Do Oregon and North Dakota Healthcare Surrogates Perform Better?

In most states an individual can appoint a healthcare agent not only without the consent of the agent but also without even discussing the appointment with the agent.  In fact, many healthcare surrogates fulfill the role of substitute decision maker with neither an understanding of the role nor an understanding of the patient's wishes.

But in Oregon and North Dakota healthcare agents must accept the appointment in writing.  (Ore. Rev. Stat. 127.525; N.D. Code 23-06.5-06)  Ideally this requirement would apprise the agent of their duties.  And it would prompt a discussion between the principal and agent.  

Robust evidence shows that surrogates perform rather poorly in terms of making the same treatment decisions that patients would make for themselves.  I wonder whether Oregon and North Dakota surrogates perform better.        

Pope Cited by NRLC before Senate Judiciary Committee

Many of my (pro-liberty) positions on end-of-life medical treatment issues do not endear me to the National Right to Life Committee.  

But I do aim to produce careful and circumspect scholarship.  Consequently, I was pleased to see the president of NRLC cite me in her testimony before the U.S. Senate Judiciary Committee this week.
    

Only a Third Who Express a Preference to Die at Home, Actually Die at Home

There is a well-known discrepancy between people's preferences to die at home and their likelihood to actually die at home.  This has already been measured several times.  Now, there is additional confirmation.

Last week, the UK Office of National Statistics released a statistical bulletin: National Survey of Bereaved People (VOICES), 2013.  The reports finds that only one third of people (35%) who express a preference to die at home, actually die at home.  And quality of care was rated significantly lower for people who died in a hospital, compared to people dying at home, in a hospice or care home.  

Rationing Is Not a Four-Letter Word

Philip M. Rosoff is a practicing physician and Professor of Pediatrics and Medicine at Duke University Medical Center, where he is also a member scholar of the Trent Center for Bioethics, Humanities, and History of Medicine, and Director of Clinical Ethics at Duke University Hospital.

He has just published Rationing Is Not a Four-Letter Word with MIT Press.  I like this book's thesis and explored it (a little) in some posts like "Top 10 North American Death Panels."

Here is the abstract:

Most people would agree that the healthcare system in the United States is a mess. Healthcare accounts for a larger percentage of gross domestic product in the United States than in any other industrialized nation, but health outcomes do not reflect this enormous investment. In this book, Philip Rosoff offers a provocative proposal for providing quality healthcare to all Americans and controlling the out-of-control costs that threaten the economy. He argues that rationing—often associated in the public’s mind with such negatives as unplugging ventilators, death panels, and socialized medicine—is not a dirty word. A comprehensive, centralized, and fair system of rationing is the best way to distribute the benefits of modern medicine equitably while achieving significant cost savings.

Rosoff points out that certain forms of rationing already exist when resources are scarce and demand high: the organ transplant system, for example, and the distribution of drugs during a shortage. He argues that if we incorporate certain key features from these systems, healthcare rationing would be fair—and acceptable politically. Rosoff considers such topics as fairness, decisions about which benefits should be subject to rationing, and whether to compensate those who are denied scarce resources. Finally, he offers a detailed discussion of what an effective and equitable healthcare rationing system would look like.

Defending Advance VSED - Hasten Death by Dehydration

VSED has been getting a lot of attention lately.  NPR radio host Diane Rehm discussed her husband's use of VSED to hasten his death.  Sir Chris Woodhead discussed VSED in the ongoing assisted dying debate that will reach the House of Lords on Friday.  And the Tampa Bay Times just published a 1000 word article.  

But I want to respond to a rather lengthy attack on me specifically.  Last Thursday, Lydia McGrew published this 5-page attack on advance VSED.   

First, let me clarify that I agree with McGrew: "The acceptance of good food and water should never be regarded as requiring explicit and mature consent."  Consent to food and water, like consent to emergency treatment, can and should be presumed.   

Second, when the individual makes an informed advance refusal of food and water (e.g. to avoid living in the advanced stages of dementia), then the presumed consent is rebutted.  People have a negative right to refuse interventions with their body.  Similarly, while consent to emergency treatment (like a blood transfusion) is presumed, that presumption does not operate when the individual has previously objected.   

Third, the refusal stands until it is revoked.  

Fourth, the refusal cannot be revoked unless the individual has the decision making capacity to revoke it.  

Fifth, an individual in advanced dementia does not have the capacity to decide about eating and drinking, because she cannot appreciate the consequences of that decision.

Therefore, the refusal stands.    

Call for Papers - AALS Section on Law, Medicine & Health Care Works-in-Progress for New Teachers

Call for Papers

AALS Section on Law, Medicine & Health Care

Works-in-Progress for New Law School Teachers

AALS Annual Meeting, Washington, DC

Saturday, January 3, 2015

  

The AALS Section on Law, Medicine and Health Care is pleased to announce a Call for Papers for a special Works-in-Progress for New Law School Teachers Program.  The Section will run the Program from 5:15 to 6:30 p.m. on Saturday, January 3, at the AALS 2015 Annual Meeting in Washington, DC.

This program will bring together junior and senior health law scholars for a lively discussion of the junior scholar's’ works-in-progress.  Junior health law scholars will submit papers that they expect to submit in the spring 2015 law review submission cycle.  After they briefly present their papers in a concurrent roundtable setting, senior scholars will provide oral comments and critiques.  This new program presents an opportunity for the audience to hear cutting edge health law scholarship by recent members of the academy.

We will limit our selection to two or three papers.

Form & Length of Submission

Eligible faculty members are invited to submit either manuscripts or abstracts dealing with any aspect of health law or policy.  Abstracts must be comprehensive enough to allow the committee to meaningfully evaluate the aims and likely content of the papers proposed.  Papers may be accepted for publication but must be at a stage where input still would be useful.  Papers must not be published prior to the Annual Meeting.

Deadline & Submission Method

To be considered, manuscripts or abstracts and a CV must be submitted electronically to both: 

Chair, Section on Law, Medicine, and Health Care

Ani B. Satz, Emory University School of Law, asatz@law.emory.edu

Chair-elect, Section on Law, Medicine, and Health Care

Thaddeus Pope, Hamline University School of Law, tpope01@hamline.edu

The deadline for submission is September 1, 2014.

Selection & Notification

Papers will be selected after careful review and discussion by the Executive Board of the AALS Section on Law, Medicine, and Health Care.

The authors of the selected papers will be notified by September 22, 2014.

If a selected author has submitted only an abstract for review, the author must submit the corresponding manuscript by December 15, 2014.

The Call for Paper participants will be responsible for paying their annual meeting registration fee and travel expenses.

Eligibility

Full-time untenured faculty members of AALS member law schools are eligible to submit papers.  The following are ineligible to submit: foreign, visiting (without a full-time position at an AALS member law school) and adjunct faculty members, graduate students who are not also enrolled in a qualifying J.D. program, fellows, non-law school faculty, and faculty at fee-paid non-member schools.  Papers co-authored with a person ineligible to submit on their own may be submitted by the eligible co-author.

Please forward this Call for Papers to any eligible faculty who might be interested.

Funerals - Posing the Dead as Living

I like the idea of remembering people as they were.  But this funeral posing also seems to feed into strong death-denying currents in our society.

20th World Federation Conference of Right to Die Societies

Check out the schedule of events for the 20th World Federation Conference of Right to Die Societies in Chicago in September.

Kentucky Judge to Decide on Hospital Treatment for Dead 2-Month Old Isaac Lopez

On Monday, July 14, Judge McKay Chauvin (Jefferson County Circuit Court, Kentucky) will determine whether Norton Healthcare and Kosair Children's Hospital must continue organ-sustaining interventions for two-month-old Isaac Lopez.  His father is accused of criminal abuse that resulted in Isaac's death. (WDRB)