Menampilkan postingan dari Juli, 2017

Brain Death: Legal Fiction Used to Justify Ending Lives Prematurely - Another California Lawsuit

Brain death is a legal fiction used to justify ending lives prematurely. That is how the family of Israel Stinson frames its argument in a new brief filed in a California federal court, last week.

Israel Stinson's family is challenging the constitutionality of the California Uniform Determination of Death Act (CUDDA). Contrast the claims made by the family of Jahi McMath. They contend only that Jahi does not (as a matter of fact) satisfy the CUDDA standards. They do not attack the (legal) validity of the standards themselves.

The Stinson family argues that "the biological basis for brain death is hotly disputed and central to this case."  They allege that Israel remained alive AFTER an official death certificate was issued. They describe brain death as a "haphazard, uneven, and utilitarian-driven rush to declare patients dead, ignoring that possibility they might be alive."

The State of California filed a motion to dismiss the family's Third Amended Complaint …

Understanding Factors Contributing to Inappropriate Critical Care: A Mixed-Methods Analysis of Medical Record Documentation

Researchers at UCLA continue to unpack their research on potentially inappropriate critical care.  In their latest piece in the Journal of Palliative Medicine, by analyzing clinical documentation, they identify factors contributing to inappropriate critical care. 

Most encouraging, the authors note that "many of these care processes are at least under partial control of the healthcare team and can be improved upon."  For example, factors include "indecision, stalling, and delays" and "physician not guiding decision making."

Texas Senate Passes Bill Limiting When Clinicians May Write DNR Orders

This week, the Texas Senate passed S.B. 11. This bill adds a new section 166.012 to the Health and Safety Code that specifies new procedures and requirements for do-not-resuscitate orders.

In short, the bill permits DNR orders to be written in only two situations:

1. With patient or surrogate consent

2. Without consent when death is imminent regardless of CPR but only if DNR is not contrary to the patient's prior instructions.

The bill sponsor observes that current Texas law is silent on requirements for the authorization, execution, or revocation of a DNR order in a hospital setting. It addresses only out-of-hospital DNR orders. Consequently. doctors can (and have) unilaterally written DNR orders for patients without discussion, let alone consent, from either the patient or a surrogate decision-maker. There was a hearing on July 21.  Healthcare providers oppose the bill.  It is supported by disability and right to life groups.

"(a) In this section, "DNR order" means an …

Jahi McMath - Accurate and Precise Language for Brain Death

Having talked with a few reporters, this week, about the status of the the lawsuits concerning Jahi McMath, I realized that is is essential to use careful and precise language.  The following is a summary of the allegations in the state medical malpractice case.

1.  All parties agree that Jahi satisfied the prevailing medical criteria for brain death in December 2013.

2.  All parties agree that because of that multiply confirmed diagnosis, Jahi was then declared legally dead under the CUDDA.

3.  The family claims that Jahi no longer satisfies the prevailing medical criteria for brain death.  Therefore, she is not legally dead.

4.  On the other hand, it is not logical to say that Jahi was correctly determined dead in 2013 and is now alive.  If she does not now meet the prevailing medical criteria for brain death, then she did not really ever meet the legal definition of death in 2013. The CUDDA, like state laws everywhere, requires that the cessation of brain function be "irreversible…

Top Bioethics Journals on Earth Based on Citation Index

Udo Schuklenk has compiled the top 40 bioethics journals based on their Google Scholar h5 index.  

I am pleased to have recently published (in just the past year) in two of the top 10 and six of the top 30.

3. American Journal of Bioethics

4. Journal of Law, Medicine and Ethics

17. Journal of Bioethical Inquiry

23. Perspective in Biology and Medicine

25. Journal of Clinical Ethics

29. Narrative Inquiry in Bioethics

The Family Said "Do Everything"

ICU nurse Debbie Moore Black has a powerful short story illustrating a situation of potentially inappropriate and unwanted medical treatment.  It is almost poetry.

End-of-Life Healthcare Sessions at ASBH 2017

The 2017 ASBH
 in October 2017 includes over 400 workshops, panels, and
papers in bioethics and the health humanities.  Here are ones that pertain
to end-of-life issues.


THU 1:30 pm:  End-of-Life Care and Decision-Making in the ICU - Limited
English Proficiency as a Predictor of Disparities (Amelia Barwise)

Importance: Navigating choices in predominantly English-speaking care settings
can present practical and ethical challenges for patients with limited English
proficiency (LEP). Decision-making in the ICU is especially difficult and may
be associated with disparities in health care utilization and outcomes in critical

Objective: To determine if code status, advance directives, decisions to limit
life support, and end-of-life decision-making were different for ICU patients
with LEP compared to English-proficient patients. 

Methods: Retrospective cohort study of adult ICU patients from
5/31/2011-6/1/2014. 779 (2.8%) of our cohort of 27,523 had LEP. 

Results: When …

Ensuring Advance Directives Are Followed and Lawsuits Are Avoided

I was delighted to take some of my recent work on informed consent law and unwanted medical treatment and work with ASCO POST on two new articles published today (here and here).

Brain Death Conference in Cuba

The 7th International Symposium on Brain Death will be held in Havana, Cuba, from December 5 to 8, 2017.

Topics include:

�    Conceptual approach to human death

�    BD criteria in different countries

�    Ancillary tests in BD

�    Autonomic nervous system assessment in BD

�    BD in childhood

�    Anencephalic infants

�    End-of-life dilemmas: terminal patient, euthanasia, assisted suicide, 

�    Legal considerations surrounding BD

�    Philosophical, theological, sociological, historical and cultural considerations of human death

�    Organ transplantation

ASBH Lifetime Achievement Awards & Cornerstone Awards - Bioethics and Medical Humanities

ASBH has announced the following awards for the October 2017 annual meeting.  

Lifetime Achievement Awards

ASBH announces two Lifetime Achievement Awards for longstanding achievement by an individual in bioethics and/or the medical humanities. Both recipients will make remarks at the 2017 ASBH Members' Meeting and Award Presentations, Friday, October 30, 3:45 pm in Kansas City, MO.

Myra Christopher is recognized as the first leader of the Center for Practical Bioethics (CPB), an applied, real-world bioethics organization emphasizing ethics and action informed by thoughtful reflection, guided by academic discipline. Christopher�s work has changed how shared decision making among families helps to match the care a loved one receives with his or her wishes, how hospital ethics committees respect and advocate for the rights of patients, and how communities care for those with terminal illness.

Steven Miles, MD is honored for three and a half decades of research and education. He has publi…

Choosing to Die - Phyllis Shacter on VSED

Check out this broadcast on Wednesday July 26 on Good Grief with Cheryl Jones.

Phyllis Shacter's husband made a series of radical choices about how his life would end. When he received two life limiting diagnoses within six weeks of each other, Alzheimers and cancer, he refused cancer treatment and employed natural methods instead. He planned and participated in his own funeral and followed what he believed was best for him, choosing to stop eating and drinking before he was unable to consciously decide how his life would end.

Throughout all of these experiences and decisions, he had a supporter and advocate in his wife Phyllis. Understanding the choices he was making, she stood as a pillar to his right to end life in the way that was right for him. He left her with a mission; by sharing his story, she would contribute to the conversation on end of life options. Powered by her love of him and the peace and beauty he felt at the end of his life, she speaks powerfully for taking our l…

Wong v. Glendale Adventist - Family Alleges Clinicians Deceived Them into Following Advance Directive

An interesting appeal is being briefed before the California Court of Appeal second district.

In 2011, Cecilia Hoh entered Glendale Adventist Medical Center complaining of a swollen foot. Plaintiff family members allege that they authorized the withdrawal of treatment, because GAMC falsely told them that Hoh had fatal lung cancer.

The plaintiffs alleged that they responsibly followed Hoh's advance directive which stated "If I should have an incurable and irreversible condition that has been diagnosed by two physicians and that will result in my death within a relatively short time . . . I direct my attending physician . . . to withhold or withdraw treatment . . . ."

The lawsuit alleges that a false diagnosis caused them to make a bad decision. Since Hoh's condition was neither incurable nor irreversible, her advance directive was not relevant.

Call for HCEC Certification Commission Members

In Spring 2017, ASBH successfully completed market research and a role delineation survey, which are critical steps in the development of a sustainable and credible certification program. In July 2017, the ASBH board agreed to appoint an HCEC Certification Commission with responsibility for the development and administration of a certification program. 

For appointment to the Commission, ASBH seeks 3-5 clinical ethics consultants who reflect the interests of the general public in the availability and implementation of an HCEC credential and are representative of the stakeholder groups, including community hospitals and regional health systems, that have an interest in the quality, governance, and operation of the certification program. (The ASBH board will also appoint one member who represents the public or non-employer consumer interest.) The Commission is expected to meet face-to-face for at least one and possibly two 1-2 day meetings and 2-3 conference calls in the coming year.