International Association of Bioethics Conference

The 11th International Association of Bioethics conference will be held in Rotterdam from June 26-29, 2012.  Abstracts are due December 1, 2011.

Choosing Life over Time

After three brutal rounds of chemotherapy and radiation failed to stop the cancer from spreading, Minnie Marshall made the decision to stop curative treatment and in July called Hospice.  Now Marshall focuses on managing her pain and enjoying time with her daughter, rather than undergoing painful treatment that won’t stop the cancer, only prolong the inevitable.

“I’d rather feel healthy in my time left than create artificial time,” Marshall said.  “I told (my oncologist) when the treatment becomes worse than the disease, I wanna stop.”  “I’d rather have two months feeling good than two and a half months and feeling bad the last month.”

Marshall isn’t the only one who prefers quality of life over quantity.  A recent poll commissioned by The Regence Foundation and National Journal found Pacific Northwest residents are more open to end-of-life options than the overall American public. According to the poll, 83 percent of Washingtonians believe enhancing the quality of life for seriously ill patients is more important than extending life for as long as possible. That compares to just 71 percent of Americans who share the same belief.    [from the Washington State Columbian]

Patients without Proxies

Now that the Legal Briefing for Journal of Clinical Ethics 22(3) is on its way, I can turn to complete the in-progress Legal Briefing for Journal of Clinical Ethics 22(4), on patients without proxies.  (The tentative plan is to follow that with one on "Advance Directive Compliance" and then "Adolescent Decision Making.")  This Article reviews the several mechanisms that providers use to make decisions for "unbefriended" patients.  The tentative outline is:

1. What is unbefriended? What is the extent of the problem?
2. Statutes authorizing “close friends” to make health care decision
3. Treatment decision made by guardian
4. Treatment decision made by doctor
5. Treatment decision made by ethics committee
6. Treatment decision made by special committee
7. Preventative measures 

Medical Futility: Recent Legal Developments

I blogged a few weeks ago about my next Legal Briefing article forthcoming in Journal of Legal Ethics 22(3).  I finally finished the last of several rounds of revisions.  The basic organization remains the same.  I am especially excited about the last section, which is an area I am exploring in greater depth.
1.      Texas Advance Directives Act
2.      Ontario Consent and Capacity Board

3.      Surrogate Selection

4.      Ex Post Cases for Damages

5.      Ex Ante Cases for Injunctions

6.      Coercion and Duress

7.      Assent and Transparency

8.      Brain Death Cases

9.      Criminal and Administrative Sanctions

10.     Conscientious Objection   

11.     Penalties for Providing Futile Treatment

Putting a price on prolonging a doomed life

In a column, yesterday, in the LA Times, David Lazarus asks "do we really want to spend hundreds of thousands of dollars extending the life of a person with a terminal illness?"  "How much money and medical resources are too much when it comes to prolonging a doomed existence? Who decides when your time is up?"  

Interestingly, Lazarus concludes that "this is a matter for medical experts, not insurance bean counters, to address. A doctor is in the best position to determine what's most appropriate for his or her patient."  

I had rather thought that the overwhelming consensus was just the opposite.  Physician practice patterns are quite strongly guided by the reimbursement incentives.  So, too often, if it's paid for it will be bought -- whether it is wanted by the patient, whether it is beneficial for the patient.