Assisted Suicide on TV in 1970

I was surprised to see assisted suicide portrayed and described as "death with dignity" on this 1970 episode of Adam 12 (at 5min).

GMC Draft on Withholding and Withdrawing Treatment to Be Issued for Consultation

Today's London Times reports more about the forthcoming GMC Guidance on end-of-life care.

"Legal precedents suggest that doctors, not patients, have the final say over whether to provide life-extending treatment or nutrition. At present they can refuse to do so if they judge it to be futile or not in the 'best interests' of the patient, because of possible pain or suffering."

"But the guidance from the GMC formally advises doctors for the first time that patients’ wishes – or those of their loved ones – should be given much greater weight in situations where there is a chance to prolong or save life, even for a short time."

"Where a patient’s wishes are explicit or interpreted by close family or their legal representatives, 'acting against the patient’s wishes should be deemed to be causing harm. . . .  Serious or persistent failure to follow this guidance will put your registration at risk. . . .  You must, therefore, be prepared to explain and justify your actions.”

Palliative Care Grand Rounds

Check out the second monthly Palliative Care Grand Rounds over at Dethmama Chronicles.

Palliative Care Grand Rounds is, according to one participant: "a monthly blog carnival highlighting what's out there in cyberspace that covers issues of hospice care, death, dying, grieving, caregiving, etc. It's your best opportunity this month to see what the cyber community is writing about these topics. And dethmama is a gripping writer, so I'm sure her turn at the rounds is something not to be missed."

Idaho Futile Care Law - Insufficient Due Process

Yesterday, the Idaho Statesman described state Senate Bill 1114, passed to the House on Tuesday. The article stated that the Senate bill will "allow medical treatment to be withheld from developmentally disabled people."  

But if enacted, the impact of this legislation will be broader and far more significant. First, the bill purports to amend the Idaho Medical Consent and Natural Death Act that governs medical treatment for all patients in Idaho, not just for the developmentally disabled.  

Second, the bill would authorize health care providers to refuse treatment, including life-sustaining treatment, that is requested by the patient or her substitute decision maker. For example, providers could withhold or withdraw mechanical ventilation, dialysis, or artificial nutrition and hydration from a patient in a vegetative state, even though such treatment could keep the patient alive for many additional years and even though the patient (through her advance directive or spouse) requested such treatment under those circumstances.  

While there must be limits to the medical technology that is deployed at the end-of-life, the bill provides distressingly thin standards or oversight for such decisions. A physician can refuse life-sustaining medical treatment as "futile" or "inappropriate" so long as the healthcare facility ethics committee agrees. But the composition of this committee is left entirely to the facility, to which all or most of the ethics committee members are economically or otherwise beholden.  

Senate Bill 1114 is closely patterned after the controversial Texas Advance Directives Act, which has been widely-criticized as being unfair to patients. The Idaho bill suffers from almost all the same due process deficiencies. Indeed, while Texas gives surrogates 48 hours notice of the ethics committee, S.B. 1114 gives only 24 hours notice.

President's Council on Bioethics Discussion Paper on Futility

On Friday, March 13th, the President's Council on Bioethics will talk about a discussion paper on medical futility, or as it is apparently being characterized, "beyond Medical rescue."

9:00 am	Session 5: Beyond Medical Rescue:  Staff Discussion Paper
10:30 am	Session 6: Public Comments
10:45 am	Adjournment

Hospital Chain CEO Says Biggest Challenge is When to Let Life End

Yesterday, at the Greater Boston Chamber of Commerce, outgoing CEO of Boston hospital giant Partners HealthCare, Dr. James J. Mongan, explained that "as the economy worsens and unemployment and government budget deficits grow, exploding health care costs are becoming a hotter issue than ever. ays one of the very biggest challenges today isn't medical or fiscal -- it's the ethical challenge of when to let life end."  "End-of-life issues,'' Mongan said, "will become even more significant as medicine advances and society ages.''

GMC to Better Respect Patient Rights

I have been meaning to finish-up an unpublished piece in which I criticize the ECHR decision in Leslie Burke.  That court had ruled there was no risk that Leslie Burke's life-sustaining treatment would be withdrawn against his wishes.  But to all reasonable readers of the UK GMC Guidance there certainly was such a risk.

Now, according to the Scotsman, even the GMC itself seems to recognize that there is such a risk.  Under a new Guidance, the wishes of dying patients are to be given more weight.  In cases where patients demand that treatments such as artificial feeding and hydration are given to them until death, doctors will be told they should  take into "account very formally and seriously the wishes of the patient" and "carefully consider the harm that might be caused by going against these wishes." 

Jane O'Brien, from the GMC, said:  "We really wanted to allay people's fears that doctors will just be on their own agenda and won't be listening to patients, and to emphasise the importance for doctors of taking into account patients' wishes and going along with them wherever that is practical and reasonable."  

Still, the Guidance stops short of telling doctors they must always provide treatment requested by patients and their families in cases where continuing this kind of care.  It "does not change the position in law that ultimately when a patient has lost capacity, a doctor will make [the] decision."

Idaho Senate Passes Texas-Style Futile Treatment Bill

Yesterday, the Idaho Senate passed S.B. 1114, which would amend Chapter 45, Title 39 of the Idaho Code, by adding a new section Section 394504A ("WITHHOLDING OR WITHDRAWING HEALTH TREATMENT – VOLUNTARY ETHICS COMMITTEE REVIEW":

(1) If the attending physician believes that the treatment requested by a patient, the patient’ advance directive or the patient’s surrogate decision maker is medically inappropriate or futile, the attending physician or health care facility in which the patient is admitted may request that an ethics committee of the health care facility review the facts and circumstances to determine if the requested treatment is medically inappropriate or futile.

(2) The ethics committee shall be comprised of at least two (2) physicians, and such other persons as the health care facility shall appoint. The attending physician may appear at the ethics committee meeting to explain the facts and circumstances of the case but may not participate as a member of the ethics committee.

(3) The patient or his legally authorized surrogate decision maker shall be given the opportunity to attend the ethics committee meeting and explain the basis for his or her request for treatment. The patient or surrogate decision maker shall be given prior notice of the ethics committee meeting at least twentyfour(24) hours before the ethics committee meeting unless the patient or surrogate decision maker waives such prior notice. The patient or surrogate decision maker shall not be entitled to be present during the ethics committee’s deliberations. The ethics committee shall provide to the patient or surrogate decision maker a written explanation of the ethics committee’s determination.

4) If the ethics committee agrees with the attending physician that the treatment requested by the patient, the patient’s advance directive or surrogate decision maker is medically inappropriate or futile, the attending physician and health care facility shall take reasonable action to assist the patient or surrogate decision maker to arrange the patient’s transfer within fifteen (15) days to another health care provider selected by the patient or surrogate decision maker who is willing to assume the treatment of the patient. The health care facility shall provide reasonably necessary lifesustaining treatment within the capacity and capability of the health care facility until the patient is transferred or until the expiration of the fifteen (15) day period described above, whichever occurs first. Following the patient’s transfer or upon expiration of the fifteen (15) day period described above, whichever occurs first, the attending physician and health care facility shall not be obligated to provide additional treatment that has been determined to be medically inappropriate or futile by the ethics committee. The patient or his surrogate decision maker shall remain responsible for the costs incurred in transferring the patient to another health care provider in addition to the cost of any health care provided prior to the transfer.

(5) If the patient or surrogate decision maker disagrees with the ethics committee determination, the patient or surrogate decision maker shall cooperate with the health care facility to arrange the transfer of the patient to another health care provider within fifteen (15) days following the ethics committee determination. The patient or surrogate decision maker may petition the district court in which the health care facility is located to lengthen the time to effect an appropriate transfer; provided however, that the district court shall extend the time only if the court finds, by a preponderance of the evidence, that there is a reasonable probability that the patient or surrogate decision maker will be able to transfer the patient to another qualified health care provider who is willing to provide the treatment requested by the patient or surrogate decision maker within the extension requested by the patient or surrogate decision maker.

(6) If an ethics committee has determined that the requested treatment is medically inappropriate or futile, but the patient is later readmitted to the health care facility within six (6) months following such ethics committee determination, the attending physician may rely on the prior ethics committee determination and withhold or withdraw treatment consistent with the prior ethics committee determination if the attending physician and one (1) physician member of the ethics committee determine that the patient’s condition either has not improved or has deteriorated since the prior ethics committee determination and that the prior ethics committee determination still applies to the patient’s condition, and they document their conclusion in the medical chart.

(7) A health care provider or surrogate decision maker who complies 1 with the provisions of this section shall be immune from criminal or civil liability for withholding or withdrawing health care that has been determined by the ethics committee to be medically inappropriate or futile. The health care facility and any person who participates in the ethics committee review or determination shall also be immune from criminal or civil liability for actions taken in good faith in connection with the ethics committee review or determination.

(8) The ethics committee review as provided in this section shall be purely voluntary.Nothing in this chapter shall require a health care facility to establish or utilize an ethics committee, nor shall this chapter require a health care provider or surrogate decision maker to submit

Niche Blogging

Several commentators (like Ohio State Law Profesor Douglas Berman) have recently called for more single-issue bloggers.  

John Marshall Law Professor Corey Yung observes that there are some negatives to a single-issue blog:   "A niche blog audience tends to be narrower and there are less regular readers. Instead, narrow-focus blogs are consulted more often when a hot topic intersects with the blog's subject matter. . . .  That means that the niche blogger has to a lot more work during the off-peak times to draw attention to the blog."

Professor Yung also notes some positives:  "Most importantly, the people who read my blog, regularly or irregularly, tend have much higher interest levels about the topics on which I blog. . . .  [R]eader feedback has served me well in enhancing my scholarly work. . . .  My blog forces me to read and think about the issues which interest me on a daily basis. . . .  I think the net effect for me has been to increase my overall work rate."

Medical Futility is, of course, a single-issue blog.  I agree with the observations of Professor Yung.

No Bills (Yet) in Texas to Eliminate or Modify "Futile Treatment" Act

The Texas Legislature began its 81st session about six weeks ago.  Yet, I have not yet seen a single bill in either the Senate or House that aims to eliminate or modify the Texas Advance Directives Act.  

During the spring of 2007, there had been many bills and much debate by those who argued that the current provisions in 166.046 are not sufficiently fair.  Others were opposed to the fundamental concept of a law that permitted health care providers to withdraw wanted life-sustaining medical treatment.  Oddly, non of those parties has lobbied such to have a bill introduced in the current legislative session.