New Frontiers in End-of-Life Ethics (and Policy): Scope, Advance Directives and Conscientious Objection

Bioethics, 31(6) 2017, 422-423
Author: Udo Schuklenk
“However, it would be premature to conclude that all arguments are settled now, if not in politics and law, and that, certainly in ethics, nothing much original could be added to the existing corpus of critical analysis and argument. In fact jurisdictions considering the decriminalization of medical aid in dying are grappling today with three issues that deserve further analysis.”
Find article here.

Doctors still provide too many dying patients with needless treatment

The Conversation, 28 June 2016
Authors: Magnolia Cardona-Morrell, Kenneth Hillman
“Many doctors are continuing to provide end-of-life patients with needless treatments that only worsen the quality of their last days, new research shows. Our review published in the International Journal for Quality in Health Care found that on average, one-third of patients near the end of their life received non-beneficial treatments in hospitals around the world.”
Find article here.

Advance care planning in Australia: what does the law say?

Australian Health Review – http://dx.doi.org/10.1071/AH15120
Authors: Rachel Z. Carter   A,  Karen M. Detering   A  B,  William Silvester   A and  Elizabeth Sutton   A
“Advance care planning (ACP) assists people to plan for their future health and personal care. ACP encourages a person to legally appoint a substitute decision maker (SDM) and to document any specific wishes regarding their future health care in an advance care directive (ACD). Formal documentation of wishes increases the chances that a person’s wishes will be known and followed. However, one of the biggest impediments for doctors following the person’s wishes is uncertainty surrounding the law, which is complicated and varies between the states and territories of Australia.”
Find abstract here.

Doctors must ask carers before placing DNAR notices on files of mentally incapacitated patients

BMJ 2015;351:h6179
Author: Clare Dyer
“Doctors must consult the carers of patients who are mentally incapacitated before placing “do not attempt cardiopulmonary resuscitation” (DNAR) notices on their files, the High Court has ruled in a landmark case.”
Find extract here.

The Texas Advanced Directive Law: Unfinished Business

The American Journal of Bioethics, Volume 15, Issue 8, 2015
Authors: Michael Kapottos & Stuart Youngner
“The Texas Advance Directive Act allows physicians and hospitals to overrule patient or family requests for futile care. Purposefully not defining futility, the law leaves its determination in specific cases to an institutional process. While the law has received several criticisms, it does seem to work constructively in the cases that come to the review process. We introduce a new criticism…”
Find abstract here and links to related commentary articles here.

Medicare opens up the end-of-life conversation

The Lancet, Volume 386, No. 9990, p220
Editorial: “Nobody wants to talk about the end of life. But conversations between physicians and their patients are essential to providing the best possible quality of health care at all stages of life. On July 8, Medicare, the largest insurer in the USA of people aged 65 years and older, announced plans to cover advance care planning. This initiative will reimburse doctors for counselling patients about end-of-life care before they become physically or mentally incapable of making decisions.”
Find editorial here.

The importance of reliable information exchange in emergency practices: a misunderstanding that was uncovered before it was too late

BMC Medical Ethics 2015, 16:46
Author: Halvor Nordby
“Many medical emergency practices are regulated by written procedures that normally provide reliable guidelines for action. In some cases, however, the consequences of following rule-based instructions can have unintended negative consequences. The article discusses a case – described on a type level – where the consequences of following a rule formulation could have been fatal.The case study accentuates the significance of prudent judgment in medical practice. In the case described, the consequence of trusting the written advance directive could have been fatal, but the point is general: for the purpose of achieving excellent organizational performance, it is insufficient for health workers to rely uncritically on rules and procedures. Even the clearest rule formulations must be interpreted contextually in order to determine ethically correct behavior and avoid potential negative consequences that are not in the patient’s best interests.”
Find article here.

Treatment-resistant major depressive disorder and assisted dying

J Med Ethics doi:10.1136/medethics-2014-102458
Authors: Udo Schuklenk, Suzanne van de Vathorst
“Competent patients suffering from treatment-resistant depressive disorder should be treated no different in the context of assisted dying to other patients suffering from chronic conditions that render their lives permanently not worth living to them. Jurisdictions that are considering, or that have, decriminalised assisted dying are discriminating unfairly against patients suffering from treatment-resistant depression if they exclude such patients from the class of citizens entitled to receive assistance in dying.”
Find abstract here. Find related commentaries and responses here.

Advance care planning in palliative care: a national survey of health professionals and service managers

Australian Health Review, published online 22 January 2015 http://dx.doi.org/10.1071/AH14118
Authors: Marcus Sellars, William Silvester, Malcolm Masso and Claire E. Johnson
“ACP is increasingly recognised as an important part of care of people in hospital and community settings. However, currently there is no empirical evidence about the national uptake and quality of ACP in palliative care settings specifically.”
Find abstract here. See also ‘Palliative care health professionals’ experiences of caring for patients with advance care directives‘.

Hospitals Wrestle With Extent of Ebola Treatment

WSJ, 31 October 2014
Author: Stephanie Armour
“U.S. hospitals are grappling with whether to withhold aggressive treatments from Ebola patients to avoid further exposing doctors and nurses to the virus. Some facilities have decided they will forgo cardiopulmonary resuscitation or may opt not to pursue invasive surgical procedures on deteriorating Ebola patients.”
Find article here.