Tag: right to die

Bioethics Blogs

India Supreme Court Declares Right to Privacy

This week, the Supreme Court of India ruled that privacy is a fundamental right.


While not framed as a right to die case, at least one concurring justice observed: “An individual’s rights to refuse life prolonging medical treatment or terminate his life is another freedom which fall within the zone of the right of privacy.”


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

Brain Injury and the Civil Right We Don’t Think About

August 25, 2017

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And there was something else: She at times was able to use her left eye to answer simple yes or no questions. That morning, she seemed to relish her new found fluency. She responded with verve, as if the determined downward swoop of her eye could signal an exclamation point.

Communicating with one eye may not seem like much, but it was something to behold. Maggie, as she was known, had suffered a complex stroke six years earlier, during her senior year at Smith College, that involved areas deep in her brain. She had been thought to be in the “vegetative state” — the term commonly used to define the unconscious brain state most of us associate with the right to die movement and the legacies of Karen Ann Quinlan, Nancy Cruzan and Terri Schiavo.

Later, Maggie was found to be in the “minimally conscious state” — a term medically formalized in 2002. Unlike vegetative patients, those in MCS are conscious. They demonstrate intention, attention and memory. They may reach for a cup, say their name and notice you when you walk into their room. The problem is that these actions may be rare and intermittent, so when family members who witnessed them share their observations with staff members, they are often attributed to a family’s wishful thinking.

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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

Quinlan at 40: Exploring the Right to Die in the U.S.

In November 2016, the Georgia State University College of Law hosted a symposium: “Quinlan at 40: Exploring the Right to Die in the U.S.”


Four published articles from this symposium are now available from the law review’s website.


Distinctive Factors Affecting the Legal Context of End-Of-Life Medical Care For Older Persons
Marshall B. Kapp


Ending-Life Decisions: Some Disability Perspectives
Mary Crossley


Unbefriended And Unrepresented: Better Medical Decision Making For Incapacitated Patients Without Healthcare Surrogates
Thaddeus Mason Pope


2016-2017 Georgia State University Law Review Symposium: Exploring the Right To Die In The U.S.
Margaret Pabst Battin

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

UpToDate – Legal Aspects in Palliative and End of Life Care in the United States

I am delighted to contribute to UpToDate, starting with “Legal Aspects in Palliative and End of Life Care in the United States.”


UpToDate is an evidence-based clinical decision support resource which clinicians trust to make the right point-of-care decisions. More than 6,500 world-renowned authors, editors, and peer reviewers use a rigorous editorial process to synthesize the most recent medical information into trusted, evidence-based recommendations that are proven to improve patient care and quality. 


Over 1.3 million clinicians in 187 countries and nearly 90% of major academic medical centers in the United States rely on UpToDate to provide the best care. More than 80 research studies confirm widespread usage of UpToDate and the association of its use with improved patient care and hospital performance — including reduced length of stay, fewer adverse complications, and lower mortality.


UpToDate is a product of Wolters Kluwer Health.  I co-author a related publication for Wolters Kluwer Law and Business: the 1500-page reference Right to Die: The Law of End-of-Life Decisionmaking.

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

How you’ll grow up, and how you’ll grow old

By Nathan Ahlgrim
Nathan Ahlgrim is a third year Ph.D. candidate in the Neuroscience Program at Emory. In his research, he studies how different brain regions interact to make certain memories stronger than others. In his own life, he strengthens his own brain power by hiking through the north Georgia mountains and reading highly technical science…fiction.

An ounce of prevention can only be worth a pound of cure if you know what to prevent in the first place. The solution to modifying disease onset can be fairly straightforward if the prevention techniques are rooted in lifestyle, such as maintaining a healthy diet and weight to prevent hypertension and type-II diabetes. However, disorders of the brain are more complicated – both to treat and to predict. The emerging science of preclinical detection of brain disorders was on display at Emory University during the April 28th symposium entitled, “The Use of Preclinical Biomarkers for Brain Diseases: A Neuroethical Dilemma.” Perspectives from ethicists, researchers conducting preclinical research, and participants or family members of those involved in clinical research were brought together over the course of the symposium. The diversity of panelists provided a holistic view of where preclinical research stands, and what must be considered as the field progresses.
Throughout the day, panelists discussed different ethical challenges of preclinical detection in the lens of three diseases: preclinical research and communicating risk in the context of Autism Spectrum Disorder (ASD), interventions and treatment of preclinical patients in the context of schizophrenia, and the delivery of a preclinical diagnosis and stigma in the context of Alzheimer’s disease.

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

The Right to Die The Law of End-of-Life Decisionmaking – 2nd 2017 Supplement

For decades, Wolters Kluwer has been publishing an annual supplement for The Right to Die: The Law of End-of-Life Decisionmaking.  This year, we are moving to a semi-annual plan.  So, there will soon be a second 2017 update, the “2017-2 Supplement.”


Highlights of this extra supplement cover the most recent legal developments—judicial cases, legislation, and news accounts of important legal proceedings that are not officially reported—concerning end-of-life decisionmaking. Some (and there are many more) specific important matters covered in the supplement include:

  • The passage of statutes authorizing medical aid-in-dying in two more states, bringing the total number of jurisdictions in which the practice is legal to seven.
  • The passage of statutes explicitly criminalizing or otherwise prohibiting aid-in-dying in two more states.
  • The passage of statutes authorizing default surrogate priority lists in two more states.
  • An innovative Montana statute authorizing physician decisionmaking for incapacitated unrepresented patients with no surrogate, agent, or guardian.
  • The passage of a statute authorizing a POLST program, bringing the total number of jurisdictions formally authorizing or regulating POLST to thirty-three. 
  • A Kansas statute forbidding the institution of a DNR order for a minor without consent from the parent or guardian. 
  • The passage of statutes in four states both forming palliative care and quality of life task forces and directing health departments to promote both professional and consumer palliative care education.
  • A strong statement of support for autonomy through advance directives from the California Court of Appeals as it awarded attorneys’ fees to a governmental agency that challenged the end-of-life decisionmaking of a husband, with his wife as agent, supported by the health providers involved in his care. 

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

The Right to Die The Law of End-of-Life Decisionmaking – 2nd 2017 Supplement

For decades, Wolters Kluwer has been publishing an annual supplement for The Right to Die: The Law of End-of-Life Decisionmaking.  This year, we are moving to a semi-annual plan.  So, there will soon be a second 2017 update, the “2017-2 Supplement.”


Highlights of this extra supplement cover the most recent legal developments—judicial cases, legislation, and news accounts of important legal proceedings that are not officially reported—concerning end-of-life decisionmaking. Some (and there are many more) specific important matters covered in the supplement include:

  • The passage of statutes authorizing medical aid-in-dying in two more states, bringing the total number of jurisdictions in which the practice is legal to seven.
  • The passage of statutes explicitly criminalizing or otherwise prohibiting aid-in-dying in two more states.
  • The passage of statutes authorizing default surrogate priority lists in two more states.
  • An innovative Montana statute authorizing physician decisionmaking for incapacitated unrepresented patients with no surrogate, agent, or guardian.
  • The passage of a statute authorizing a POLST program, bringing the total number of jurisdictions formally authorizing or regulating POLST to thirty-three. 
  • A Kansas statute forbidding the institution of a DNR order for a minor without consent from the parent or guardian. 
  • The passage of statutes in four states both forming palliative care and quality of life task forces and directing health departments to promote both professional and consumer palliative care education.
  • A strong statement of support for autonomy through advance directives from the California Court of Appeals as it awarded attorneys’ fees to a governmental agency that challenged the end-of-life decisionmaking of a husband, with his wife as agent, supported by the health providers involved in his care. 

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

The Right to Die The Law of End-of-Life Decisionmaking – 2nd 2017 Supplement

For decades, Wolters Kluwer has been publishing an annual supplement for The Right to Die: The Law of End-of-Life Decisionmaking.  This year, we are moving to a semi-annual plan.  So, there will soon be a second 2017 update, the “2017-2 Supplement.”


Highlights of this extra supplement cover the most recent legal developments—judicial cases, legislation, and news accounts of important legal proceedings that are not officially reported—concerning end-of-life decisionmaking. Some (and there are many more) specific important matters covered in the supplement include:

  • The passage of statutes authorizing medical aid-in-dying in two more states, bringing the total number of jurisdictions in which the practice is legal to seven.
  • The passage of statutes explicitly criminalizing or otherwise prohibiting aid-in-dying in two more states.
  • The passage of statutes authorizing default surrogate priority lists in two more states.
  • An innovative Montana statute authorizing physician decisionmaking for incapacitated unrepresented patients with no surrogate, agent, or guardian.
  • The passage of a statute authorizing a POLST program, bringing the total number of jurisdictions formally authorizing or regulating POLST to thirty-three. 
  • A Kansas statute forbidding the institution of a DNR order for a minor without consent from the parent or guardian. 
  • The passage of statutes in four states both forming palliative care and quality of life task forces and directing health departments to promote both professional and consumer palliative care education.
  • A strong statement of support for autonomy through advance directives from the California Court of Appeals as it awarded attorneys’ fees to a governmental agency that challenged the end-of-life decisionmaking of a husband, with his wife as agent, supported by the health providers involved in his care. 

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

Bending the Odds: Pedagogy and Dialogue in Large Lecture Courses by Sandra Hyde

As academics in large public research universities, I am always amazed that when we speak of an ideal pedagogy, we speak about our small intimate seminars where we have the time and resources to experiment with 25 students or less. In my 13 years of teaching, I look forward to those settings when I get to teach one small undergraduate seminar a year. Over the years, I have also tried to make my large lecture hall shrink by trying to utilize different techniques to foster student based learning and most important, to create more interactive group problem solving and reduce the teacher as lord model of education. While this often works in small seminars, those wonderful nuggets of intimate interactive learning, I find it a challenge to accomplish this when I am in large lecture halls (over 200 students) with limited to graduate student teaching support.

In a large Introduction to Medical Anthropology course (what is called Anthropology 227 at McGill), I have worked over the years to integrate more student-interactive learning. I often compare teaching this course to managing a large ocean-liner with staff of different standing and students who are extremely eclectic as they are drawn from across campus from multiple faculties. For example, students in engineering and medicine will take the course as their one social science requirement and for others they find introduction to medical anthropology intriguing. Students in the humanities are also looking to take their one social science course. There are also medical practitioners and their allied health colleagues often nursing students returning to university to complete their BS.

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.