Futility in Wisconsin

I just finished one very full day (7:30 a.m. - 5:00 p.m.) of discussing medical futility in Madison, Wisconsin  It was both enjoyable and rewarding.  I posted a PDF of the slides (over 200) to my major presentation here. 

Unilateral Refusal of Treatment by Providers: Ethical and Legal Challenges

"Unilateral Refusal of Treatment by Providers: Ethical and Legal Challenges" is the title of my presentation for Meriter Health Services’ 21st Annual Fall Ethics Conference in Madison, Wisconsin, tomorrow. (PDF brochure here)

Palliative Care Grand Rounds (Nov. 2010)

Compassion and Choices is hosting this month's Palliative Care Grand Rounds -- "the awesome little (and big) nuggets of great blogging on all things hospice and palliative care."

Medicare Coverage for Advance Care Planning

Charlie Sabatino reports:

Yesterday,  CMS pre-posted the 2000+ page physician payment final rule and comments on the OFR website.  Formal publication in the Federal Register is projected to be Nov. 29.  The final rule includes reimbursement requirements for the new annual wellness/preventive care exam under the Medicare changes that were included in the healthcare reform bill.  In response to comments urging CMS to require that physicians offer voluntary advance care planning as part of the annual exam, and CMS agreed!

You'll recall that a legislative provision to offer voluntary ACP every 5 years was dropped from the healthcare reform bill because of hysteria over government encouraged euthanasia.  This approach to the annual wellness exam restores some sanity to the picture.  ACP has already been a required part of the "Welcome to Medicare" since the Medicare Modernization Act of 2003, and since ACP requires an ongoing effort, it makes a lot of sense to revisit it at least annually.  This is a big step forward in normalizing advance care planning.  The relevant pages [of the final regulation] are 766-768 for the commentary and 1488-1494 for the reg language.

APPELLATE DIVISION IMPLIES MEDICAL PROVIDERS MAY REFUSE TREATMENT BASED UPON FUTILITY OF CARE

Daniel Levy has an op-ed in this week's New Jersey law Journal on the Betancourt case. The central part of his analysis is as follows:

[T]he Appellate Division did not resolve the substantive issue of whether a health care provider may withdraw care based upon futility . . . . The court seemed unwilling to rule on the issue because such a ruling would be 'whole-cloth legislation from the bench.' The court did, however recognize that the debate on medical futility would continue and should be addressed 'in thoughtful consideration by the Legislature as well as Executive agencies and Commissions charged with developing the policies that impact on the lives of all.'  Although at first glance it may appear that the Appellate Division side-stepped on an important issue with possibly nationwide consequences, the suggestion that the issue is best left for proper legislation may be the best course of action. The hospital sought an openended exception to the right-to-die doctrine for whenever a health care provider deems treatment to be unnecessary. While an exception that would allow some ability for a health care provider to refuse to continue treatment that is deemed unethical may be appropriate in certain circumstances, accepting such an argument might have led to an overbroad exception.  The Legislature may in general be better to craft a medical futility statute that would set the requirements for when a health care provider can refuse to continue providing treatment that would be considered futile.