Saturday, August 30, 2014

Religiously Affiliated ICU Patients Receive More Aggressive End-of-Life Care

A study just published in the August 2014 issue of the Journal of Surgical Research finds that religiously affiliated intensive care unit patients receive more aggressive end-of-life care in the ICU. Yet this high-intensity care does not translate into any significant difference in survival.

Study Objectives
Previous studies have already demonstrated that religious patients receive more aggressive end-of-life care. In this study, the Vanderbilt surgeon authors sought to examine the effect of religious affiliation on EOL care in the ICU setting. (The lead author, Myrick Clements Shinall, Jr., earned an M.Div. concurrently with his M.D.) 

Study Itself
The authors looked at  patients admitted to any adult ICU at a tertiary academic center who required at least 2 days of mechanical ventilation and who died within 30 days of admission. This group had 334 patients, with 235 affirming a religious affiliation. The affiliated and non-affiliated patients had similar levels of acuity.

Findings
The authors used hospital charges, ventilator days, hospital days, and days until death as proxies for intensity of care among the EOL patients.  Religiously affiliated patients in the EOL group incurred:

  • 23% more hospital charges
  • 25% more ventilator days
  • 23% more hospital days
  • 30% longer time until death  
Despite this, survival did not differ significantly among affiliated and non-affiliated patients.

Friday, August 29, 2014

Jahi McMath Still Responding to Verbal Commands

Jahi McMath was declared dead both by multiple neurologists and by a California court in December 2013.  

Yet, just days ago her mother made the following announcement to the crowd at the New Beginnings Community Center's summer gala event at the Long Island Aquarium
 "She has good days and bad days. . . . Some days I ask her to move her left hand, or her right hand and she does...I'm her mom and I know that my daughter is in there."

Thursday, August 28, 2014

Providence Institute for Human Caring

Providence Health & Services is establishing the Providence Institute for Human Caring under the leadership of Dr. Ira Byock.  

Based at Providence TrinityCare Hospice in Torrance, Calif., the new institute will support clinicians, patients and families across the five states that Providence serves and others nationwide.

The institute will bring greater attention to the personal side of illness, dying, caregiving and grieving. Its goal is to offer clinicians the resources, training and support they need to have meaningful conversations with patients and families about underlying worries and desires related to a medical condition, so that together they can develop the best approach to care.  

Wednesday, August 27, 2014

Brain Death Is a Flash Point in End-of-Life Law, Ethics and Policy

My latest post over at the American Journal of Bioethics blog is now posted here:  "Brain Death Is a Flash Point in End-of-Life Law, Ethics and Policy."

Tuesday, August 26, 2014

Death: Why the Brain Matters (Video)

This spring, UCLA hosted a mini symposium titled "Death: Why the Brain Matters."  Happily the video is now available.  The speakers were 
  • Alex Capron, Professor, Law and Medicine, USC
  • James Hynds, Senior Clinical Ethicist, UCLA Health System
  • Paul Vespa, Director, Neuro ICU, RRUCLA Medical Center


Monday, August 25, 2014

Elder Mediation Training in Minneapolis

Next month, the Mediation Center at Hamline University will offer a 20-hour, three day Elder Mediation Training, on September 25, 26 and 27.

This program will expand your skills into the growing field of Elder Mediation. The workshop covers strategies for facilitating adult family conversations around issues like:

  • Living arrangements
  • Caregiving
  • Financial planning
  • Medical decisions
  • Adult guardianship mediation
  • Mental capacity
  • Wills and estate planning
  • Multi-party mediation
  • Mediation intake. 

Janeen Massaros and John Lundblad will also cover how to handle strong emotions in family conflict situations and move forward. This class uses vignettes and role plays to help you develop your skills.

Saturday, August 23, 2014

Supreme Court of Canada - Assisted Suicide Oral Arguments on October 15

Lee Carter
On October 15, 2014, the Supreme Court of Canada will hear oral arguments in the case of Lee Carter, et al. v. Attorney General of Canada, et al.  Written  Factums of key parties are available here.

The plaintiffs were terminally ill patients seeking physician aid in dying.  Ms. Kay Carter and the applicant Ms. Gloria Taylor both suffered from intractable and progressive diseases and are now deceased. They had joined with the others in bringing a civil claim before the British Columbia Supreme Court challenging the constitutionality of the Criminal Code provisions against assisted suicide and euthanasia, specifically ss. 14, 21(1)(b), 21(2), 22, 222(1)-222(5), and 241. They focused their case, however, on s. 241, which prohibits aiding another person to commit suicide. 


The plaintiffs succeeded at trial notwithstanding the Supreme Court of Canada's 1993 decision in Rodriguez v. British Columbia (Attorney General) that s. 241 did not infringe Charter rights. A majority of the Court of Appeal, however, allowed the Attorney General of Canada’s (“AGC”) appeal.


The questions to be addressed concern the Canadian  Charter of Rights (Right to life, Equality, Fundamental justice).  Specifically, 

  • Whether trial judge erred in distinguishing Rodriguez
  • Whether the Criminal Code provision prohibiting aiding person to commit suicide infringes the Charter
  • If so, whether such infringement is justifiable 

There are quite a number of interveners.  Their briefs/factums are due August 29. 
  • Attorney General of Ontario
  • Attorney General of Quebec
  • Attorney General of British Columbia
  • Council of Canadians with Disabilities and the Canadian Association for Community Living
  • Christian Legal Fellowship
  • Canadian HIV/AIDS Legal Network (the 'Legal Network'') and the HIV & AIDS Legal Clinic Ontario (''HALCO'')
  • Association for Reformed Political Action Canada
  • Physicians' Alliance Against Euthanasia
  • Evangelical Fellowship of Canada
  • Christian Medical and Dental Society of Canada
  • Canadian Federation of Catholic Physicians' Societies
  • Dying with Dignity
  • Canadian Medical Association
  • Catholic Health Alliance of Canada
  • Criminal Lawyers' Assocation (Ontario)
  • Farewell Foundation For The Right To Die
  • Association québécoise pour le droit de mourir dans la dignité
  • Canadian Civil Liberties Association
  • Catholic Civil Rights League
  • Faith and Freedom Alliance and Protection of Conscience Project
  • Alliance Of People With Disabilities Who Are Supportive of Legal Assisted Dying Society
  • Canadian Unitarian Council
  • Euthanasia Prevention Coalition and Euthanasia Prevention Coalition - British Columbia
  • Advocates' Society
  • David Asper Centre For Constitutional Rights

Wednesday, August 20, 2014

Ethics, Law & Clinical Practice - Spectrum Health 2014 Ethics Conference

If you will be in or near Grand Rapids, Michigan on Friday, September 5, 2014, come to Spectrum Health's 2014 ethics conference for clinicians: “Ethics, Law and Clinical Practice" at the Calvin College Prince Conference Center.

This is a one-day symposium addressing the ethical complexities in health care today. Conference sessions and networking opportunities are designed to increase awareness and provide strategies to clinicians from all disciplines to support ethical care in a variety of settings. 

Agenda
Hubris to Humility: Medical Power in Medical Futility Conflicts
Thaddeus Pope, JD, PhD
Director, Health Law Institute Associate Professor of Law
Hamline University School of Law

When Parents and Providers Disagree: Understanding and Responding to Conflicts in the Care of Children
Douglas Diekema, MD, MPH
Director, Education Treuman Katz Center for
Pediatric Bioethics
Professor of Pediatrics and Bioethics
University of Washington School of Medicine

Current Concepts in Disclosure
Kelly Saran, MS, RN, CPHRM
Administrative Director, Office of Clinical Safety
University of Michigan Health System

Humor: Finding a Balance
Judge Sara Smolenski, JD
Chief Judge, State of Michigan 63rd District Court

Objectives

  • Provide a forum to discuss challenges in clinical practice from an ethical perspective.
  • Explore how legal considerations influence clinical and ethical decision making at the bedside in a range of clinical settings.
  • Explore the interrelationship between ethics and law
  • Identify ethically- and legally-informed personal, professional and institutional strategies for addressing challenging situations in clinical practice.