Wednesday, August 27, 2014

Brain Death Is a Flash Point in End-of-Life Law, Ethics and Policy

My latest post over at the American Journal of Bioethics blog is now posted here:  "Brain Death Is a Flash Point in End-of-Life Law, Ethics and Policy."

Tuesday, August 26, 2014

Death: Why the Brain Matters (Video)

This spring, UCLA hosted a mini symposium titled "Death: Why the Brain Matters."  Happily the video is now available.  The speakers were 
  • Alex Capron, Professor, Law and Medicine, USC
  • James Hynds, Senior Clinical Ethicist, UCLA Health System
  • Paul Vespa, Director, Neuro ICU, RRUCLA Medical Center

Monday, August 25, 2014

Elder Mediation Training in Minneapolis

Next month, the Mediation Center at Hamline University will offer a 20-hour, three day Elder Mediation Training, on September 25, 26 and 27.

This program will expand your skills into the growing field of Elder Mediation. The workshop covers strategies for facilitating adult family conversations around issues like:

  • Living arrangements
  • Caregiving
  • Financial planning
  • Medical decisions
  • Adult guardianship mediation
  • Mental capacity
  • Wills and estate planning
  • Multi-party mediation
  • Mediation intake. 

Janeen Massaros and John Lundblad will also cover how to handle strong emotions in family conflict situations and move forward. This class uses vignettes and role plays to help you develop your skills.

Saturday, August 23, 2014

Supreme Court of Canada - Assisted Suicide Oral Arguments on October 15

Lee Carter
On October 15, 2014, the Supreme Court of Canada will hear oral arguments in the case of Lee Carter, et al. v. Attorney General of Canada, et al.  Written  Factums of key parties are available here.

The plaintiffs were terminally ill patients seeking physician aid in dying.  Ms. Kay Carter and the applicant Ms. Gloria Taylor both suffered from intractable and progressive diseases and are now deceased. They had joined with the others in bringing a civil claim before the British Columbia Supreme Court challenging the constitutionality of the Criminal Code provisions against assisted suicide and euthanasia, specifically ss. 14, 21(1)(b), 21(2), 22, 222(1)-222(5), and 241. They focused their case, however, on s. 241, which prohibits aiding another person to commit suicide. 

The plaintiffs succeeded at trial notwithstanding the Supreme Court of Canada's 1993 decision in Rodriguez v. British Columbia (Attorney General) that s. 241 did not infringe Charter rights. A majority of the Court of Appeal, however, allowed the Attorney General of Canada’s (“AGC”) appeal.

The questions to be addressed concern the Canadian  Charter of Rights (Right to life, Equality, Fundamental justice).  Specifically, 

  • Whether trial judge erred in distinguishing Rodriguez
  • Whether the Criminal Code provision prohibiting aiding person to commit suicide infringes the Charter
  • If so, whether such infringement is justifiable 

There are quite a number of interveners.  Their briefs/factums are due August 29. 
  • Attorney General of Ontario
  • Attorney General of Quebec
  • Attorney General of British Columbia
  • Council of Canadians with Disabilities and the Canadian Association for Community Living
  • Christian Legal Fellowship
  • Canadian HIV/AIDS Legal Network (the 'Legal Network'') and the HIV & AIDS Legal Clinic Ontario (''HALCO'')
  • Association for Reformed Political Action Canada
  • Physicians' Alliance Against Euthanasia
  • Evangelical Fellowship of Canada
  • Christian Medical and Dental Society of Canada
  • Canadian Federation of Catholic Physicians' Societies
  • Dying with Dignity
  • Canadian Medical Association
  • Catholic Health Alliance of Canada
  • Criminal Lawyers' Assocation (Ontario)
  • Farewell Foundation For The Right To Die
  • Association québécoise pour le droit de mourir dans la dignité
  • Canadian Civil Liberties Association
  • Catholic Civil Rights League
  • Faith and Freedom Alliance and Protection of Conscience Project
  • Alliance Of People With Disabilities Who Are Supportive of Legal Assisted Dying Society
  • Canadian Unitarian Council
  • Euthanasia Prevention Coalition and Euthanasia Prevention Coalition - British Columbia
  • Advocates' Society
  • David Asper Centre For Constitutional Rights

Wednesday, August 20, 2014

Ethics, Law & Clinical Practice - Spectrum Health 2014 Ethics Conference

If you will be in or near Grand Rapids, Michigan on Friday, September 5, 2014, come to Spectrum Health's 2014 ethics conference for clinicians: “Ethics, Law and Clinical Practice" at the Calvin College Prince Conference Center.

This is a one-day symposium addressing the ethical complexities in health care today. Conference sessions and networking opportunities are designed to increase awareness and provide strategies to clinicians from all disciplines to support ethical care in a variety of settings. 

Hubris to Humility: Medical Power in Medical Futility Conflicts
Thaddeus Pope, JD, PhD
Director, Health Law Institute Associate Professor of Law
Hamline University School of Law

When Parents and Providers Disagree: Understanding and Responding to Conflicts in the Care of Children
Douglas Diekema, MD, MPH
Director, Education Treuman Katz Center for
Pediatric Bioethics
Professor of Pediatrics and Bioethics
University of Washington School of Medicine

Current Concepts in Disclosure
Kelly Saran, MS, RN, CPHRM
Administrative Director, Office of Clinical Safety
University of Michigan Health System

Humor: Finding a Balance
Judge Sara Smolenski, JD
Chief Judge, State of Michigan 63rd District Court


  • Provide a forum to discuss challenges in clinical practice from an ethical perspective.
  • Explore how legal considerations influence clinical and ethical decision making at the bedside in a range of clinical settings.
  • Explore the interrelationship between ethics and law
  • Identify ethically- and legally-informed personal, professional and institutional strategies for addressing challenging situations in clinical practice.

Tuesday, August 19, 2014

Minnesota v. Final Exit Network - Assisted Suicide Case Resumes

The Minnesota assisted suicide case against the Final Exit Network begins again at 9:00 a.m. on September 8, 2014, in the Dakota County Judicial Center in Hastings. 

In June 2014, the Supreme Court of Minnesota denied the State's petition for review of the Court of Appeal's September 30, 2013 decision in favor of FEN.  The Supreme Court also dissolved the stay of proceedings in the trial court, which has been in effect since March, 2013.  

The case now resumes in the trial court as if the defendants faced a new indictment.  Instead of being charged primarily under a statute that prohibits "advising, encouraging, or assisting in a suicide," the new indictment charges them only with "assisting in a suicide."  

Final Exit Network, Inc, and Larry Egbert are each charged with assisting in a suicide, aiding and abetting to assist in a suicide, interfering in a death scene, and aiding and abetting to interfere in a death scene.  Roberta Massey is charged only with aiding and abetting to assist in a death scene.

At the September 8 hearing, the judge will set a trial date, discuss pending motions, decide whether any additional pretrial hearings are necessary and, if so, schedule them. 

Monday, August 18, 2014

Nursing Homes Rank as Worst Setting For End-of-Life Care

Reported end-of-life care experiences are typically worse in the nursing home setting, according to the latest results of a recent CMS survey developed and field tested by RAND.

The Hospice Experience of Care Survey measured experiences of patients and their caregivers in three hospice settings: 

  1. Nursing home (including both skilled and regular nursing facilities)
  2. Home care (including assisted living facilities) 
  3. Inpatient care (acute care hospitals and freestanding hospice IPUs).
The overall ratings were:
  • Home = 92.2
  • Hospital = 93.0
  • Nursing Home = 90.2
Nursing home results were particularly lower for Hospice Team Communication, Providing Emotional Support, and Understanding the Side Effects of Pain Medication.

The survey is meant to act as a pilot to test the future Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey, which will be implemented at eligible hospices nationwide beginning in 2015. 

Monday, August 11, 2014

"Critical Gaps" in Legal Knowledge of Doctors Practicing End-of-Life Medicine

Queensland researchers led by Ben White at the Australian Centre for Health Law Research, Queensland University of Technology (where I'll be tomorrow), have just published research in the Medical Journal of Australia demonstrating "critical gaps in the legal knowledge of many doctors who practise end-of-life medicine."

The study focused on (1) the validity and effect of advance directives and (2) the authority of substitute decisionmakers.  The results show that physicians do not
possess sufficient legal knowledge:

  • to determine whether an advance directive presented to them is valid. 
  • to determine whether they are legally obliged to follow a directive that refuses treatment in a situation when providing treatment is clinically indicated. 
  • to determine the legally authorized decisionmaker  where there are various people who have an interest in the well-being of a patient

I am sure that U.S. results would be the same or worse.  The authors rightly conclude that doctors' "lack of legal knowledge places their patients’ interests and rights at risk
— and them at legal risk."