N.Y. Bill to Promote ACP in Medicaid Population

A few days ago, New York Senator Patrick Gallivan introduced S.B. 4830.  This bill would require the provision of a model health care proxy form, living will or other comparable materials to individuals applying for medical assistance.  As I have written before, these sorts of measures are wholly appropriate.  ACP should be promoted in at least the ways that organ donation and NOKRs already are.  Here is the text of the bill:

Every person making application for medical assistance, and every person on whose behalf an application is made, shall, if interested,  be given  the New York state Department of Health model health care proxy form, living will or comparable materials and instructions by the person taking the application, except where doing so would impede the immediate provision of health care services.

A Bittersweet Season: Caring for Our Aging Parents--and Ourselves

Seven Forthcoming Futility Articles

There are seven short articles on medical futility published OnlineFirst over the past few weeks in the Journal of Bioethical Inquiry.

Same Coin-Different Sides? Futility and Patient Refusal of Treatment

Eleanor Milligan

Futility Determination as a Process: Problems with Medical Sovereignty, Legal Issues and the Strengths and Weakness of the Procedural Approach

Cameron Stewart

No Chance, No Value, or No Way: Reassessing the Place of Futility in Health Care and Bioethics

Sarah Winch and Ian Kerridge

Defining Medical Futility and Improving Medical Care

Lawrence J. Schneiderman

The Futility of Futility: Death Causation is the ‘Elephant in the Room’ in Discussions about Limitation of Medical Treatment

Michael A. Ashby

Minimally Conscious States, Deep Brain Stimulation, and What is Worse than Futility

Grant Gillett

Medical Futility and the Death of a Child

Nancy S. Jecker

Lessons from Seville: Identifying & Reducing Inappropriate End-of-Life Treatment in New Jersey

I am editing my Grand Rounds presentation for the University Medical Center at Princeton:  "Lessons from Seville: Identifying & Reducing Inappropriate End-of-Life Treatment in New Jersey."  I am excited about this one.  I go beyond the classic medical futility dispute to examine a far broader context.  I group the root causes of inappropriate end-of-life treatment into four categories and identify several solutions within each category.  

The Unspoken

The Unspoken - A 3 minute Film About Father-Son Communication  (HT: Pallimed)

Pressured to Refuse Ventilator -- Persuasion vs. Coercion

Simon Fitzmaurice, an Irish man with motor neuron disease (MND), revealed to the Irish Times how health professionals pressured him to refuse the ventilator that is keeping him alive.  Shortly after being admitted, a doctor informed him it was rare and expensive for patients with his condition to have a ventilator at home.  Fitzmaurice said the doctor told him: “That it is time for me to make the hard choice.  He tells me that there have only been two cases of invasive home ventilation, but in both cases the people were extremely wealthy. . . .  This is it now for you.  It is time for you to make the hard choice, Simon.”

There is a growing consensus that patients ought not be abandoned to their autonomy.  Physicians should share their recommendation.  Indeed, if they feel strongly about it, they might even attempt to persuade the patient with evidence and argument.  But physicians must be careful not to stray from rational persuasion to badgering, manipulation, or coercion.  Unfortunately, some patients often experience mere persuasion as coercion.   Other patients feel that the physician does not share enough.  

Anti-Euthanasia Cards

I do not regularly write about developments concerning Physician Aid-in-Dying.  Indeed, that would be quite a challenge with all the legislative initiatives and court cases now active across the globe.  But I was fascinated with this story in the Telegraph recently.  It reports that “many elderly people in the Netherlands are so fearful of euthanasia that they carry cards around with them saying that they do not want it.”  Some 6000 members of the Dutch Patients’ Association (NPV) have “living will declarations” stating that they do not want euthanasia if they are taken into hospital or a nursing home. 

Now, there may be some basis for concern about involuntary euthanasia in the Netherlands.  I am not writing about that.  My more immediate concern is that similar fear, misinformation, and distrust here in the United States will cause many people to complete the same sorts of cards (with respect to passive, not active, euthanasia), undermining the positive potential of advance care planning.  For example, the NRLC has been distributing a "Will to Live" for several years.  While such documents may accurately reflect the preferences of some individuals, they are inappropriate for many.