Thursday, April 16, 2015

Current Trends in End-of-Life Medical Treatment (MP3)

This week, I am visiting Southern Illinois University as the John and Marsha Ryan Bioethicist in Residence.  I did two talks in Carbondale and am doing another in Springfield.  

I also talked to the local NPR station, about current trends in bio-ethics and end-of-life medical treatment.  A recording is here.

Patients without Surrogates - Twitter Chat

Check this out on Monday night.  Decision making for the unbefriended is the biggest bioethics issue that too few are talking about.

Wednesday, April 15, 2015

National Healthcare Decisions Day

Tomorrow is National Healthcare Decisions Day.  Do you have an advance directive?  Is is up-to-date with your agent and alternate agent?  If not, get it done today.

Tuesday, April 14, 2015

VSED Podcast on TWIHL

Check out my podcast on VSED as well as others in the new series THE WEEK IN HEALTH LAW.  

Each week, health law professors Frank Pasquale and Nicolas Terry bring in a guest to discuss the most pressing issues in Health Law & Policy.

Sunday, April 12, 2015

Limits of Default Surrogate Laws, Importance of Advance Directives

For patients who lose capacity and have no legally appointed surrogate decision maker, most states have laws that specify a hierarchy of persons who may serve as surrogate decision makers by default. But these state "default surrogate consent statutes" vary in their recognition of important relationships beyond the nuclear family, such as friends, more distant relatives, and intimate relationships outside marriage.

A research study just published in JAMA shows substantial number of patients (>7% of the >100,000 patient sample) had a next-of-kin relationship outside the nuclear family. 

The authors recommend that states consider adopting uniform default consent statutes broad and inclusive to reflect the evolving social ties in the United States.  In the meantime, it is important for individuals to complete advance directives to opt out of the default surrogate rules and select the people whom they trust and who know them best.

Saturday, April 11, 2015

Is International Consensus on Brain Death Achievable?

Commenting on a new study in NEUROLOGY that shows a wide diversity of brain death practice, James Bernat asks "is international consensus on brain death achievable?"

Bernat observes: "Worldwide concurrence on death determination criteria can enhance public confidence in physicians’ ability to determine death by eliminating the possibility that patients declared dead in one jurisdiction would be considered alive in another. International harmonization also is a constructive step toward improving global systems of organ transplantation."

But, Bernat notes, "formidable medical and societal barriers must be overcome before such consensus becomes possible." 

In addition to other sources of variation results, Bernat notes "disagreement over the conceptual question of whether brain dead patients are truly dead or only “legally dead.” Surveys continue to show both widespread misunderstanding of the brain death concept and its rejection as equivalent to biological death by some health care professionals."

Friday, April 10, 2015

Neither Doctors nor Laypersons Understand Brain Death

Here is a good presentation with some disturbing data from the Society of Critical Care Medicine (SCCM).

Toronto Police Criminally Charge Nurse for Stopping Life Support without Consent

Deanna Leblanc
Toronto police have arrested Joanna Flynn (50), a former nurse at Georgian Bay General Hospital for allegedly cutting off a patient’s life support without authorization.  

She is charged with manslaughter and with criminal negligence causing death. The victim, Deanna Leblanc (39), died at the hospital on March 2, 2014.  

The hospital CEO observed "A criminal charge involving someone at our hospital is a highly distressing occurrence and will create a good deal of anxiety for our community." (Toronto Star)  Mark Handelman said he has never seen a Canadian health care practitioner criminally charged for ending life support.