Conflicting interpretations or conflicting opinions? Being clear about the UN-CRPD

JME Blog, 3 November 2017
Authors: Matthé Scholten, Jakov Gather
“When a patient is incompetent to make a particular treatment decision due to impaired decision-making capacity, it is common practice that the decision is based on an advance directive or made by a substitute decision-maker on behalf of the patient. The substitute decision-maker’s task is to choose the treatment option that the patient would have chosen had he or she been competent. Recent reports prepared by the United Nations (UN) strongly repudiate this practice. According to these reports, article 12 of the UN Convention on the Rights of Persons with Disabilities (CRPD) states that persons with mental disabilities may on no account be denied the right to make their own treatment decisions.”
Find article here.


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.”
Find article here.

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 –
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.