Good, Good Links.

*Ethan Remmel, a terminal cancer patient, kept a blog at Psychology today. On June 12 he died using Washington State's Death with Dignity law. You can read his posts here. You can read about him here. (h/t janek)

*I know Candy Chang because we spent time together at a Global Studio in Johannesburg, South Africa. My spouse at the time was presenting at the workshop; Candy was an architecture student with more spunk and creativity and productivity than you can imagine. Here's a link to her project in New Orleans that fits this site's MO perfectly. Before I Die. You can read more about Candy here.

*Thaddeus Pope points us to a new article at The Journal of Clinical Ethics on the use of the Best Interest Standard (BIS) (Pay to read article). Pope writes:

In this issue of JCE, Douglas Diekema argues that the best interest standard (BIS) has been misemployed to serve two materially different functions. On the one hand, clinicians and parents use the BIS to recommend and to make treatment decisions on behalf of children. On the other hand, clinicians and state authorities use the BIS to determine when the government should interfere with parental decision-making authority. Diekema concedes that the BIS is appropriately used to “guide” parents in making medical treatment decisions for their children. But he argues that the BIS is inappropriately used as a “limiting” standard to determine when to override those decisions. Specifically, Diekema contends that the BIS “does not represent the best means for determining when one must turn to the state to limit parental action.” He argues that this limiting function should be served by the harm principle instead of by the BIS.

*Pope also notes a new article he's co-authored which appears in the current Widener Law Review. It addresses the legal practice of voluntarily stopping eating and drinking (VSED). From his blog (October):

Patients with decision-making capacity may choose (through contemporaneous instructions) to voluntarily stop oral eating and drinking to accelerate the dying process. Moreover, patients without capacity often have the same option. Voluntarily stopping eating and drinking (VSED) is a clinically validated “exit option” that enables a good quality death. Significant and growing evidence supports VSED as a means of accelerating the dying process. Nevertheless, VSED is widely resisted by healthcare practitioners either because they think that it is illegal or because they are uncertain of its legality.

Will Selecting Surrogate Decision-Makers for Dying Patients Reduce Futile Care Disputes?

Thaddeus Pope -- ya'll know I'm a fan -- has a new article in the St. Louis Journal of Health Law and Policy addressing the selection of health care proxies, or surrogates, as a means of preventing futile care disputes. When parties surrounding a dying patient disagree about what medical treatments to pursue, if any, law suits can ensue. Pope examines the use of surrogates to reduce the chance of these conflicts, citing both benefits and detriments, and gives us a summary of state laws.

William Colby, the lawyer for Nancy Cruzan's family, writes in Unplugged that the definition of death has changed so drastically in such a short span of time that laws, hospital best practices, and the public, forced to reckon with these changes, have not been able to keep up. Pope's work is always a reminder that the issues surrounding patients' rights and futile care are not straight-forward or simple and that they are constantly evolving.

You can read the full article here

You can read the abstract at Pope's site, Medical Futility Blog

Love's Demand.

From Thaddeus Pope at Medical Futility Blog: "Hastening Death Can Be Love's Demand."

Here is an abstract of a presentation that I will make at the 2010 Film and History Conference, this November, in Milwaukee.

For several years, I have been writing about the mechanisms for resolving medical futility disputes. One of the primary causes for such disputes is the firm conviction of family members that love demands continued life support for the patient. Love requires not “giving up” on the patient.

More than four decades after the introduction of technology (such as dialysis, ventilators, artificial nutrition & hydration) that can prolong life but not cure or reverse disease, many individuals still hold unrealistically optimistic notions about what medicine can offer chronically critically ill patients. And even those who believe and understand the prognosis often cannot let go.

Hospital clergy, ethics consultants, and social workers spend significant time counseling families, and help them appreciate that consenting to palliative care or hospice is not only consistent with love but even required by love. Three movies beautifully exemplify this re-conceptualization of love: The Event (2003), It’s My Party (1996), and My Life (1993). In each, family members oppose the patient’s decision to forgo therapy or to hasten death. They feel that love demands biological life be prolonged as long as possible. But as the ongoing or inevitable decline becomes increasingly obvious, the family realizes that love demands supporting (and even helping) the patient make a peaceful exit.