Tuesday, May 4, 2010

Should You Have a Living Will?

There's a fantastic post at GeriPal about the efficacy of the Living Will and Advance Directive documents that many end of life rights advocates -- including myself -- have promoted. What the articles does well is look at a number of current studies and articles and address points made by prominent activists. It asks us what the best way is for a patient to protect their rights at the end of life. Sadly, there is no foolproof way to ensure that the medical decisions made for you will be consistent with what you want. I recommend you read the entire post, but here's a clip:

“Enough. The living will has failed, and it is time to say so.” So said Angela Fagerlin and Carl Schneider in 2004. “Living wills are still widely and confidently urged on patients, and they retain the allegiance of many. For these loyal advocates, we offer systematic proof that such persistence in error is but the triumph of dogma over inquiry and hope over experience.” Joann Lynn wrote an essay titled Why I Don’t Have a Living Will, saying, “I do not have a living will because I fear that the effects of having one would be worse, in my situation, than not having one. How could this be? A living will of the standard format attends to priorities that are not my own, addresses procedures rather than outcomes, and requires substantial interpretation without guaranteeing a reliable interpreter.” Thomas Pendergast said, “[Since the passage of the Patient Self Determination Act in 1990] advance directives are recorded by medical personnel more often but are not completed by patients more frequently. The process of recording them does not enhance patient-physician communication. When available, advance directives do not change care or reduce hospital resources. The most ambitious study of advance care planning, the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments [SUPPORT], failed to show any change in outcomes after an extensive intervention.” Prominent figures in palliative care decried persistent research and health policy efforts to promote living wills, saying, “when have living wills ever been shown to do anything???!!!”

And yet, after being thrashed to within an inch of death, two recent studies breathed life into advance directives. Before getting into the particulars of these studies, it’s important to understand how and why we came to have advance directives in the first place.

Labels: , ,

Qaddafi on Switzerland.

Libyan leader Muammar Qaddafi has called for the nation of Switzerland to be dissolved because assisted suicide is legal there. At Foreign Policy, an excerpt from the Der Spiegel interview:

SPIEGEL: Don't Libyans also have secret accounts in Switzerland?

Gadhafi: Yes, there are also Libyans who have such accounts, and many of them have also died in unexplained ways. All around the world, the families of these people are going to sue Switzerland. And one more thing: Switzerland is the only country that allows euthanasia. Why does only Switzerland do that?

SPIEGEL: Medical euthanasia is also legal in the Netherlands. And, it cannot go unmentioned that Libya has previously had citizens killed abroad who were said to be disloyal.

Gadhafi: But we are talking now about Switzerland. It is possible that among the Libyans who you are asking about -- and who died abroad -- there were also some who died because they had secret accounts in Switzerland.

SPIEGEL: And you are seriously maintaining that Switzerland as a state ordered the killing of these people?

Gadhafi: The investigations will show this. And this brings me back once again to the phenomenon of assisted suicide. A large number of people have been deliberately eliminated under this pretext. Switzerland maintains that these individuals expressed the desire to take their lives. But in reality it was done to get at their money. More than 7,000 people have died like this. I am thus calling for Switzerland to be dissolved as a state. The French part should go to France, the Italian part to Italy and the German part to Germany.

Labels: , , ,

Bidens Dedicate Hospice Room

Joe Biden and his family have dedicated a room at St. Francis Hospital in Wilmington to Catherine Finnegan Biden, the vice president's mother. Writes WHYY news:

Vice President Biden's mother died earlier this year at the age of 92. Before her death, Mrs. Biden received care at the hospice in St. Francis Hospital. After her death, the hospice leaders asked the family if they could rename the family room in her honor, and the family agreed. Tom Taylor, regional director for Compassionate Care Hospice, says the family room was picked because family was so important to Mrs. Biden. "It was just so evident by the way she supported her children, her grand children," Taylor said. "It was a very family-centric moment. This is going to be their first Mother's Day without their mother."

Labels: , ,

Schiavo v Schindler

More noise from the destructive relationship between Michael Schiavo and the Schindler family: A new report out of Florida called the Terri Schindler Schiavo Foundation's finances into question last week; now Michael Schiavo is threatening to sue the Schindlers for using Terri Schiavo's name to raise money.

The news, first reported at conservative LifeNews by ridiculously prolific Steven Ertelt, immediately spread across the "pro-life" blogosphere causing all of the Schindler's tried-and-true supporters like Wesley J. Smith to weigh in. The article is rife with misconceptions regarding Schiavo's death; misconceptions that the Schindlers (and Smith and Ertelt) have worked tirelessly to maintain in their fight against patients' rights to removal from artificial nutrition and hydration. The renewed animosity should prove interesting to watch, particularly as it plays into state-level discussions regarding end of life care, health care reform, and patients' rights. The Schindler family, particularly Bobby Schindler, have worked in the past few months to fashion themselves as advocates for the disabled. Other disabled rights activists view this terminology creep as somewhat suspect.

Labels: , , , , ,

Bentancourt v. Trinitas, New Jersey

If you haven't been following the end-of-life rights case in New Jersey, you can catch up on the developments at Thaddeus Pope's Medical Futility Blog. He presented to the court and is posting related materials at his site. From Saturday's post, an online letter from the New Jersey Hospital Association:

A three-judge panel heard arguments this week in Betancourt v. Trinitas Regional Medical Center, which involves important end-of-life issues. In addition to legal counsel for Trinitas, arguments were heard from NJHA, the Catholic Healthcare Partnership of New Jersey and the Medical Society of New Jersey, which together submitted a friend-of-the court brief on behalf of Trinitas.
The case involves an appeal by Trinitas from a lower court order which effectively compelled healthcare professionals to provide life-sustaining medical treatment (in this instance, kidney dialysis) indefinitely to a dying patient in a permanent vegetative state, despite medical professionals having determined that the treatment was not medically justified and was against the standard of care.
The appellate court heard oral argument for approximately 90 minutes. John Zen Jackson, from the law firm of Kalison, McBride, Jackson and Robertson, presented the case for NJHA, CHPNJ and MSNJ. Questions from the judges reflected a disparity of views. The principle of patient self-determination and autonomy was emphasized by one, while another appeared to question whether that principle alone was sufficient to compel the hospital and its physicians to continue providing care beyond a point that they believed was appropriate. The court also asked questions about the process for making decisions regarding end-of-life treatment and the role of the family and non-medical persons. NJHA’s joint brief suggested a process for resolution of such disputes, including internal hospital reviews and a procedure for transfers to a different healthcare facility.
Another aspect of the case is whether it should be considered at all by the court in light of the death of the patient as the appeal was being filed, and the lack of interest on the part of his family in continuing to litigate the matter. Jackson, among others, noted that the issue could recur and needed to be addressed now, rather than at a later time.

Labels: , , , ,