Saturday, March 23, 2013

EOL Links

Michael Cook, editor of BioEdge, the Australian "bioethics" website that likes to think of itself as "pointed" and "edge"-y, wrote this after the new pope was selected earlier this month, clearly qualifying any positions they may take on bioethics issues as applicable only to... Catholic leadership:
The fact that about 6,500 journalists were reporting on the white smoke suggests that his ideas on bioethics ought to be taken into account, whether or not you agree with them. I hope that my own sympathies don’t colour the articles in BioEdge.

Australia continues to have a lively discussion about euthanasia.

Friend Ashton Applewhite will be giving a talk, "How Ageism Warps Our View of Long Life," at Cooper Union on Monday, April 8th at 6:30.  I don't necessarily agree with Ashton's premise but that doesn't mean we shouldn't go.  More details here.

The Journal of General Internal Medicine recently included an article by Amy S. Keller titled, "Out-of-Pocket Spending In the Last Five Years of Life," is a goodread!  For those banking on Obamacare to clean up our impending crisis regarding end of life care, this will be a call to consider the breadth and depth of social, economic and medical challenges we continue to face.  Care at the end of life is surely rationed, but not only by insurance companies.  Economic constraints and a failed social commitment to elders and the most vulnerable is catching up with us.  (via the excellent GeriPal)

Speaking of GeriPal, their March 21 email included this fascinating tidbit:

AAHPM decided to keep the "H" (for hospice), as reported by Tim Quill in the fall AAHPM quarterly (online for members only).  See this previous post introducing the controversy. The process of deciding about the "H" was thoughtfully done, including focus groups and a member survey.  Only 11% of members responded (guilty as charged) but 87% of those who responded felt the current name describes "who we are and what we do."

For those of you who haven't been watching the discussion, the H has been contested by some who felt that hospice was too strongly associated with death and therefor tainting the care and benefits of the rest of the organization... palliative care.  Long there has been a move to make palliative care an overall standard of care for every patient.  The fact that it has in some ways come out of the hospice movement, some felt, conveyed to the public that palliative care was really only for the dying.  Essentially, it was a bit of a branding conversation.

Don't miss Aanand D. Naik's argument, also at GeriPal, of "Why Choosing Wisely Will Have Limited Success."  The Choosing Wisely campaign is aimed at doctors, whose "decisions ultimately account for for over 80% of all health care expenditures."

Elizabeth Dzeng writes at "The Health Care Blog" about a recent case that illustrates how the Hippocratic call to "do no harm" is often confused with "do everything," "Hippocratic Hypocrisy: When it Comes to CPR, Is Less Care Actually Better":

Doctors at another hospital said there was nothing more they could do, but his family desperately wanted him to live so they brought him to our hospital.
The fistulas in his abdomen were so large, his bowels were open to the air. Blood frequently gushed out of his wounds, necessitating blood transfusions and other desperate measures. The only way to stop the bleeding was to push hard on these wounds, which inflicted excruciating pain. Despite these aggressive treatments, there was no hope of long-term survival.
 His family was not ready to let him go and so they told us to take any measures possible to keep him alive. In order to do this, I would have to crack his ribs during chest compressions and electrocute him in an attempt to restart his heart. Regardless of whether we could keep the heart beating, the rest of his body would still be irreparably consumed by cancer.  This was, in my view, the wrong choice from an ethical and clinical perspective.  It was anguishing to be forced to inflict this sort of violence on this dying man. How could I uphold my oath to do no harm when I knew he was leading a tortuous existence, and yet I was instructed by his family to keep him alive and in this state?
Read the rest of Dzeng's brilliant article, then catch this one from today's New York Times about the FDA and regulation of defibrillators.  Clearly the author is contributing to the public's belief that resuscitation, whether by manual CPR and/or defibrillators, is guaranteed recovery.

The devices, which can be found in malls, airports, casinos and churches in addition to medical settings, re-establish cardiac rhythms in patients whose hearts have abruptly stopped or lost their regular beats.  Such cardiac arrests kill as many as 400,000 people a year in the United States, according to the American Heart Association, more deaths than caused by Alzheimer's disease, diabetes and accidents combined.

Did "automatic external" defibrillator manufacturers pay for this plug? Ok, just kidding.

Also at The Health Care Blog, Elaine Warples talks about impending death, "Truth at the End of Life."

At his Medical Futility Blog, Thaddeus Pope points us to three upcoming presentations on consciousness in persistent vegetative state patients.  The issue is particularly appealing to those who oppose the removal of artificial life support from persistent vegetative state patients like Terri Schiavo, including the Catholic Church leadership.

Remember when coverage for voluntary advanced care planning was removed from Obamacare without so much as a struggle?  Representative Blumenauer has introduced HR 1173 to institute coverage for such planning with a physician into the Social Security Act, via Medicare.  Blumenauer is from Oregon, where Death with Dignity is legal, and has been a constant advocate for end of life issues. (also via my smart friend Thaddeus Pope at Medical Futility Blog)

British Columbia's federal court is hearing an aid in dying appeal case right now.  Here's one ruffling headline:  "Banning assisted suicide akin to 'torture'"

Former governor of Washington State, Booth Gardner has died.  He was a champion of aid in dying.  Gardner was 76 and died of Parkinson's disease.  Read more here and here.

"Belgium Becomes World Leader in Harvesting Organs after Euthanasia," writes hyperbolic LifeNews.  Well duh.  Euthanasia's basically only legal in Belgium and a couple US states.  While methods of "harvesting"organs can be controversial, this piece is too ideological to be helpful to the discussion.


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