plans to require the appointment of a guardian ad litem for the fetus to ensure that her interests are represented.

Representative Krause is a former lawyer with Liberty Counsel, an "international nonprofit litigation, education, and policy organization dedicated to advancing religious freedom, the sanctity of life . . ."

Monday, November 17, 2014

Janina Kolkiewicz Wakes Up in Morgue after Pronounced Dead

On November 6, a Polish physician made a house call on 91-year-old Janina Kolkiewicz.  But after finding "no basic life functions," the physician declared her dead.  Two hours later she was taken to the morgue.

The physician checked for a pulse on a forearm and neck arteries, listened for a heartbeat and the sound of breathing, and checked the pupils for reaction to light, but found none. (CBC News)

Nevertheless, shortly before midnight, an undertaker who brought in another body noticed that Kolkiewicz was moving inside a bag she had been placed in. Once it was opened, she complained of being cold and asked for hot tea, the media said. She was then taken home.

Local officials are urging a regional court to void the death certificate that discontinued Kolkiewicz's benefits such as her pension.

The Guardian collects other cases to make the point that this situation is not as uncommon as you might think.

Sunday, November 16, 2014

Oregon Death with Dignity Act - 20th Anniversary

Last week marked the 20th anniversary of the Oregon Death with Dignity Act.  

Ballot initiative 16 was approved in the November 8, 1994 general election. 627,980 votes (51.3%) were cast in favor, 596,018 votes (48.7%) against.  But an injunction delayed implementation of the Act until October 27, 1997.