Family in dispute over care of woman with brain damage

The Guardian, 17 October 2017
Author: Josh Halliday
“A family is in dispute over the ongoing care of a woman with brain damage who had suggested she would want to die in such circumstances, a court has heard. The woman, identified as Mrs P, is said to be in a “minimally conscious state” on an acute hospital ward following a fall last year. A Court of Protection judge is being asked to consider whether she should continue to receive clinically assisted nutrition and hydration.”
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Dutch geriatrician faces charges over euthanasia case

BMJ 2017; 359: j4639
Author: Tony Sheldon
“A specialist in elderly care medicine could face prosecution under the Netherlands’ euthanasia laws after ending the life of a 74 year old nursing home patient with advanced dementia. The woman was considered no longer competent to consent but had previously signed a living will requesting euthanasia. Yet Dutch public prosecutors have launched a criminal investigation, claiming a “serious suspicion” that a criminal offence had been committed. This is the Netherlands’ first such investigation under the reporting arrangements established in the 2002 euthanasia law.”
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Aid-in-dying laws and the physician’s duty to inform

Journal of Medical Ethics 2017; 43: 666-669.
Author: Mara Buchbinder
“On 19 July 2016, three medical organisations filed a federal lawsuit against representatives from several Vermont agencies over the Patient Choice and Control at End of Life Act. The law is similar to aid-in-dying (AID) laws in four other US states, but the lawsuit hinges on a distinctive aspect of Vermont’s law pertaining to patients’ rights to information. The lawsuit raises questions about whether, and under what circumstances, there is an ethical obligation to inform terminally ill patients about AID as an end-of-life option. Much of the literature on clinical communication about AID addresses how physicians should respond to patient requests for assisted dying, but neglects the question of how physicians should approach patients who may not know enough about AID to request it.”
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Is there a place for CPR and sustained physiological support in brain-dead non-donors?

Journal of Medical Ethics 2017; 43: 679-683.
Author: Stephen D Brown
“The paper first focuses narrowly on requests for CPR and then expands its scope to address extended physiological support. It describes how refusing the brain-dead non-donor’s requests for either CPR or extended support would represent enduring harm to the antemortem or previously autonomous individual by negating their beliefs and self-identity. The paper subsequently discusses potential implications of policy that would allow greater accommodations to those with conscientious objections to currently accepted brain-based death criteria, such as for cost, insurance, higher brain formulations and bedside communication. The conclusion is that granting wider latitude to personal conceptions around the definition of death, rather than forcing a contested definition on those with valid moral and religious objections, would benefit both individuals and society.”
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Children can decide their medical treatments under Victoria’s unique advance directive laws

The Conversation, 4 October 2017
Author: Carolyn Johnston
“Writing an advance care directive is part of the planning process, but a directive means the person’s preferences are bound to be followed by law. All states and territories have varying laws enabling adults to make advance care plans or directives. In Victoria, new legislation will come into effect in March 2018, creating clear obligations for health practitioners to respect advance directives.”
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Increasing organ donation rates by revealing recipient details to families of potential donors

J Med Ethics, September 2017
Authors: David Shaw, Dale Gardiner
“Many families refuse to consent to donation from their deceased relatives or over-rule the consent given before death by the patient, but giving families more information about the potential recipients of organs could reduce refusal rates. In this paper, we analyse arguments for and against doing so, and conclude that this strategy should be attempted. While it would be impractical and possibly unethical to give details of actual potential recipients, generic, realistic information about the people who could benefit from organs should be provided to families before they make a decision about donation or attempt to over-rule it.”
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Does the doctrine of double effect apply to the prescription of barbiturates? Syme vs the Medical Board of Australia

J Med Ethics, September 2017
Author: Xavier Symons
“The doctrine of double effect (DDE) is a principle of crucial importance in law and medicine. In medicine, the principle is generally accepted to apply in cases where the treatment necessary to relieve pain and physical suffering runs the risk of hastening the patient’s death. More controversially, it has also been used as a justification for withdrawal of treatment from living individuals and physician-assisted suicide. In this paper, I will critique the findings of the controversial Victorian Civil and Administrative Tribunal (VCAT) hearing Syme vs the Medical Board of Australia. In that hearing, Dr Rodney Syme, a urologist and euthanasia advocate, was defending his practice of prescribing barbiturates to terminally ill patients.”
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Organ Donation: Presumed Consent and Focusing on What Matters

JME Blog, 25 September 2017
Author: Rebecca Brown
“It makes intuitive sense that presumed consent systems would increase organ donation rates, and those who fail to support their introduction often come under criticism. Such criticism tends to assume that failure to support presumed consent is due to a failure to properly recognise the importance of organ donation or a sentimental or squeamish attitude towards bodies as well as oversensitivity towards those who are hesitant about organ donation. Yet, even if one is very concerned with increasing organ donation rates, there are grounds for scepticism about the helpfulness of presumed consent systems as a means of achieving this.”
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Why I needed to let my little brother die

The Guardian, 26 September 2017
Author: Cathy Rentzenbrink
“Everyone involved was compassionate, and I have always felt grateful that they tried not to make it horrible for us. But it was horrible. That’s why I welcomed last week’s ruling by Mr Justice Peter Jackson that in future, where doctors and families are in agreement they should not have to go to court to seek permission for treatment to be withdrawn from patients in a persistent vegetative or minimally conscious state.”
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As Victorian MPs debate assisted dying, it is vital they examine the evidence, not just the rhetoric

The Conversation, 20 September 2017
Authors: Ben White, Andrew McGee, Lindy WIllmott
“A starting point is to distinguish between claims that something should or should not happen (a moral claim about right and wrong), and claims that something is or is not happening (a factual or empirical claim). This distinction matters, because what justifies each type of claim is different.”
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