Medical Futility Blog: Vermont’s New Normal: End-of-Life Care & Physician Aid in Dying

On October 29, 2013, the Vermont Ethics Network is holding a day-long discussion about end-of-life care in Vermont with the passage of Act  39 (Vermont’s new law on patient choice and control at the end-of-life).  The day’s presentations will focus on:

via Medical Futility Blog: Vermont’s New Normal: End-of-Life Care & Physician Aid in Dying.

Death with Dignity and Palliative Care | Death with Dignity National Center

Forbes contributor Dr. Peter Ubel recently put forth an op-ed titled “Death With Dignity Should Not Be Equated With Physician Assisted Suicide” in which he admirably gives readers more information about the Washington Death with Dignity Act, the soundness of the law as a public policy, and how well it’s worked in practice. He raises the excellent point that people shouldn’t think of dying with dignity as only physician-assisted death.

via Death with Dignity and Palliative Care | Death with Dignity National Center.

‘One also needs a bit of trust in the doctor … ’: a qualitative interview study with pancreatic cancer patients about their perceptions and views on information and treatment decision-making

Conclusions The findings can serve as starting point for reflection on professional decision-making in pancreatic cancer and larger representative surveys on ethical issues in treatment decision-making in pancreatic cancer.

via ‘One also needs a bit of trust in the doctor … ’: a qualitative interview study with pancreatic cancer patients about their perceptions and views on information and treatment decision-making.

Decisional capacity in cognitively impaired patients with Parkinson disease

As memory and executive cognitive abilities decline, these patients demonstrate initially subtle but increasingly salient changes in important decisional capacities such as treatment consent, research consent, and financial decision-making. These progressive decisional impairments raise critically important ethical issues concerning patients’ personal autonomy and competency, with implications for patients and families, and for physicians, scientists, bioethicists, and legal professionals.

via Decisional capacity in cognitively impaired patients with Parkinson disease.

Medical Futility Blog: Medical Futility at ASBH Meeting

The ASBH Annual Meeting is exactly two months away.  Here are four sessions related to medical futility:

via Medical Futility Blog: Medical Futility at ASBH Meeting.

Why Are Advance Care Planning Decisions Not Implemented? Insights from Interviews with Australian General Practitioners | Abstract

Conclusions: Problems in implementation of ACPs are multifactorial and not necessarily due to deliberate nonadherence by health professionals. Potential solutions to improve the clinical impact of ACP are discussed.

via Why Are Advance Care Planning Decisions Not Implemented? Insights from Interviews with Australian General Practitioners | Abstract.

Medical Futility Blog: PA Court Refuses to Appoint Guardian to Override Patient Wishes

I have defended (here, here, and here) surrogate selection as a mechanism for resolving medical futility disputes.  But there are certainly limits.  Two of the most obvious are these.  First, a surrogate cannot consent to stopping LSMT when the patient herself specifically requested it.  Second, the provider should not even be turning to a surrogate when the patient still has capacity.

Remarkably, St. Luke’s Hospital in Allentown, PA seems to have ignored both these limits.

via Medical Futility Blog: PA Court Refuses to Appoint Guardian to Override Patient Wishes.

Medical Futility Blog: Medical Futility Comprises Significant Fraction of Ethics Consults

In a piece forthcoming in the Journal of Oncology Practice, Andrew G. Shuman and colleagues at Memorial Sloan-Kettering Cancer Center reviewed clinical ethics consultation databases at two institutions from 2007 through 2011 that related to adult patients with cancer.  They identified a total of 208 eligible patient cases. The most common primary issues leading to ethics consultation were:…

via Medical Futility Blog: Medical Futility Comprises Significant Fraction of Ethics Consults.

“I’m the Decider! (Is That OK with You?)” – Cancer Network

Today, after reviewing a CT scan (and screwing my courage to the sticking-place) I went into an exam room, looked a patient in the eye and said:

“The liver lesions have started to grow again. I think we need to change your treatment.”

via “I’m the Decider! (Is That OK with You?)” – Cancer Network.

A Good Death: How Boomers Will Change the World a Final Time | TIME.com

Surely the world has heard enough of the Baby Boomers, who have dominated the political, cultural and economic landscape for six decades. But a generation that has refused to go quietly into any life stage will, it seems, be heard from one final time on the biggest issue of them all: how to die.

via A Good Death: How Boomers Will Change the World a Final Time | TIME.com.