Tag: resuscitation

Bioethics Blogs

British Columbia Court of Appeal Tosses Unwanted Treatment Claim

I have recently highlighted (here and here and here) the growing success of legal claims when clinicians administer unwanted life-sustaining treatment.  One recent case from British Columbia goes the other way.


Brenlee Kemp sued Vancouver General Hospital for battery on her mother. The trial court rejected the hospital’s claim to dismiss the claim. The court ruled the battery claim should go to trial, because there was conflicting evidence regarding whether consent was given.


The Court of Appeal reversed. The court explained that the existence of express consent is irrelevant, because the clinicians had implied consent. First, Brenlee made desperate pleased to “help” her mother. Second, she was present during the resuscitation and made on objections to the resuscitation efforts taking place in close proximity to her.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

British Columbia Court of Appeal Tosses Unwanted Treatment Claim

I have recently highlighted (here and here and here) the growing success of legal claims when clinicians administer unwanted life-sustaining treatment.  One recent case from British Columbia goes the other way.


Brenlee Kemp sued Vancouver General Hospital for battery on her mother. The trial court rejected the hospital’s claim to dismiss the claim. The court ruled the battery claim should go to trial, because there was conflicting evidence regarding whether consent was given.


The Court of Appeal reversed. The court explained that the existence of express consent is irrelevant, because the clinicians had implied consent. First, Brenlee made desperate pleased to “help” her mother. Second, she was present during the resuscitation and made on objections to the resuscitation efforts taking place in close proximity to her.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Variability in the Initiation of Resuscitation Attempts by Emergency Medical Services Personnel during out-of-hospital Cardiac Arrest.

Variability in ICU treatment has been well documented.  In contrast, I had understood that EMS resuscitated and transported everyone who was not obviously dead. 


But apparently there is variability even there. A new article in Resuscitation concludes: “The proportion of patients with OHCA who receive resuscitation attempts is variable across EMS agencies and is associated with EMS response interval, ALS unit availability and geographic region. On average, survival was higher among EMS agencies more likely to initiate resuscitation.”

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

Few Americans Plan For End-of-Life Decisions, Even If They Are Sick

Michael S. Dauber, MA, GBI Visiting Scholar

Many moral dilemmas faced by clinicians, patients, and their families arise when individuals have not made plans for the end of their lives or discussed their wishes with their loved ones. To prevent and mitigate these issues, ethicists have suggested for decades that individuals should complete documents such as advanced directives like living wills (legal documents that indicate one’s wishes for interventions like intubation and cardiopulmonary resuscitation (CPR)), and to name a healthcare proxy (an individual to make decisions on one’s behalf in the event one becomes unable). Such measures tend to make it easier for individuals to address moral dilemmas in practice and to determine the ethically appropriate surrogate decision maker for a patient.

According to a recent study published in Health Affairs, few Americans have taken either of these measures. Researchers compiled results from over 150 studies of end-of-life planning measures and determined that only 36.7 percent of those surveyed had completed some sort of advanced directive, with 29.3 percent of those individuals completing living wills and 33 percent empowering a healthcare proxy. The study also found that 42 percent of individuals aged 65 or older had completed some sort of advanced directive, as opposed to 32 percent of individuals younger than 65.

There are several reasons why individuals may be hesitant to complete healthcare proxies. Many young people may feel they can put off decisions about care at the end of their lives because such matters are comparatively unlikely to occur in the short term.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

What We Do When We Resuscitate Extremely Preterm Infants

by Jeremy R. Garrett, Brian S. Carter & John D. Lantos

This editorial is made available on bioethics.net. The editorial along with the target article and open peer commentary is available via tandfonline.com

Neonatal intensive care is one of the most successful medical innovations of the last half century. Every year, in the United States alone, nearly 500,000 babies are born prematurely. Before neonatal intensive care, most of those babies died, and those who survived often suffered significant life-limiting impairments. Today, most preemies survive without impairments.

In spite of this success, neonatal intensive care unit (NICU) care has always been viewed as ethically problematic. The objections to this care have taken different forms at different times.

Economists questioned whether neonatal intensive care was cost-effective. Careful studies showed that it was more cost-effective than any other form of intensive care, and even more cost-effective than many modalities of preventive care (including, for example, Pap smears).

Some parents claimed that doctors were not honestly informing them of the potential long-term sequelae of NICU care, and that, if honestly informed, many parents would choose palliative care. Careful studies showed that these parents were unusual. Most parents want more intensive care than even doctors and nurses think is appropriate, and they want it even when informed that survivors might be left with significant disabilities.

Bioethicists and doctors argued that neonatologists were playing God, that premature babies were not full-fledged persons, and that saving disabled babies was like an ill-conceived military mission. Each of these attempts to undermine the commitment made by parents, doctors, and society to saving preemies has been met with hard questions and strong rebuttals.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

Saving or Creating: Which Are We Doing When We Resuscitate Extremely Preterm Infants?

August 3, 2017

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Abstract

Neonatal intensive care units represent simultaneously one of the great success stories of modern medicine, and one of its most controversial developments. One particularly controversial issue is the resuscitation of extremely preterm infants. Physicians in the United States generally accept that they are required to resuscitate infants born as early as 25 weeks and that it is permissible to resuscitate as early as 22 weeks. In this article, I question the moral pressure to resuscitate by criticizing the idea that resuscitation in this context “saves” a human life. Our radical medical advancements have allowed us to intervene in the life of a human before it makes sense to say that such an intervention “saves” someone; rather, what the physician does in resuscitating and treating an extremely preterm infant is to take over creating it. This matters, I argue, because “rescues” are much more morally urgent than “creations.”

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The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

End-of-Life Healthcare Sessions at ASBH 2017

The 2017 ASBH
conference
 in October 2017 includes over 400 workshops, panels, and
papers in bioethics and the health humanities.  Here are ones that pertain
to end-of-life issues.


THURSDAY, OCTOBER 19


THU 1:30 pm:  End-of-Life Care and Decision-Making in the ICU – Limited
English Proficiency as a Predictor of Disparities (Amelia Barwise)


Importance: Navigating choices in predominantly English-speaking care settings
can present practical and ethical challenges for patients with limited English
proficiency (LEP). Decision-making in the ICU is especially difficult and may
be associated with disparities in health care utilization and outcomes in critical
care. 


Objective: To determine if code status, advance directives, decisions to limit
life support, and end-of-life decision-making were different for ICU patients
with LEP compared to English-proficient patients. 


Methods: Retrospective cohort study of adult ICU patients from
5/31/2011-6/1/2014. 779 (2.8%) of our cohort of 27,523 had LEP. 


Results: When adjusted for severity of illness, age, sex, education, and
insurance status, patients with LEP were less likely to change their code
status from full code to do not resuscitate (DNR) during ICU admission (OR,
0.62; 95% CI, 0.46-0.82; p


Conclusion: Patients with LEP had significant differences and disparities in
end-of-life decision-making. Interventions to facilitate informed
decision-making for those with LEP is a crucial component of care for this
group.


THU 1:30 pm:  “But She’ll Die if You Don’t!”: Understanding and
Communicating Risks at the End of Life (Janet Malek)


Clinicians sometimes decline to offer interventions even if their refusal will
result in an earlier death for their patients. For example, a nephrologist may
decide against initiating hemodialysis despite a patient’s rising creatinine
levels if death is expected within weeks even with dialysis.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Brain Death – 3rd Edition by Wijdicks

This third edition introduces new research in the intensive care unit, newly unearthed historical data on important US-UK differences, a thorough discussion of US guidelines and how it is used in hospital practices, and compares guidelines used elsewhere in the world. In this incisive work, the many complexities of diagnosis and management of brain death are examined but it also illuminates cultural beliefs and bioethical problems, highlights the nature of conferences with family members, and captures several organ procurement issues. The book also includes 30 commonly asked practice problems to resolve diagnostic uncertainties and conflicts along with 12 video clips to assist in neurological evaluation.  

Chapter 1: History of Brain Death

A New Comatose State Appears

Defining Neurologic Criteria for Death in Us

Chapter 2: Neurology of Brain Death

The Pathology of Brain Death

Clinical Examination in Adults

The Clinical Determination of Brain Death in Children

Documentation

Teaching Brain Death Determination

Errors and Alleged Recoveries

Legal Definitions and Obligations

Chapter 3: International Criteria of Brain Death

Guidelines in the United Kingdom

Guidelines World Wide

Consensus for a Uniform World Wide Standard

Chapter 4: Beliefs About Brain Death

Religious Beliefs

Cultural Views

Religious Conflict Resolution

Chapter 5: Critics and Brain Death

The Uncertainty of Death

Emerging Controversies

Critique

Chapter 6: Procurement After Brain Death 

Transitioning to Organ Donation

Organ Procurement Organizations

Organ Donation Requests

Preparation for Determining Organ Suitability

Donation Protocols

Medical Management of the Organ Donor

Chapter 7: Clinical Problems in Brain Death and Organ Donation

1. The Qualifications of the Examiner

2. Clinical Mimics

3.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Texas Legislature Special Session Tackles DNR Orders and Medical Futility

The Texas Legislature is holding a special session that starts today. The session, which follows a five-month regular session that concluded May 29, can last no more than 30 days.


One of the agenda items is “strengthening patient protections relating to do-not-resuscitate orders.”  Already four bills have been introduced.


HB 152, like many bills over the past decade, would amend TADA by eliminating the 10 day transfer period. The amendment would require continued treatment until transfer.


The other three bills are identical. Among other things, HB 12, HB 43, and SB 11 would require patient or surrogate consent for DNR orders unless all three of the following are satisfied:

  1. It is not contrary to the directions of a patient who was competent at the time the patient conveyed the directions.
  2. The patient ’s death is imminent, regardless of the provision of cardiopulmonary resuscitation.
  3. The DNR order is medically appropriate.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Burke and Wills: Why We Might All Fear the Judgment in Charlie Gard

The Case of Donald Wills

Donald Wills is a self-made man. He is billionaire British banker who has taken an interest in technology. He believes the Singularity is near and wishes to live as long as possible. He completes an advance directive to use his money to keep him alive at all costs, should he become ill and unable to express his wishes. He tells his wife about these desires.

Donald develops a rare condition where the mitochondria in all his cells stop working. The mitochondria are power packs for every cell. Donald’s muscles stop working and he is admitted to a famous London hospital and has to be put on a breathing machine. His brain is affected- he suffers fits which need to be controlled by medication. There is no known cure and he is going downhill.

Doctors call in his wife and explain his dismal prognosis. “It is,” they say, “in his best interests to stop this burdensome treatment in intensive care. He will never regain normal brain function but he is conscious at times and feels pain. He should be allowed to die with dignity.” After all, Donald is 75.

Donald’s wife, Melanie, is shattered. But she goes on the internet to see if anything can be done. She knows this is what Donald would want. She finds a world expert at a world class centre in Boston who has trialled a new treatment, X, on ten patients and has obtained significant results in one of them. She calls the expert and he tells her there is some chance of some improvement in her husband but it is low.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.