Lawrence v. Oakland Children’s Hospital

On November 28th, 1-year-old Hiram Lawrence Jr. was critically injured in a shootout in Oakland, California.  Hiram’s parents now report that physicians at Oakland Children’s Hospital, have been pushing them to pull their son off life support because he has not shown any signs of brain function.  The parents said:  "We don't understand . . . He's still recovering."  

OCH physicians apparently plan to conduct two more tests to determine if the toddler has brain activity.  If not, Hiram would be removed from life support, against his family's wishes. The parents explained:  “Unfortunately, we have come to a crossroads. We are unable to come to an agreement on the continuum of care for baby Hiram.”  The family has retained Oakland attorney Ivan Golde to try to stop the hospital from taking the boy off life support before the family gets a second opinion.  (KTVU; NBC Bay Area)

Legal Briefings on Clinical Ethics - NEW

I am continuing my series of "Legal Briefings" on topics in clinical ethics for the JOURNAL OF CLINICAL ETHICS.  These are 15-20-page systematic summaries of legislative, regulatory, judicial, and other legal developments concerning the selected issue.  I have completed the following eight briefings.  

I am now finishing up a briefing on "Patients without Proxies: Decision Making for the Unbefriended."  If you have a policy, a bill, or any other material relevant to this topic, I would love to get a copy.  This topic is under-explored in the literature, and I really want this to be as absolutely comprehensive as possible.

1.     Legal Briefing: Medical Futility and Assisted Suicide, 20(3) J. CLINICAL ETHICS 274-86 (2009).

2.     Legal Briefing: Advance Care Planning, 20(4) J. CLINICAL ETHICS 289-296 (2009).

3.     Legal Briefing: Informed Consent, 21(1) J. CLINICAL ETHICS 72-82 (2010). 

4.     Legal Briefing: Conscience Clauses and Conscientious Refusal, 21(2) J. CLINICAL ETHICS 163-180 (2010). 

5.     Legal Briefing: Organ Donation, 21(3) J. CLINICAL ETHICS 243-263 (2010). 

6.     Legal Briefing: Crisis Standards of Care, 21(4) J. CLINICAL ETHICS 358-367 (2010) (with Mitchell Palazzo). 

7.     Legal Briefing: Healthcare Ethics Committees, 22(1) J. CLINICAL ETHICS 74-93 (2011).

8.     Legal Briefing: Medically Futile and Non-Beneficial Treatment, 22(3) J. CLINICAL ETHICS 277-296 (2011).

Five Reasons 30% of Healthcare Spending is Waste

The New York Times has an interview with former CMS administrator Donald Berwick.  Berwick says that 20 percent to 30 percent of health spending is “waste” that yields no benefit to patients.  He offered five reasons for this waste:

1. Over-treatment of patients – much of this is end-of-life medicine 
2. Failure to coordinate care
3. Administrative complexity 
4. Burdensome rules
5. Fraud

Much is done that does not help patients at all,” Dr. Berwick said, “and many physicians know it.”

Too Old for Lifesaving but Expensive Procedures?

The Chicago Tribune explores a question that will be increasingly asked over the next few years:  Should physicians, as some in Chicago recently have, perform a balloon angioplasty on a 96-year-old or implant a new heart valve in a 101-year old?  

The article reviews the widely-published arguments of Daniel Callahan. I am glad these discussions are getting much greater public exposure.  This will help inform and spur a much-needed societal debate.  I like much of Callahan's argument, but think that while age might be one relevant factor, I think the answer to these questions should focus more on the capacity to benefit.

Death and Dying - in THE CONVERSATION

I blogged a few times (here and here) about the excellent series on end-of-life issues in the Globe and Mail.  I should also note that THE CONVERSATION just wrapped up its own excellent eight-part series on end-of-life issues.

A NEW Revised Uniform Healthcare Decisions Act

The Uniform Healthcare Decisions Act is nearing its twentieth birthday.  But the Uniform Law Commission still lists only six state adoptions.  As I have argued elsewhere, I think the ULC should also count Alabama, California, Delaware, and Tennessee.  But even with those additions, UHCDA adoptions would only total ten.  Compare that to 40+ adoptions of other health-related uniform acts like the Anatomical Gift Act or the Determination of Death Act.  

While some states could certainly profit from adoption of UHCDA, others like Virginia have already innovated far beyond UHCDA.  It is perhaps time to review best practices from around the country and prepare a new revised UHCDA.

New Scholarship on Medical Futility

Fall classes are over.  I celebrated by handing out a bottle of sparkling wine to each student in Torts.  It was, after all, not just the last class of the semester.  It was also my last class at Widener University.  In January, I begin my new job as Director of the Health Law Institute at Hamline University.  

Even better, in the past few days, I finished turnaround revisions on, and cleaned my desk of five (5) new articles which should now be flowing down the pipeline toward publication:

• "Review of Lawrence J. Schneiderman and Nancy S. Jecker, Wrong Medicine: Doctors, Patients, and Futile Treatment," 12 AMERICAN JOURNAL OF BIOETHICS (forthcoming 2012).
• "The Courts, Futility, and the Ends of Medicine," 306 JAMA (forthcoming 2012) (with Douglas B. White).
• "Legal Fundamentals of Surrogate Decision Making," 140 CHEST (forthcoming 2012) (5th in series: Intersection of Law and Medicine).
• "Physicians and Safe Harbor Legal Immunity," 21(2) ANNALS HEALTH L. (forthcoming 2012).
• "Responding to Requests for Non-Beneficial Treatment," 5 MD-ADVISOR: A JOURNAL FOR THE NEW JERSEY MEDICAL COMMUNITY (forthcoming Jan. 2012).

Now, I can turn to tackle a way-too-long list of in-progress projects with upcoming deadlines on:

• Decision making for the unbefriended, patients without proxies (for J. Clinical Ethics)
• American Thoracic Society policy statements on both conscientious objection and futility
• A Cochrane Review on "Advanced Care Planning for End Stage Renal Disease"
• "Futility in the Cardiac Intensive Unit"   
• And (in case any of my editors read this) other new and edited manuscripts

Want to live forever? There's an app for that

The must have applelet that humanity has been waiting for has finally hit the iStore: iMortal.  The iMortal app will let the owner live forever.  Finally, a solution to all these end-of-life disputes.  

Premature Declaration of Death

A post, today, over at FORBES describes a family's dispute with a hospital in which the patient was prematurely declared "dead."