Hot Pot

Another hot pot meal after the first day of the conference.
Putting all the different foods into the pot and fishing it back
out is only part of the fun.

The Chinese will never let your glass stand empty. And every
few minutes someone from your table (and many come over from
other tables) will make a toast. The respectful thing to do is
drink "bottoms up" and tilt your glass toward the other to show
you finished. Of course, too much of this can really test the
limits of one's endurance.

Circular Conference Rooms

One thing about the China-U.S. health law conference that I
was unable to convey with my limited photography skills is the
circular shape of the venue room.

While law schools often have semi-circular and horseshoe
shapes, I am not sure I have seen too many fully circular
rooms. This room had a center circle where the more senior
speakers and guests sit. A second larger ring is where other
professors sit. And students sit in the outer rings.

This design kept everyone engaged with the topic and with each
other. Interestingly, the shape of every table at almost
every of the many restaurants at which we ate in Chongqing was
also circular. Surely the same principle animates the design
of both academic rooms and dining tables: the locals' great
collegiality and friendliness.

Filial Piety and Overly Aggressive End-of-LIfe Care

I spoke this week at the Southwest University of Political
Science and Law. While there are over 600 law schools in
China, SWUPL is one of only five universities that focuses on
law (as opposed to law being just a department in a larger
comprehensive university).

I compared challenges facing the United States and China with
respect to reducing end-of-life healthcare costs in order both
to preserve economic security and expand access. One obstacle
in both the United States and China is that families often
demand overly aggressive care, treatment more aggressive than
the patient would choose for herself.

But this is a far more significant obstacle in China for two
reasons. First, decision making is made on a familial,
collective level rather than on an individual, autonomy level.
So, advance care planning (patient consent) to do less is not
so viable and option. Second, filial piety runs deep, and
children feel that they must insist on all available
technology in order to be good children. See this carving
illustrating the concept from my visit to the fantastic Dazu
World Heritage Site.

2009 AMA Resolution 3: Limiting Futile Care at End of Life (FL)

The AMA YPS proposed this resolution a few weeks ago, but it was
not adopted by the House of Delegates.

"RESOLVED, That our American Medical Association seek
legislation by the United States Congress that will allow the
creation of a methodology directed by physicians (MDs/DOs) that
permits physicians (MDs/DOs) to either not engage in or to
suspend futile care at the end of life; and that those
physicians (MDs/DOs) be given immunity from liability when such
decisions are made in good faith and within the standard of care
with clear and convincing legal and ethical standards.
(Directive to Take Action)."

Professor Forzley and Juliya

The foreign visitor coordinator from S.W.U.P.S.L., Juliya, has
been a superb hostess. She scooped us up from the airport and
deposited us at the hotel. She has taken us out to eat and has
shown us notable sites. And, of course, she does all the
translating.

But that is just a job description and does not do justice to
the masterful execution of the duties. Juliya is actually quite
gifted for this type of job, which is probably a mix of innate
talent and experience dealing with many visiting professors.
Here she is with Professor Forzley at lunch today in Old Town.

Friday Lunch -- Hot Pot

The things to eat in Chongqing is hot pot. We did not get
traditional hot pot today, but seafood hot pot.

As you can tell from the picture, there is basically a large pot
with broth on a burner in your table. The server brings all
sorts of seafood and vegetables. They cook in the pot and she
fishes them out and serves them as they are done cooking. This
is a fun way to eat. And you get to try a whole bunch of
different things, almost too many.

Ciqikou Old Town - part 3

Ciqikou Old Town - part 2

Ciqikou Old Town - part 1

Friday afternoon, we went to Ciqikou Old Town. Professor
Forzley thought that we should visit this Community Health
Center. But the main focus of the Old Town (as with many like
that in San Diego) is shopping and fun.

Friday Morning in Chongqing

The hotel is quite nice. Here is the view from my window. But
even better is the immediate surrounding area in the Shapinga
sector of the city.

There are pedestrian-only shopping walkways that stretch some 20
blocks in several directions around the hotel. I like that sort
of thing in any city. Here it is especially important because
one does not want to have to cross more streets than necessary
given the randomness of traffic rule compliance.

Southwest University of Political Science and Law

Our host here in Chongqing is the Southwest University of
Political Science and Law.

The official U.S. - China health law conference begins Monday.
But since the university was on the way to something else this
morning, we stopped by to snap this photo by the front gate.

Blogging from China

Blogging from China is a little tricky because my website, and
indeed many Google-affiliated services, are simply not
accessible. Yahoo is king here.

Today, Friday Dec. 11th, was our first complete day. Professor
Forzley and I arrived on Wednesday night and stayed over in
Beijing. On Thursday, we flew to Chongqing and got situated
here.

It was a great day, really. Assuming that attaching pictures to
emails actually works to post them on the blog, I will do a
series of posts with pictures.

Dogs for Ethics Committees and Ethics Consultants

This month’s ABA Journal reports on the growing interest in the use of dogs in courthouses.  Perhaps the same can be adapted for use by hospital ethics committees.

If Duval County, Fla., Judge Emmet Ferguson has his way, there will be a dog in every courthouse across the country.  “Dogs put smiles on people’s faces, and there usually aren’t a lot of smiles in a courthouse,” says Ferguson, who works out of Jacksonville.  Ferguson is working to establish a service dog program in the Duval County court system. His effort reflects a small but growing international trend of using trained dogs in a variety of courthouse settings to reduce the tension inherent in the adversarial process.

Advocates say the dogs are used most often to calm witnesses and victims, especially children. But, they say, having a dog in the courthouse helps everyone.  The mere presence of dogs can be highly effective.  When you have opposing counsel down on his or her knees patting the dog before negotiations, that starts everything off in a friendlier way.

Health Law in U.S. Law Schools

Check out the AALS Law and Medicine Section Newsletter, for a snapshot of what has been going on lately with U.S. law school professors teaching and writing in health law, public health law, and bioethics.

Yarick v. Pacificare - to Save Money, Docs Pressure Surrogates to Stop Life Support

Yesterday, the California Fifth District Court of Appeal published an opinion in Yarick, v. Pacificare of California, No. F057032.  The appellate opinion holds that the plaintiff’s state law claims against a federal Medicare Advantage program were preempted by the 2003 Medicare Prescription Drug, Improvement and Modernization Act, 42 U.S.C. Section 1395w-26(b)(3).  But what is even more interesting are the pending claims against the healthcare providers.

In early January of 2006, Mr. Yarick, who “was over 85 years of age,” was admitted to defendant San Joaquin Community Hospital because he had fallen and broken his leg. Mr. Yarick had surgery to repair his broken leg and, three days later, was transferred to Rosewood Health Facility, operated by defendant American Baptist Homes of the West, for rehabilitation and custodial care.

Over the next three weeks, Mr. Yarick's condition deteriorated in various ways. Nevertheless, Rosewood Health Facililty and defendant Bakersfield Family Medical Group, despite the objection of Mr. Yarick's family, discharged Mr. Yarick. When the family arrived to receive Mr. Yarick upon discharge, they found him “slumped in a wheel chair and not responsive.” The family called an ambulance, which transported Mr. Yarick to Mercy Hospital, operated by defendant Catholic Healthcare West.

Mr. Yarick was diagnosed with multiple conditions, including pneumonia and congestive heart failure. Over the next two weeks, according to the complaint, doctors of defendant Bakersfield Family Medical Group first counseled, and then pressured, appellant to terminate efforts at curing Mr. Yarick and to substitute, instead, “comfort” or end-of-life care. Although plaintiff continued to insist on curative care, as a result of the efforts of the various defendants, Mr. Yarick died on February 18, 2006.

The fourth amended complaint alleges that all of the foregoing events happened because of the financial pressures and incentives that arose from the care providers' contracts with respondent. The complaint alleges respondent's contracts with providers offer insufficient payment to permit the providers to make decisions and to provide care based on patients' reasonable medical needs, requiring the providers to substitute a standard of financial expediency. It alleges some of the contracts provide financial incentives for the refusal to provide reasonably necessary medical care. It alleges respondent has failed to implement and utilize necessary quality control mechanisms that would require providers to give good medical care despite the financial incentives not to do so.

Does Grady Memorial's Cessation of Outpatient Dialysis Constitute Tortious Abandonment

Grady Memorial Hospital closed its outpatient dialysis unit in early October, citing expenses. The hospital has paid a separate dialysis clinic to provide three months of additional care for those patients with no health insurance, no government assistance and no place else to go.  But that extended care expires Jan. 3, and the approximately 30 patients receiving this care -- virtually all low-income illegal immigrants -- worry that their health will spiral downward after that.  (Atlanta Journal-Constitution)

Patient advocates have an ongoing lawsuit to force Grady to reopen the outpatient dialysis clinic.  But the judge has been cool to the arguments that Grady has denied these patients their rights under the state constitution.  A group called Grady Advocates for Responsible Care plans to argue that Grady's closure of the clinic constitutes "medical abandonment" of the patients.

The abandonment argument seems very tough given, among other things:  (1) the global, non-patient-specific nature of the decision, (2) the significant notice, and (3) the significant assistance that these patients have been given.  Indeed, the famous 1982 Payton v. Weaver case seems to be on point and seems to support the hospital.

Still, the question of whether a healthcare provider can ever stop life-sustaining treatment for patients who have no other alternative lies at the heart of futility disputes.  And it is hardly a settled question, as illustrated by the appellate briefing on tortious abandonment in Betancourt v. Trinitas.  

Palliative Care Grand Rounds 1.11

Palliative care grand rounds is up at Death Club for Cuties.  Through the author's entertaining narrative, the reader is guided through various recent relevant blogs and will probably find 1 or 2 news ones valuable and worth following.


The author, Jerry, is "a nurse practicing in the busy neurosciences intensive care unit of a large urban teaching hospital."  His specific clinical interest is "caring for patients and families at the end of life."  He is an ELNEC trainer and a graduate student.

Betancourt v. Trinitas -- Most Requested NJ Court Opinion in 2009

The New Jersey Law Journal's sixth annual Legal Almanac contains, among other things, a list of the judicial opinions which were most requested by attorneys in the State.  


Elder law attorney Donald Vanarelli noticed that "one of the most requested judicial opinions was the unpublished decision in Betancourt v. Trinitas Regional Medical Hospital, which didn’t involve any award of money damages at all."


"[I]n the Betancourt case, Judge John Malone, the Chancery Judge in Union County, found that the decision to continue or terminate life support was not for the courts to decide. Instead, Judge Malone appointed a 73 year old comatose patient’s daughter as his guardian and granted her petition to restrain defendant Hospital from discontinuing or suspending life-supporting treatment." 

Texas Advance Directives Act: More than 1000 Unilateral Refusals

There are no formal data kept on usage of the section 166.046 unilateral refusal provision in the Texas Advance Directives Act.  But one can make a reasonable estimate based on some collected data.

One widely reported figure indicates that the formal process was used 65 times collectively in 11 hospitals over a 5-year period and in 5 hospitals over a 2-year period.  That means it was used about once per "hospital year" [(11 x 5 = 55)  + (5 x 2 = 10)].  These figures might be understated because the process may be used more frequently today, after: (1) further provider education, (2) surviving judicial and legislative challenges, and (3) increased end-of-life conflict.

There are 583 hospitals in Texas.  And TADA has been in effect for over 10 years.  Therefore, one might surmise that the formal process has been used nearly 6000 times (583 x 10).  But that would be too high because not all hospitals will have these types of cases.  Still, using even a conservative figure of just 100 hospitals, suggests that the process has been used at least 1000 times.

To be clear, the process has a duration.  So, it can be "used" in different ways.  Take the 1000 cases figure.  About 500 of these patients would have been transferred or would have died during the 10-day waiting period.  Only the other 500 would have had life-sustaining treatment unilaterally withdrawn.

Moreover, it is worth noting that these 1000 cases would be relatively rare.  These  intractable cases would comprise only 6.70% of the far broader universe of nearly 15,000 futility ethics consultations (14,000 of which would have achieved provider-family consensus).

NEW - Presidential Commission for the Study of Bioethical Issues

Yesterday, President Barack Obama signed an Executive Order creating a new Presidential Commission for the Study of Bioethical Issues.  He also announced today he has appointed Amy Gutmann to serve as Chair and James W. Wagner to serve as Vice Chair of the Commission.


President Obama said, “As our nation invests in science and innovation and pursues advances in biomedical research and health care, it’s imperative that we do so in a responsible manner.  This new Commission will develop its recommendations through practical and policy-related analyses.  I am confident that Amy and Jim will use their decades of experience in both ethics and science to guide the new Commission in this work, and I look forward to listening to their recommendations in the coming months and years."


The President’s Commission for the Study of Bioethical Issues will advise the President on bioethical issues that may emerge from advances in biomedicine and related areas of science and technology. The Commission will work with the goal of identifying and promoting policies and practices that ensure scientific research, health care delivery, and technological innovation are conducted in an ethically responsible manner.

Rom Houben -- No Cause to Overhaul Treatment Standards

Media in Europe and around the world are reporting that Rom Houben, who was diagnosed as being in a vegetative state for over 20 years, appears to have been conscious the whole time.


Art Caplan argues that the Belgian medical reports strain credulity. But even if they were true, it is unclear that this case would or should ground a fundamental sea change in how patients with serious brain injuries are treated.  We already know that there is a low but significant rate of diagnostic and prognostic inaccuracy.  But that is true of most other areas of medicine (like oncology) as well.  We make recommendations on the best available data -- even though that data fails to speak with certainty to the specific instant patient before us.  


If the chance for error meant we aggressively treat everyone, then we would be over-treating 1000 patients in the chance that it might achieve some level of success for 1.  Of course, while medicine cannot be designed this way, surrogate decisions surely will be affected by the high profile of this and similar cases.  

Palmer v. ETCH -- The Legality of a Tennessee Medical Futility Policy

The Palmer family's Knox County Chancery Court complaint against East Tennessee Children's Hospital is available here.  The family also individually named all the healthcare providers and the members of the ethics committee. 


While an earlier meet and confer letter referenced EMTALA and the ADA, the complaint seeks a TRO and injunction solely on the basis of an alleged violation of the Tennessee Health Care Decisions Act, Tenn. Code Ann. 68-11-1801 to 1815 (which is largely based on the UHCDA).  But exactly how strong is the case under the Tenn. HCDA?


Sure, as the complaint alleges, a health care provider and institution must "comply with a health care decision for the patient made by a person then authorized to make health care decisions for the patient."  TCA 1808(b)(2).  But section 1808 itself is clear that any such obligation holds only "except as provided in subsections (c), (d), and (e)"


Here, it appears that the hospital is invoking (and its "Inappropriate Intervention" policy is based on) section 1808(e):  "A health care provider or institution may decline to comply with an individual instruction or health care decision that requires medically inappropriate health care or health care contrary to generally accepted health care standards applicable to the health care provider or institution."

1808(f) then providers that "a health care provider or institution that declines to comply with an individual instruction or health care decision pursuant to subsection . . . (e) shall:  (1) Promptly so inform . . . any person then authorized to make health care decisions for the patient [and] (2) Provide continuing care to the patient until a transfer can be effected or until the determination has been made that transfer cannot be effected."   This language clealy shows that Tennessee is NOT a so-called treat to transfer jurisdiction.  This is confirmed in 1808(f)(4) which states "If a transfer cannot be effected, the health care provider or institution shall not be compelled to comply."  Immunity is probably available for this conduct under 1811(a)(2). Nevertheless, the complaint does allege that ETCH "interfered" with family attempts to transfer Baby Gabriel to other facilities.  Section 1808(f)(3) provides that "unless the patient or person then authorized to make health care decisions for the patient refuses assistance, [the facility must] immediately make all reasonable efforts to assist in the transfer of the patient to another health care provider or institution that is willing to comply with the instruction or decision."   Moreover, without due diligent transfer efforts, subsection (f)(2) would also not be satisfied because there would be no reasonable basis for a "determination" that a transfer could not be effected.  Since this is a fact question with life and death stakes, the court would probably have granted the TRO.  The hospital had better have documented its transfer efforts.

Gabriel Palmer - Futility Dispute in Knoxville, TN

9-month-old Gabriel Palmer was diagnosed with a rare disease that family members said is affecting the growth of his wind pipe.  According to a recently-filed complaint, East Tennessee Children's Hospital told Gariel’s family that it "was going to cease Gabriel's respirator, medications, pulse oximeter and milk feeding because they considered his care futile."  ETCH further stated that the facility ethics committee "would meet soon to make the formal decision of withdrawal of treatment, but that the decision was a foregone conclusion."  (WBIR NBC; CBS)

 
The family, with the support of the ADF, sought a TRO from the local court.  But they dropped that complaint after reaching an agreement with the hospital.  The family’s attorney reported:  "There was a [three hour] ethics committee meeting of the hospital where they were to decide the future care of the child."  "The decision was made that the child will remain a patient at least for now at the Children's Hospital."

East Tennessee Children's Hospital released the following statement regarding Gabriel Palmer's care late Monday:

In critical care situations like Gabriel's, it is not uncommon to reach a place in the child's treatment where discussions are held to see how best to proceed.  When this situation occurs, input both from the family and from the child's medical team is solicited.  That is what was being addressed today, because the best interest of the child and family are always at the forefront of everything we do. We have and will continue to provide the highest quality care for Gabriel and every child and Children's Hospital.  No care has been withheld from Gabriel, and our medical team continues to work with the family to look at any possibilities that can be identified for his continued treatment.

Senator Cornyn on Medicare Rationing

From a Friday news conference with Republican Senators:

CORNYN: In addition to everything that Senator Kyl and Senator Murkowski have said, I think we all recognize that most of the costs in our health care system are in the end-of-life, with chronic diseases. And to me, the disturbing thing about what we're seeing with regard to mammograms and the possibility that -- is it Medicare will not pay for procedures where the cost-benefit analysis is such that we may lose some people. They may die for lack of care, but the government says, because we're running the show, we're concerned about costs more than anything else; we're not going to pay for it.

And so the implications to me are not just in the mammogram stage, but cervical cancer, obviously prostate cancer, all sorts of cancer, but primarily about end-of-life, which is the most expensive. And at what point is the government going to step in and say, "We're not paying for that," and you're going to die earlier than you would if you'd received that treatment. To me, that's the most disturbing part of that implication.

New NIH Brochure on Palliative Care

The HIN National Institute of Nursinf Research has released a new patient-oriented brochure on palliative care:  "Palliative Care: The Relief You Need When You’re Experiencing the Symptoms of Serious Illness," The brochure explains in easy-to-understand language what palliative care is, who it benefits, and how it works. The brochure also addresses certain misconceptions about palliative care, such as that it is only for the dying.  (NIH press release 11-20-09)



Although the primary purpose of palliative care is to reduce pain and distressing symptoms, research has discovered it offers other benefits as well, including improvements in patient-provider communication, emotional support, and satisfaction with overall care.


The brochure also highlights:

• how to decide if someone needs palliative care,
• how to ask a health care provider for palliative care,
• how palliative care differs from hospice care,
• what kind of specialists participate on a palliative care team, and
• insurance coverage for palliative care treatment.

Tiny Babies, Large Questions: Ethical Issues in Prenatal and Neonatal Care

Tiny Babies, Large Questions: Ethical Issues in Prenatal and Neonatal Care

Sixth Annual Pediatric Bioethics Conference
Friday and Saturday, July 23 and 24, 2010
Bell Harbor International Conference Center, Seattle, Washington

For most families, pregnancy and the birth of a child is an exciting and joyous time of hope and celebration. But sometimes, difficult and challenging ethical issues can emerge regarding the application of medical technology, the role of parental decision-making — and the impact of these decisions on tiny and vulnerable human beings.

Topics and Speakers

Whatever Happened to Baby Doe? The Transformation from Under-treatment to Over-treatment

Norman Fost, MD, MPH, University of Wisconsin

Neonatal Resuscitation: What Makes the Gray Zone Gray?

John Lantos, MD, Center for Practical Bioethics, Kansas City

When the Beginning is the End: Ethical and Practical Issues in Neonatal End-of-Life Care

Marcia Levetown, MD, University of Texas

Better Early than Never? Ethical Dilemmas in Preterm Birth and Survival in Resource-Poor Settings

Maneesh Batra, MD, and Maureen Kelley, PhD, University of Washington

Whose Best Interest: Resuscitation Decisions for Premature Infants

Annie Janvier, MD, Montreal Children’s Hospital

Making Trouble Making Babies: What Limits on IVF?

Jeff Ecker, MD, Harvard Medical School

10 Ways to Cut Health-Care Costs Right Now

Business Week has a great article summarizing 10 ways to cut health care costs.  

1. CRACK DOWN ON FRAUD AND ABUSE
2. DEVELOP A HEALTHY WORKFORCE
3. COORDINATE CARE THROUGH FAMILY DOCTORS
4. MAKE HEALTH A COMMUNITY EFFORT
5. STOP INFECTIONS IN HOSPITALS
6. GET PATIENTS TO TAKE THEIR MEDICINE
7. DISCUSS OPTIONS NEAR THE END OF LIFE
8. USE INSURANCE TO MANAGE CHRONIC DISEASE
9. LET WELL-INFORMED PATIENTS DECIDE
10. APOLOGIZE TO THE PATIENT

In explaining number seven, the article states:  "Aetna discovered that high-quality care for the dying actually lowers costs. The insurer started its Compassionate Care program in 2004 to educate terminally ill patients and their families about treatments, living wills, and hospice care. 'It was about dignity, not cost control' . . . Instead of unneeded tests and futile treatments, patients got more nursing care, pain management, and psychological support . . . ."

The Cost of Dying -- 60 Minutes (Sun. 11-22-09)

This Sunday, on 60 Minutes, Steve Kroft interviews Ira Byock about the cost of dying in America.

Byock takes Kroft through the intensive care unit at Dartmouth-Hitchcock. "This is the way so many Americans die," he says. "It's extremely expensive. It's uncomfortable. Many times they have to be sedated so they won't reflexively pull out a tube or sometimes their hands are restrained."

Last year, Medicare paid $50 billion just for doctor and hospital bills during the last two months of patients' lives.  The vast majority of people say they want to die at home, but 75 percent die in a hospital or nursing home.  Dr. Elliott Fisher of the Dartmouth Institute for Health Policy tells Kroft his research suggests that 30 percent of hospital stays in America are unnecessary. He says hospitals have become the "path of least resistance,' because it's easiest for doctors to manage patients there. Fisher points out that most doctors get paid based on the number of patients they see, and most hospitals get paid for the patients they admit. Add to this the fact that the government or private insurers are footing about 85 percent of all health care bills and it's easy to see why end-of-life care is so costly.

David Walker, former head of the Government Accountability Office explains, "We have a system where everybody wants as much as they can get, and they don't understand the true cost of what they are getting. The one thing that could bankrupt America is out-of-control health costs." 



Watch CBS News Videos Online

Captain Michael Fontana -- Trial begins

Capt. Michael Fontana is accused of intentionally giving three elderly Texas patients lethal doses of medication, killing them with his self-described “aggressive” care for end-of-life patients.  His trial began on Tuesday.  (San Antonio Express News)

The three patients who died in intensive care last summer at Wilford Hall Medical Center in San Antonio were nearing the end of their lives, but family members wanted them comfortable, not hastened to death.  The prosecuting attorney explained:  “All three people had something in common: excess doses of medication given by the accused resulting in a quicker death than anticipated."

“People are there for a reason. They’re there because they’re critically ill. They’re there because they’re dying,” said Capt. Brent Dishman, one of Fontana’s attorneys. “These patients were expected to die, and they died as anticipated.”  "He cared for these patients."  "You can see that, from his actions, his only intent was to make the people more comfortable."  (Austin Statesman)

Can't We at Least Decide Not to Treat the Dead?

There are many tough decisions that are being and need to be made in Medicare and other rationing.  But it seems that one of the easier decisions is to save health care resources for the living.  Sure, we "could" provide treatment to dead people.  But that is not required under state law governing the practice of medicine.  Nor is there much of any justification for doing it in any case.


So, why does it often prove to be such a tough decision?  Today, in Columbus, Ohio, "County authorities are weighing a decision about whether or not to remove a brain-dead child, who is under the county's custody, from life support at Nationwide Children's Hospital."  One commissioner said "the decision to discontinue life support is one of the toughest she's heard of that local courts and JFS has had to make."  (Lancaster Eagle Gazette)


Why is it a tough decision?  Why is the hospital seeking or even waiting for consent?

Transparency in Surrogate Decision Making

The British Court of Protection has the powers to:

• decide whether a person has capacity to make a particular decision for themselves;
• make declarations, decisions or orders on financial or welfare matters affecting people who lack capacity to make such decisions;
• appoint deputies to make decisions for people lacking capacity to make those decisions;
• decide whether an LPA or EPA is valid; and
• remove deputies or attorneys who fail to carry out their duties, and
• hear cases concerning objections to register an  LPA or EPA and make decisions about whether or not an LPA or EPA is valid.

British newspapers sued for media access to the Court.  Lawyers for the press argued that the principle of open justice – which generally requires cases be held in public – should apply to cases of adults with impaired mental capacity where there is a public interest in the case.  High Court judge Mr Justice Hedley  ruled, this month, that that the court should allow the media to attend one of its private hearings,

This Obituary Is Not about Me

The following obituary was published in an Indiana newspaper.  I received some condolences.  This is not about me.  

Thaddeus Harris Pope MD Passed away Nov. 6, 2009 in Indianapolis. Dr. Pope was the son of the late Thad Sr. and Iredell Pope, and grew up in Dunn, NC. He received a chemistry degree as well as a medical degree from the University of North Carolina at Chapel Hill. Dr. Pope served in the US Air Force from 1959 to 1961. He was a member of many medical organizations including the American Academy of Otolaryngology and the Triologic Society. He practiced medicine at McPherson Hospital in Durham, NC, and Culver Union Hospital in Crawfordsville, IN. His interests included inventing medical and surgical products. Dr. Pope is survived by his wife Anne Jacobs Pope, daughters Rosalind Brinn Pope, Marion Pope and John Gibson, and Susan Holmes Pope. He is also survived by his sister, Polly and Gordon Clapp of Dunn, NC. Indiana Funeral Care entrusted with arrangements.