Sunday, August 2, 2015

Coerced Consent to Stop Life Sustaining Treatment

Only in rare and narrow circumstances does U.S. law permit
clinicians to stop life-sustaining treatment WITHOUT the consent of the patient or surrogate.  Therefore, the focus of many policies and guidelines is on getting that consent.

Unfortunately, that consent is often not informed or voluntary.  I have written about this before (for example, here and here).

Yesterday, in the Detroit Free Press David Blumenthal discusses how some physicians refer to themselves as "The Grim Reaper”  “Oh, just give me 10 minutes with the family, I’ll convince them to pull the plug.” 

Blumenthal observes that "the situation worsens when, often for cultural or religious reasons, families decide to continue aggressive care for their loved ones even after achieving a better understanding of the prognosis and painful course of illness. In these cases, the doctor, conditioned to hammer home the bad news expecting the family to eventually relent becomes, ultimately, callous."

"Because large medical teams rotate weekly, they often each feel the need to encourage reducing treatment, frequently ignoring families who I’ve seen plead for the subject not to be brought up again."

Last Day in Hospice [EOL in Art 83]

B.D. Colen took some impressive photographs of Bill Potter at a New Hampshire hospice where he was dying of lung cancer.  The black-and-white snapshots give a glimpse not only into Potter’s final hours, but also into his family’s efforts to surround and celebrate their loved one. 

Saturday, August 1, 2015

Grace Before Dying - Photographs of the Hospice Program at Louisiana State Penitentiary [EOL in Art 82]

Grace Before Dying is an award-winning photographic documentary by Lori Waselchuk that chronicles the prisoner-run hospice program at the Louisiana State Penitentiary, in Angola. 

Waselchuk collaborated with the Angola Prison hospice volunteer quilters to create two traveling exhibits featuring photographs and quilts.

Decision Making for Unknown & Vulnerable Patients: A Survey

Please participate in this survey on medical decision making for Unknown and Unrepresented Patients.

The Community Ethics Committee (CEC) has become a valued resource for the ethics leadership of Massachusetts General Hospital, Boston Children’s and other institutions affiliated with Harvard Medical School.

Now you can provide a valuable voice to the CEC in its current study of an especially vulnerable patient population. These patients are known by various names -- unrepresented, unbefriended, adult orphans, etc. -- but the CEC refers to them as Unknown and Unrepresented Patients.

Due to dementia, brain trauma, substance abuse or other reasons, these patients at least temporarily cannot comprehend their medical situation or influence decisions. Further compounding the mystery, they have no one to speak for them, and there is no available documentation of their wishes.

Decisions that sometimes involve life-sustaining treatment can be left to overburdened courts, inadequately resourced public guardianship, or decision-making practices and biases unique to each physician, hospital or care facility. The result ranges from neglect to over-treatment, potentially harming both the patient and the moral values and integrity of doctors and nurses caring for them.

This patient population is growing commensurately with a doubling of the elder population  nationally by 2030. The conservative estimate is that 25,000 of these unknown humans die in American critical care wards annually. Most of these involve a decision to withhold or withdraw life-sustaining treatment.

How, and by whom, ought medical decisions be made for patients who cannot make their own and have no one who knows them well enough or cares enough to make it for them?

You can inform this important project by answering 10 questions in this survey. The time commitment is small, but the contribution is great.

Friday, July 31, 2015

Nominate this Blog for the ABA Blawg 100

If you find this blog of value, please consider nominating it for the American Bar Association's 100 best legal blogs.

Nominations are due here by August 16, 2015.

Texas Advance Directives Act - Symposium

The August issue of the American Journal of Bioethics [15(8)] includes a target article and peer commentaries on the Texas Advance Directives Act.  

Here is an extract from the table of contents.   I am pleased to be included among these.

The Texas Advanced Directive Law: Unfinished Business
Michael Kapottos & Stuart Youngner
pages 34-38

Pining for Courts to Resolve Intractable Disputes Between Families and Physicians Is a Pipe Dream
John J. Paris & Andrew Hawkins
pages 39-40

The Texas Advance Directives Act: Must a Death Panel Be a Star Chamber?
Thaddeus Mason Pope
pages 41-43

Futility and Fairness: A Defense of the Texas Advance Directive Law
Nancy S. Jecker
pages 43-46

The Texas Advance Directives Act Is Not About Professional Integrity
Tom Tomlinson
pages 46-48

A Texas Perspective on TADA: Physician Autonomy and the Corporate Practice of Medicine Act
Craig M. Klugman & Brigid Sheridan
pages 48-49

The Unfinished Business of Developing Standards for End-of-Life Care: Leveraging Quality Improvement and Peer Review
Jeffrey T. Berger
pages 50-51

The Misleading Vividness of a Physician Requesting Futile Treatment
Colleen M. Gallagher, Jeffrey S. Farroni, Jessica A. Moore, Joseph L. Nates & Maria A. Rodriguez
pages 52-53

Professionally Responsible Clinical Ethical Judgments of Futility
Laurence B. McCullough
pages 54-56

TADA Is Still Unfair
Philip M. Rosoff
pages 56-58

Finishing the Texas Advance Directives Law
Chris Hackler
pages 58-60

Funeral Home Staff at the Hospice [EOL in Art 81]

Yesterday, I blogged about Ed Kashi's Aging in America: The Years Ahead.  Here is another photograph from that collection.  Virginia Magrath watches as her husband's body is taken away by funeral home staff after his passing in the On Lok hospice. 

Ain't the Way to Die - Awesome Video Encouraging ACP