Wednesday, April 23, 2014

More Visibility and Awareness of VSED & VRFF Option to Hasten Death

I recently published my second legal analysis of VSED (VRFF) as a legal and comfortable means to hasten death.  (Here is the first.)  I am pleased to see the mainstream media devoting more attention to VSED.  

I blogged about one example here.  This week, WBUR ran a story titled "Aid-In-Dying Loophole: Advocates Want You To Know You Can Stop Eating And Drinking."  This was based on the story of Jackie Wilton's use of VSED as blogged by her daughter.

Tuesday, April 22, 2014

Hospital Patients’ End-of-Life and Care Wishes Now Part of Electronic Medical Records

Lumināt today announced a development partnership with UMass Memorial Health Care for an advance care planning technology platform to integrate patients' end-of-life directives into their electronic medical records (EMR). 

Lumināt's development partnership is ground-breaking because:
  • It is the first time that advance care plans have been integrated into an EMR system.  Previously, advance care plans were filed away with a patient's physician, leaving them open to interpretation from doctor to doctor.
  • It leverages cloud-based technology to enable all providers in the UMass Memorial system to access, understand and implement the patients end-of-life wishes.
  • It helps family members capture and understand the patient's end-of-life preferences, too.
  • Ultimately, it saves the patient and family emotional and financial stress associated with unwanted health care services at the end of life.

Here is the official new release:

MINNEAPOLIS (April 21, 2014) — Lumināt announces a development partnership with UMass Memorial Health Care (UMass Memorial) for an industry-leading advance care planning platform to fully integrate patients’ end-of-life directives into their electronic medical records. This ground-breaking development partnership will equip all UMass Memorial providers to access, understand and implement patients’ wishes, reducing the cost of care at end of life while improving care quality and satisfaction of patients and their families.

“Unwanted end-of-life health care services can have a significant emotional and financial impact on patients and their families. It’s estimated that $40 to $70 billion in unwanted health care services will be delivered at patients’ end of life in the next decade,” says Tom Valdivia, M.D., M.S., chief executive officer of Lumināt. “Advance care plans should not be viewed as a ‘nice to have.’ Not having an advance care plan should be considered a medical error.”

The partnership between Lumināt and UMass Memorial will enable physicians to consistently document the end-of-life wishes from patients – from palliative care preferences and specific spiritual beliefs, to identifying the individuals who should be involved and informed in the decision-making process. The data is then fed into the patient’s electronic medical record via cloud-based technology, giving the entire provider system the same information and instructions, and helping family members understand the patient’s end-of-life preferences.

“Lumināt’s advance care planning platform integrated with UMass Memorial’s electronic medical records is a first in the industry,” says Valdivia. “Up to this point, patients completed the advance care directive on paper and submitted it to their physician to be filed away. As a result, the instructions weren’t accessible by all providers and were left open to interpretation from doctor to doctor.”

Lumināt and UMass Memorial’s development partnership is based on a shared dedication to improving care for patients near end of life.

“Unless communicated in advance, many medical treatments provided at the end of life are inconsistent with patients’ wishes,” says David Fairchild, M.D., senior vice president of clinical integration at UMass Memorial. “As UMass Memorial transitions to being an accountable care organization, we recognized the opportunity to use Lumināt technology to enable and support conversations about end of life.”

About Lumināt
Lumināt is a leading advance care planning solutions company that helps health care providers achieve the Triple Aim for people at end of life. Lumināt’s cloud-based, private-label technology offers a way for patients to document their wishes, share them with providers at the right time, and get the end-of-life care they want. Founded in 2012, Lumināt is committed to helping provider organizations deliver better care at a lower cost. For more information, please visit www.luminat.com.

About UMass Memorial Health Care

UMass Memorial Health Care is Central Massachusetts' largest not-for-profit health care delivery system, covering the complete health care continuum with UMass Memorial Medical Center, its academic medical center, member and affiliated community hospitals, freestanding primary care practices, ambulatory outpatient clinics, a rehabilitation group and mental health services. UMass Memorial is the clinical partner of the University of Massachusetts Medical School. To learn more about UMass Memorial, please visit www.umassmemorial.org, Facebook, Twitter and YouTube.

Monday, April 21, 2014

Medicare Choices Empowerment and Protection Act (S. 2240)

I recently blogged about the Medicare Choices Empowerment and Protection Act (S. 2240).  I have since heard quite a few bioethicists criticize this bill.    

Much of this criticism seems appropriate.  There are a lot of ill-informed and misinformed advance directives out there.  If enacted, this legislation would prompt MORE of them.  In short, this legislation seems focused on the volume and number of advance directives, NOT on their quality.

The only caveat to that assessment would be if DHHS develops some very good accreditation criteria.  Perhaps DHHS will certify only advance directives completed with sophisticated interactive patient decision aids.  That would help ensure that the government's $75 is paying for "good" advance directives. 

I am informed by one highly respected clinician ethicist that one such certifiable interactive advance care planning tool is MyDirectives.  It prompts the patient to think about values prior to making choices about future care plans, allows very flexible choices including time-limited trials in a more effective manner than a paper document, is easy to update (since the directive created is digital), and is easily retrievable from the web (in fact has the potential to automatically populate EMRs).

Doing Everything Possible: The Best or Worst Thing about American Medicine (VIDEO)

The World Affairs Council of Philadelphia has posted a video of my March 2014 debate with Wesley Smith: "Doing Everything Possible: The Best or Worst Thing about American Medicine."



Sunday, April 20, 2014

DHHS Will Pay You $75 to Register Your Advance Directive

Under the Medicare Choices Empowerment and Protection Act (S. 2240), which was introduced this month, the Department of Health & Human Services will pay Medicare beneficiaries $75 to register their advance directives.  

As I have reviewed before, most legislative and regulatory attempts have tried to promote advance care planning by paying clinicians more.  Those efforts failed.  In contrast, the instant bill focuses on providing financial incentives to the beneficiaries themselves.

Basically, DHHS will develop accreditation criteria and accredit certain providers of advance directives.  Once a beneficiary has adopted a certified advance directive, she can register it under the DHHS program and earn the incentive payment.

Saturday, April 19, 2014

10 Common Questions (and their Answers) on Medical Futility

Four Mayo Clinic physicians have just published a high level overview of medical, ethical, legal, financial, and policy issues relating to medical futility.  Here are the 10 questions.  Read the article for the answers.
  1. What is the definition of medical futility?
  2. How do challenges in prognostication contribute to medical futility?
  3. What and who are the principal movers encouraging medical care that may be considered futile?
  4. What are the financial arguments that may encourage or discourage the provision of medically futile care?
  5. What are the core legal concerns that influence the provision of medically futile care?
  6. Does the definition of medical futility differ depending on the type of patient?
  7. Do the standards of appropriate vs. futile medical care change with time?
  8. How does one adjudicate OUTSIDE the legal system whether medical care is futile and whether such care should be continued or stopped?
  9. How does one adjudicate WITHIN the legal system whether medical care is futile and whether such care should be continued or stopped?
  10. How does one prevent medical futility?
  

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: http://www.nhdd.org  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:http://theconversationproject.org/

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: www.nhdd.org  Do it today.

SPREAD THE WORD FURTHER: Please share NHDD information with your members/contacts/colleagues by forwarding this email or a link to www.nhdd.org 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:  http://www.nhdd.org/join/

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