Palliative Care = Murder?

Among Doctors, Fierce Reluctance to Let Go

Paula Span
New York Times
March 29, 2012

Even when the system works as it’s supposed to, and palliative care specialists arrive like the cavalry to provide comfort care, to stop fruitless and painful interventions and to support what patients want, their own colleagues may brand them murderers.

The Best Care Possible

Ira Byock, MD

The way Americans die in this country is a national disgrace. That's according to Dr. Ira Byock in his new book, The Best Care Possible: A Physician's Quest to Transform Care through the End of Life. Lorell LaBoube talks about it with Dr. Byock in this edition of The Bioethics Channel.

Dr. Byock is the keynote speaker at the annual dinner of the Center for Practical Bioethics on April 19th 2012, and a presenter the next day for the Joan Berkley Bioethics Symposium.

For more information and to register click here.

Links:

· Dinner Registration
· Symposium Registration

The Defining Death Debate

Rob Stein
NPR
March 28, 2012

Proponents defend restarting circulation with the ECMO machine. "They are in fact dead," said Jeffrey D. Punch, director of the transplant center at the University of Michigan. Punch said of the patients, noting that circulation has only been restored with a machine and no one will try to revive the donors' hearts in any way. Doctors wait five minutes after the hearts stop beating to make sure the patients are really gone, he added.

Links:

A Struggle To Define 'Death' For Organ Donors, Rob Stein, NPR, March 28, 2012

Resuscitating the Dead Donor Rule, David Magnus, The Bioethics Channel, August 28, 2011

Adding an Agent to "The Talk"

Helen Emmott
Sandy Silva

The Center for Practical Bioethics has been promoting Caring Conversations for years as a way for families to prepare for a serious illness or the end of life. Now the Center has revised the workbook and Lorell LaBoube talks about it with Helen Emmott and Sandy Silva in this edition of The Bioethics Channel.

Link to podcast here.

Hope in Pediatric Palliative Care

Chris Feudtner, MD, PhD, MPH

Thinking and feeling your way through pediatric palliative care. Chris Feudtner, MD, of the Children's Hospital of Philadelphia explains the concept in this edition of The Bioethics Channel.

Link to podcast here.

Part 2: The Ethics (?) of Legislating Medical Practice

Legislators and other public policy makers have an ethical obligation to develop fair and equitable policy that promotes the health and wellbeing of ALL it's citizens.

They are obligated to create policies that support the right of children to grow up as healthy as possible, to become educated to the the extent of their capacity, to establish families and have children if they choose and to work and be productive.

All of that is to say to compete on a level field in a capitalistic society.

They have special obligations to those who are "lesser situated" as a former colleague, Don Reynolds used to say to protect their interests even when they cannot compete.

With regard to Medicine, I believe their duties and obligations, i.e., thiose of legislators, are limited to assuring that those who practice medicine (in the generic sense) are properly trained, maintain competence, are of good character and act within the accepted professional standards of good practice.

This has all become very confused in that professional associations have given much more attention to the interests of their members, especially income, than they have to developing and promoting "standards" of practice and upholding the integrity of their professions and therapeutic relationships.

Physicians, once the most powerful professionals/people in our society, have stood on the sidelines and been neutered by people all too willing to usurp their power and authority for personal gain -- usually economic gain.

-- Myra Christopher, Kathleen Foley Chair for Pain and Palliative Care, Center for Practical Bioethics

The Ethics (?) of Legislating Medical Practice

It’s the legislative season throughout the US at both the state and federal levels. Which prompts a question that might at first seem a bit naïve. But before we ask the question, a bit of background.

All of us have likely observed at one time or another a physician, a group of physicians or a corporation appeared to perhaps be attempting to use a legislative process to change the practice of medicine.

For example: XYZ Company devises a new tool to diagnose a disease. The legislature is lobbied to change the law so that this particular test becomes akin to a mandatory screening. One consideration is the financial gain to be garnered by the XYZ Company if the legislative change is made. More importantly, the legislature is not the body to determine if proper human subject testing has been completed, among other considerations.

So here’s the question: what is the proper (ethical) relationship between legislative and regulatory bodies when it comes to the practice of medicine?

Promises and Pitfalls: The Healthcare Handoff

Transitions of Care from the Home and Community – Promises and Pitfalls.

That’s the subject of a presentation by Penny Feldman of the Visiting Nurse Service of New York to be delivered in Kansas City April 20th 2012 during the Joan Berkley Bioethics Symposium.

For a preview of Dr. Feldman’s remarks click here. For more information on the symposium and to register click here.

The Joan Berkley Symposium is part of the Annual Dinner and Bioethics Symposium event sponsored by the Center for Practical Bioethics April 19 and 20.

For more information on the Center’s annual fundraiser and to sponsor the Center’s work, visit www.practicalbioethics.org.

Relieving Pain in America

Myra Christopher
Opinion Editorial

Huffington Post
March 8, 2012

Unfortunately, the notion that there is a causal connection between prescribing medications for chronic pain and the abuse of these medications is held by many, including policy makers.

As a consequence, knee-jerk policy decisions have been made that make the lives of those with chronic pain even more miserable.

Link: Relieving Pain in America

Painkiller Access Debated as Patients Suffer

Radley Balko
The Huffington Post
March 9, 2012

Doctors are terrified of criminal or administrative investigations which can end their medical careers, even if they're eventually cleared, says Myra Christopher of the Center for Practical Bioethics.

"They feel besieged. And it's not necessarily even a fear of criminal charges. It's about getting investigated, about having the DEA come and say, 'We'd like to look through your files.' You then have to pay for a defense, and take time away from your practice to defend yourself."

This, Christopher and other patient advocates say, is why it's so difficult for pain patients to find conscientious doctors to treat them.

Links:

* Policy Brief: Balance, Uniformity and Fairness: Effective Strategies for Law Enforcement for Investigating and Prosecuting the Diversion of Prescription Pain Medications While Protecting Appropriate Medical Practice

**News Release: Few physicians actually tried or sanctioned for improperly prescribing pain medications

***Podcast: What's Next? The IOM Report on Pain, The Bioethics Channel, Myra Christopher

A Tale of Two Headlines

John Carney
President/CEO
Center for Practical Bioethics

It's a tale of two headlines – different stories, but somewhat related, in this edition of The Bioethics Channel. Lorell LaBoube, program host, discusses how assisted suicide in Georgia coincides with advance care planning in California with John Carney of the Center for Practical Bioethics.

Links:

*Podcast: A Tale of Two Headlines
**76% of patients neglect end-of-life care planning, American Medical News, February 27
***Georgia high court strikes down assisted suicide law, American Medical News, February 20

Have you had "The Talk?"

April 16th is National Healthcare Decisions Day, a day to identify someone to speak for you when you can no longer speak for yourself.

Take this opportunity to have “The Talk” using the updated version of Caring Conversations from the Center for Practical Bioethics. It's a booklet that helps guide families in making practical preparations for serious illness or the end of life.

For a free copy of the new Caring Conversations click here.