Wednesday, May 23, 2018

California AG Files Appeal in From Court Decision Setting Aside Physician-Aided Death Law

Both Becky and I have written about a California trial court's recent ruling that a California's law permitting physician assistance in death was enacted in an unconstitutional manner.  The judge granted a window of five days before the ruling would become effective, to permit any appeal. That appeal has now been filed by the California Attorney General.  From the Los Angeles Times:  

California Atty. Gen. Xavier Becerra on Monday filed an appeal against a judge's recent ruling overturning the state's physician-assisted suicide law. . . . 

 

Becerra's action Monday moves the case to an appeals court, which will decide the future of the law. He also asked that the law stay in place while the matter is further litigated, a request that will most likely be granted, said Kathryn Tucker, an attorney who heads the End of Life Liberty Project at UCSF/UC Hastings Consortium on Law, Science & Health Policy.

As Becky says, stay tuned.  But probably best not to hold your breath while awaiting the next ruling. 

May 23, 2018 in Advance Directives/End-of-Life, Current Affairs, Ethical Issues, Health Care/Long Term Care, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Monday, May 21, 2018

California Aid-in-Dying Law Overturned

A number of news outlets reported that a trial court judge has overturned California's aid-in-dying law. As an example, the LA Times reported Riverside judge overturns California's doctor-assisted suicide law. The judge ruled "that the California Legislature violated the law by passing the End of Life Option Act during a special session dedicated to healthcare issues, according to the plaintiffs in the case as well as advocates for the law."  The law, which has been in effect about 6 months, has already been used, according to sources quoted in the article.  "In the first six months California's law was in effect, more than 100 people made use of it to end their lives. Fifty-nine percent of them had cancer, according to state data." Both sides on this issue are quoted in the article. The state attorney general has 5 days from the order's entry to file an appeal.

Stay tuned.

 
 

May 21, 2018 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Health Care/Long Term Care, Other, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Thursday, May 17, 2018

State Judge Overturns California's Assisted Suicide Law

On May 15, 2018, a state judge issued a long-awaited ruling, concluding that the California Legislature violated the state constitution by enacting the state's End of Life Option Act that became effective in 2016 during a 2015 special session dedicated to healthcare issues.  From the Los Angeles Times:

A Riverside County judge overturned California's physician-assisted suicide law on Tuesday, giving the state attorney general five days to file an appeal to keep the law in place.

 

California's law, which allows terminally ill patients to request lethal medications from their doctors, has been the subject of a fierce and emotional debate since it was approved in 2015. The state was the fifth in the nation to legalize the practice.

 

Superior Court Judge Daniel A. Ottolia said Tuesday that the California Legislature violated the law by passing the End of Life Option Act during a special session dedicated to healthcare issues, according to the plaintiffs in the case as well as advocates for the law.

 

"We're very happy with the decision today," said Alexandra Snyder, head of the Life Legal Defense Foundation, one of the groups that filed the lawsuit. "We will now wait and see what the attorney general does."

 

In a statement emailed to The Times, California Atty. Gen. Xavier Becerra said: "We strongly disagree with this ruling and the state is seeking expedited review in the Court of Appeal."

For more, read Riverside Judge Overturns California's Doctor-Assisted Suicide Law.

May 17, 2018 in Advance Directives/End-of-Life, Current Affairs, Ethical Issues, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Thursday, May 10, 2018

David Goodall Has Ended His Life

Earlier in the week we'd blogged about Australian David Goodall who, at 104, had decided he'd lived more than long enough and traveled to Switzerland to end his life.  The New York Times, among other news outlets, reported that he has done so. A Song Before Dying: David Goodall, 104, Australian Scientist, Ends His Life in Switzerland reports that "[o]n Thursday, Mr. Goodall died about 12.30 p.m. local time, according to Exit International, a right-to-die organization of which he had been a longtime member."  His decision has caught a lot of media attention, and the article relates that he held a final press conference the day before his death.

He was crystal clear about why he had chosen “the Swiss option.” Euthanasia and assisted dying are banned in Australia, though Victoria State has passed a law on assisted dying that goes into effect next year; it will apply only to terminally ill patients who have a life expectancy of no more than six months... He said he hoped his life story would “increase the pressure” on Australia to change its laws. “One wants to be free to choose his death when death is at the appropriate time,” Mr. Goodall said.

Mr. Goodall wanted no events marking his death. The article concludes that when he was asked "[h]ow would he like to be remembered? “As an instrument of freeing the elderly from the need to pursue their life irrespective,” he said at the news conference on Wednesday. .. At one point, he was asked what tune he would choose for his last song, and he said the final movement of Beethoven’s Ninth Symphony. Then he began to sing, with verve and vigor... According to Mr. Nitschke, Mr. Goodall did end up choosing Beethoven, and he died the moment “Ode to Joy” concluded."

 

*updated to correct location

May 10, 2018 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Health Care/Long Term Care, International, Other | Permalink | Comments (0)

Tuesday, May 8, 2018

Being "too old" as the basis for seeking Aid-in-Dying?

Last week the Washington Post ran an article about Australian David Goodall. This Australian scientist just turned 104. Now he’s flying to Switzerland to die explains that Goodall thinks he has lived too long. "When asked whether he had a nice birthday, he told the news organization: 'No, I’m not happy. I want to die. ... It’s not sad, particularly. What is sad is if one is prevented. My feeling is that an old person like myself should have full citizenship rights, including the right of assisted suicide,' the 104-year-old man added." In the article he expressed regret that he had to leave his home country to travel to another where aid-in-dying is available. The article reviews the laws in various European countries as well as the states in the U.S. that have legalized medical aid-in-dying.

Goodall has been active for many years as an "honorary research assistant", but his long career has had some blips. The article reports that in 2016 "the school ... deemed him unfit to continue making the trek to campus.... after nearly two decades on the campus, Goodall was told to leave amid concerns about his well-being. The incident gained international media attention, with Goodall, then 102, calling it ageism in the workplace.... University officials later reversed their decision."

His goal is to die on May 10.  According to CNN earlier today, he has checked into a clinic in Switzerland.

May 8, 2018 in Advance Directives/End-of-Life, Consumer Information, Health Care/Long Term Care | Permalink | Comments (0)

Thursday, April 26, 2018

Commission on Law & Aging-Latest Issue of BIFOCAL

Happy Friday! If you haven't read the latest issue of BIFOCAL, the publication of the American Bar Association Commission on Law & Aging, check it out here. This issue contains 6 articles, including the implications of the tax bill on older Americans, POLST issues to avoid, the new Medicare cards, a book review, and a preview of the 2018 NALC conference.  Access the latest issue here.

April 26, 2018 in Advance Directives/End-of-Life, Books, Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare, Programs/CLEs | Permalink | Comments (0)

Wednesday, April 18, 2018

New Issue Brief from National Center on Law & Elder Rights

The National Center on Law & Elder Rights has released an issue brief, Drafting Advance Planning Documents to Reduce the Risk of Abuse or Exploitation.  The issue brief offers 4 key lessons:

  1. Extra care in the creation of advance care planning documents can reduce the risk of abuse and exploitation.
    2. Requiring accountability, additional checks and balances, and limited authority are drafting tools lawyers can utilize to limit risk of abuse.
    3. Attorneys should advise clients to be extra diligent when selecting the agent(s) named in advance planning documents.
    4. Authorizing revocation by third parties can help to limit the damage done by named agents who start to abuse or exploit the client. 

I was intrigued by #4-the idea of naming a third party who could step in.  The section, Five Safeguards to Consider Adding to a Financial POA discusses that among others.  Here's how the issue brief explains the third party revocation provision: "Grant a power to revoke the agent’s authority to a trusted third person. This is a serious power to give any third person, so it requires an exceptional level of trust and reliability in the third person. But, if the agent’s actions prove seriously out of line, this can be a last resort. Some powers of attorney also authorize law enforcement or adult protective services to revoke the authority of the agent if they believe abuse or exploitation is taking place." Sample language is also included for each of the 5 Safeguards.

The brief discusses selection of agents and drafting health care directives in addition to drafting POAs. Practice tips are included as well as case examples. The issue brief is available here.

To learn more about the corresponding webcast click here.  To download the PowerPoint for the webcast, click here.

April 18, 2018 in Advance Directives/End-of-Life, Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, Other, Programs/CLEs, Property Management, State Statutes/Regulations, Webinars | Permalink | Comments (0)

Monday, April 16, 2018

Hawaii Governor Signs Medical Aid-in-Dying bill

Hawaii's governor signed into law the medical aid-in-dying bill, making medical aid-in-dying legal in Hawaii starting January 1, 2019.  Hawaii is now the 6th state with a statute, in addition to the District of Columbia.  Montana dealt with the issue via a Montana Supreme Court opinion.  The Hawaii law provides safeguards. The law is known as "'Our Care, Our Choice' Act" and according to the article published in the Honolulu paper, took two decades to become a reality.

April 16, 2018 in Advance Directives/End-of-Life, Current Affairs, Health Care/Long Term Care, State Statutes/Regulations | Permalink | Comments (0)

Sunday, April 15, 2018

Do The Hospital Doctors See Your Advance Directives?

Of late it seems to me that we have seen a lot of articles dealing with issues regarding end of life wishes.   The New York Times ran an article in late March about doctors actually seeing a patient's advance directive.  You’ve Detailed Your Last Wishes, but Doctors May Not See Them is written by a doctor who summarizes first-hand experiences in a hospital with one patient in the ER who "had done everything we could have asked. He’d been brave enough to talk with his doctors about his cancer and acknowledge that time was short. He had designated a health care proxy. But there he was, surrounded by strangers, the intubation he never would have wanted looming and the record of that conversation buried in his electronic record." 

Here's how the doctor described the problem, as "not about individuals, but instead about a system that doesn’t sufficiently protect patients from getting care they do not want."  The issue it seems is documenting the info or the ability to retrieve the info in the chart.

This doctor "delved into the unexpectedly interesting world of advance care planning and electronic health records, interviewing clinicians with on-the-ground experience recording and retrieving these conversations and representatives from the companies behind some of the most widely used electronic records."  The stories shared are quite interesting and highlights the issues that arise without a national standard.

Here are some suggestions the author included in the article:

What could really make a meaningful difference, I heard time and time again, is standards for sharing, or “interoperability” across all electronic records that would benefit every patient, everywhere. At least, all related advance care planning documentation should be in one place in the medical record and accessible with one simple click of the mouse. Beyond that, maybe all health systems could require identification of a health care proxy for all patients, so we would know who should make decisions if the patient can’t. Maybe patients should be able to access their health records through a patient-facing interface, send in their own directives, or even update related notes. Ideally, the electronic record isn’t just a clunky online version of a paper chart but actually a tool to help us do our jobs better.

 

April 15, 2018 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Health Care/Long Term Care, State Statutes/Regulations | Permalink | Comments (2)

Wednesday, April 11, 2018

Mark Your Calendars: Drafting Advance Planning Documents to Reduce the Risk of Abuse or Exploitation

Mark your calendars for April 18, 2018 at 2 p.m. edt for a free webinar from the National Center on Law & Elder Rights, Drafting Advance Planning Documents to Reduce the Risk of Abuse or Exploitation. Here is the description that I received in the email announcing the webinar:

In 2016, Medicare began reimbursing physicians for counseling beneficiaries about advance-care planning. At around the same time, Health Affairs released a study finding that only one-third of older adults have completed any health care planning documents. For attorneys counseling older adults, completing advance planning documents is just one part of care planning. Drafting these documents in a way that reduces the risk of abuse and exploitation is a critical component of providing good counsel.

This webcast will discuss ways to work with clients to select lower-risk agents, tools to document and communicate health care values, and tips for drafting documents to reduce the risk of exploitation.

To register, click here.

April 11, 2018 in Advance Directives/End-of-Life, Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Estates and Trusts, Health Care/Long Term Care, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Tuesday, April 10, 2018

Right to Try Bill Passes House on Second Try

According to the New York Times, late last month, the House of Representatives passed the right to try bill on their second attempt. House Passes Bill That Would Give Patients Access to Experimental Drugs explains that "[s]upporters said the bill would give dying patients a chance to obtain potentially helpful prescription drugs without waiting for the completion of clinical trials or going through a process established by the Food and Drug Administration to allow the use of “investigational drugs” outside clinical trials." There were supporters as well as opponents of the bill. 

The House and Senate bills would establish a new pathway providing access to unapproved medicines for certain patients who had exhausted other treatment options. To qualify under the House bill, a patient would have to have some kind of terminal illness: a condition that is likely to cause death “within a matter of months” or “irreversible morbidity that is likely to lead to severely premature death.”

Nothing in the bill would require pharmaceutical companies to provide experimental drugs to patients who requested them. Drug manufacturers sometimes turn down requests because they have only a limited supply or they are concerned about legal and medical risks.]

To address such concerns, the legislation would shield drugmakers, doctors and hospitals from some of the legal risks of providing unapproved drugs to patients. Doctors and hospitals would generally be protected unless they engaged in gross negligence or willful, reckless or criminal misconduct.

April 10, 2018 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Other, Science | Permalink | Comments (0)

Sunday, April 8, 2018

As Individuals with Developmental Disabilities Live Longer, They May Outlive Caregiver Parents

During Dickinson Law's recent program on Dementia Diagnosis and the Law, one of our panelists, Elder Law practitioner Sally Schoffstall raised an issue planning professionals are seeing more often, families who are concerned about the long-range needs of children with developmental disabilities. I know that over the years I have often had law students whose interest in disability and estate planning law began with a brother or sister with special needs, and they are thinking about their own future roles in helping the family plan. 

The good news is that better early health care often means an extended life for disabled children, but that very fact raises the probabilities on living longer than the people who have been primary caregivers, especially their parents. As we heard from medical professionals at our conference, individuals with Down Syndrome, for example, are now less likely to succumb to physical impairments such as developmental  heart problems, but still face a significant risk of early onset of dementias, with an estimated 30 percent of those in their 50s already experiencing symptoms similar to Alzheimer's Disease.  

On May 21-22, a St. Louis-based nonprofit organization, Association on Aging with Developmental Disabilities (AADD) will hold its 28th annual conference.  The conference draws an audience of professionals from a wide range, including social workers, nurses and other service providers.  As with most people, individuals with disabilities want to "age in place," and that takes extra planning to manage financial assets.  Pamela Merkle, executive director for AADD explains:

"Sessions will focus on giving them the tools they need to successfully support people with developmental disabilities who are aging,” says Merkle. 

 

She explains that many of the issues faced by older persons with developmental disabilities mirror those of aging individuals in general, such as isolation, depression and how to handle retirement. “Like most people, they want to ‘age in place,’ not spend their golden years in a nursing home. Given that living within the community is more cost-effective, it’s important to both the seniors and our communities that there be more public programs to support that choice,” she continues. . . . 

 

For individuals who are 50 or older, AADD offers retirement services. While some of the participants have held community-based jobs, others spent decades in sheltered workshops. As with many members of the general population, they often tend to define themselves through the jobs they held for so many years. “So we focus on identity: ‘I’m a volunteer” or “I’m active in my church,’” explains Merkle. “If you don’t have something in place to fill the void after retirement and to maintain the skills you’ve developed, you’ll retire to your couch. You won’t be an active part of the community, and will most likely spend your “golden years” alone.”

For more, see this commentary from the Special Needs Alliance, and look for related links.  My thanks to Sally for providing links to this conference information! 

April 8, 2018 in Advance Directives/End-of-Life, Cognitive Impairment, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Estates and Trusts, Ethical Issues, Health Care/Long Term Care, Housing, Legal Practice/Practice Management, Programs/CLEs | Permalink | Comments (0)

Tuesday, April 3, 2018

More on Dementia Advance Directives

Recently we wrote about a dementia advance directive and now, Kaiser Health News has a story about an ‘Aggressive’ New Advance Directive Would Let Dementia Patients Refuse Food. where "a New York end-of-life agency has approved a new document that lets people stipulate in advance that they don’t want food or water if they develop severe dementia. ...The directive, finalized [in March] by the board for End Of Life Choices New York, aims to provide patients a way to hasten death in late-stage dementia, if they choose.."  The article explains that although dementia is a terminal condition, the medicaid aid-in-dying laws don't apply to someone with it. So instead, "[t]he document offers two options: one that requests “comfort feeding” — providing oral food and water if a patient appears to enjoy or allows it during the final stages of the disease — and one that would halt all assisted eating and drinking, even if a patient seems willing to accept it."

There was a significant amount of press coverage about whether an advance directive covers hand feeding as a result of a case out west where a patient with an advance directive was hand fed over her husband's objections.  Typically the directives are silent about the provision of food and fluids by hand. Here, "[t]he New York directive, in contrast, offers option A, which allows refusal of all oral assisted feeding. Option B permits comfort-focused feeding.... [with] both options ... invoked only when a patient is diagnosed with moderate or severe dementia, defined as Stages 6 or 7 of a widely used test known as the Functional Assessment Staging Tool (FAST). At those stages, patients would be unable to feed themselves or make health care decisions."  This document is different than the one  we reported on in our earlier blog post. As the article explains, "[t]he new form goes further than a similar dementia directive introduced last year by another group that supports aid-in-dying, End of Life Washington. That document says that a person with dementia who accepts food or drink should receive oral nourishment until he or she is unwilling or unable to do so... [while the]  New York document says, 'My instructions are that I do NOT want to be fed by hand even if I appear to cooperate in being fed by opening my mouth.'"

Experts interviewed for the article expressed concerns about whether such instructions would be honored.

Stay tuned.

 

April 3, 2018 in Advance Directives/End-of-Life, Cognitive Impairment, Consumer Information, Dementia/Alzheimer’s, Health Care/Long Term Care, State Cases, State Statutes/Regulations | Permalink | Comments (1)

Monday, April 2, 2018

Supported Decision-Making as an Alternative to Adult Guardianship

Dickinson Law Presentation and Panel Discussing Guardianship Oversight and the Courts 3.29.18During the Continuing Judicial Education program on "Dementia Diagnosis and the Law" at Dickinson Law on March 29, I offered a list of developments potentially affecting the future of guardianships.  One item on my list could have been a stand-alone session in and of itself -- the concept of supported decision-making.  I promised the audience I would post some additional materials on the topic here.  

For background, as we discussed with the judges, under most states' laws governing guardianships, courts are obligated to search for the least restrictive alternative to a plenary guardianship.  Courts sometimes struggle with this issue, especially for older adults, if the incapacitating issue proves to be any of the forms of progressive neurocognitive disorders associated with dementia. If a judge makes a finding of incapacity, and if there is an appropriate, trustworthy guardian available, the judge may feel that it is better to leave it up to the appointed individual to strike the right balance between protection and autonomy on individual issues such as choice of housing or daily activities.  The court might find that granting full powers, but trusting the guardian to exercise the powers appropriately, is better than requiring the parties to return to the court for a series of orders, as the incapacity advances, conferring new directions for the guardian to follow. 

During the conference we confronted the issues driving the recent calls for reform of guardianship systems, including the latest well-publicized incidents of abuse of authority by an appointed guardian or a private guardianship agency, in locations such as Las Vegas, Nevada and New Mexico.

A published commentary by Cardozo Law's Rebekah Diller, an associate clinical professor, explains the movement behind supported-decision making as a better alternative: 

During  the last several decades, guardianship has been the subject of continual calls for reform, often spurred by revelations of guardian malfeasance and other abuses in the system. Recent developments in international human rights law and disability rights advocacy, however, pose a more fundamental challenge to the institution. Article 12 of the United Nations Convention on the Rights of Persons with Disabilities (CRPD), with its declaration that everyone, regardless of mental disability or cognitive impairment, is entitled to make decisions and have those decisions recognized under the law, offers no less than a promise to end adult guardianship as we know it.

So, what exactly is "supported decision-making?" Professor Diller explains:

 The support can take the form of accessible formats or technological assistance in communication.  Or it can take the form of "supported decision-making" arrangement, in which "supporters" assist individuals with decision-making in relationships of trust. In whatever form, the support is an appropriate accommodation that enables the individual to enjoy the right to legal capacity.

The author warns there is no single model for supported decision-making.  Ideally, the individual designates in advance his or her desired supporter, and the movement behind this approach believes this selection can be recognized even if the individual might not be found to have the requisite capacity to enter into a contract or to execute a formal power of attorney. 

In 2015, Texas became the first state in the U.S. to pass a supported decision-making statute, and the Texas statutory approach views this option as a better alternative for individuals who need assistance in making decisions about activities of daily living, but who are not considered to be "incapacitated" as that concept is defined in guardianship law.  The Texas statute contemplates an individual who can act voluntarily, in the absence of coercion or undue influence. Information about Texas' law is available here. 

In 2016, Delaware became the second state to enact legislation enabling the option of Supported Decision-Making, with Senate Bill 230.  

In 2012, the ABA Commission on Disability Rights and the ABA Commission on Law and Aging, working with U.S. government representatives, hosted a round table discussion on supported decision making for individuals with "intellectual disabilities."   The ABA captured a host of materials related to this discussion on this website.

In 2017, the ABA House of Delegates adopted a resolution on supported decision-making and endorsed its possible use as a less-restrictive alternative to guardianship, including use of this approach as grounds for termination of an existing guardianship and restoration of rights.   

Earlier this year, on February 15, 2018, the ABA hosted a webinar on "Supported Decision-Making as a Less Restrictive Alternative: What Judges Need to Know."  While the webinar appears to have been offered only as a one-time "live" option, perhaps a recording will become available in the near future.  Here's an ABA webpage providing details. 

My special thanks to Pennsylvania Elder Law Attorney Sally Schoffstall, who served as a panelist at the Dickinson Law event last week, for providing me with a copy of The Arc's information on the Texas Supported Decision-Making law, linked above. Additional thanks to Dickinson Law James Adams for photographing the conference! 

April 2, 2018 in Advance Directives/End-of-Life, Cognitive Impairment, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Estates and Trusts, Ethical Issues, Legal Practice/Practice Management, Programs/CLEs, Property Management, State Statutes/Regulations | Permalink | Comments (0)

Friday, March 30, 2018

Medically-Assisted Dying Advances in Hawaii

The Hawaii legislature has approved legislation to legalize Medical Aid-in-Dying, according to the New York Times. Doctor-Assisted Suicide Close to Becoming Law in Hawaii reports that the bill now goes to the Hawaii governor, who has indicated that he will sign the bill.  The bill contains safeguards similar to other medical aid-in-dying statutes, including

a requirement that two health care providers confirm a patient's diagnosis, prognosis, ability to make decisions and that they voluntarily made the request. A counselor also must determine that the patient is capable and does not appear to be suffering from a lack of treatment of depression.

The patient must make two oral requests for the life-ending medication, with a 20-day waiting period between each. They also must sign a written request witnessed by two people, one of whom can't be a relative.

The measure creates criminal penalties for anyone who tampers with a request or coerces a prescription request.

Assuming the Governor signs the bill, Hawaii will be the 6th state to have such a law, joining Washington, Oregon, Vermont, Colorado and California, along with the District of Columbia.  Montana, although without such a statute, has a state supreme court opinion addressing the issue.

March 30, 2018 in Advance Directives/End-of-Life, Consumer Information, Crimes, Current Affairs, Health Care/Long Term Care, State Statutes/Regulations | Permalink | Comments (0)

Monday, March 19, 2018

Med Students Learn to Talk About Dying

Kaiser Health News featured a story about teaching med students how to talk about death to patients and families. Oregon Medical Students Face Tough Test: Talking About Dying features a test administered to med students in Oregon. " OHSU officials say they’re the first medical students in the U.S. required to pass a tough new test in compassionate communication."

Compassionate communication test requires that the med students "[b]y graduation this spring ... be able to show that, in addition to clinical skills, they know how to admit a medical mistake, deliver a death notice and communicate effectively about other emotionally and ethically fraught issues."  The curriculum was revamped to incorporate "communication, ethics and professionalism" throughout.   Communication is required learning in all medical schools but the OSHU approach may be groundbreaking with the evaluation component.  

March 19, 2018 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Ethical Issues, Health Care/Long Term Care | Permalink | Comments (0)

Sunday, March 18, 2018

No Right To Try Law Yet

Two weeks ago we reported that the House of Representatives were scheduled to vote on the Right to Try Bill that had previously passed the Senate.  If you were betting that the House would also pass the bill, you would be .... wrongHouse Rejects Bill to Give Patients a ‘Right to Try’ Experimental Drugs explains the vote wasn't particularly close.  "The bill was considered under special fast-track procedures that required a two-thirds majority for passage, and it fell short. When the roll was called, 259 House members supported the bill, and 140 opposed it." Those that voted against the bill, the majority Democrats, were worried about patient harms, whether creating false hope or harming patients since the drugs wouldn't have gone through the rigorous FDA process. The article quotes one of the House leadership that the bill will be brought back for another vote, but even so there is no guarantee of passage. There are a number of opponents to the bill, including medical personnel and patient advocaates.  "[M]ore than 75 patient advocacy groups, including the lobbying arm of the American Cancer Society, opposed the bill. .. The American Medical Association said it “does not believe that the bill will substantially improve patient access to investigational therapies.” And the American Society of Clinical Oncology, representing cancer doctors, said the bill “could do more harm than good for patients with life-threatening illnesses” because it would remove the Food and Drug Administration from the evaluation of the risks and potential benefits of some treatments."

A House Committee will address the bill on March 19, according to a March 16, 2018 post from Bloomberg BNA Health Care Daily report so stay tuned.

March 18, 2018 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care | Permalink | Comments (0)

Tuesday, March 13, 2018

Expanding the Right to Physician-Aided Dying?

The Washington Post recently ran an article about efforts underway by some folks to expand Oregon's physician-aided dying law to include those individuals who do not have terminal illnesses. In Oregon, pushing to give patients with degenerative diseases the right to die explains efforts to expand the scope of Oregon's law to cover those with degenerative diseases, such as "[p]eople with Alzheimer’s, Parkinson’s, Huntington’s, multiple sclerosis and a host of other degenerative diseases [who] are generally excluded from the Oregon law." Why? you might ask. "[B]ecause some degenerative diseases aren’t fatal. People die with Parkinson’s, for example, not because of it. Other diseases, such as advanced Alzheimer’s, rob people of the cognition they need to legally request the suicide medications."

The article notes that this effort isn't limited to just Oregon. In fact, there are "[r]elatively modest drives ... afoot in Washington state and California, where organizations have launched education campaigns on how people can fill out instructions for future caregivers to withhold food and drink, thereby carrying out an option that is legal to anybody: death by starvation and dehydration. (It is often referred to as the “voluntarily stopping eating and drinking” method.)"

Interestingly, the article reports that not all in the right to die movement are in favor of broadening the law.  In fact "groups such as Compassion & Choices, the nation’s largest right-to-die organization, and the Death With Dignity National Center, a main author of the original law, have little appetite for widening access to lethal drugs in the states where medically assisted suicide already is legal."

These initiatives aren't just limited to the U.S. The story reports in Canada The Quebec "provincial government is studying the possibility of legalizing euthanasia for Alzheimer’s patients. Unlike medically assisted suicide, a medical doctor would administer the fatal dose via injection. A survey in September found that 91 percent of the Canadian province’s medical caregivers support the idea."

The Oregon legislature has taken the first step,  the passage last month of legislation to investigate "how to improve the process of creating and carrying out advance directives. Gov. Kate Brown (D) is expected to sign it."

The article also reminds us of the Harris case where Mrs. Harris, with an advance directive, was spoon fed by the facility where she resided.  There have been a number of folks requesting language added to their advance directives to avoid the spoon-feeding issue according to the attorney for Mr. Harris.

March 13, 2018 in Advance Directives/End-of-Life, Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Health Care/Long Term Care, State Statutes/Regulations | Permalink | Comments (1)

House to Vote on Right To Try Bill

We have previously blogged about right to try laws and the bill making its way through Congress. The House of Representatives is scheduled to vote on the bill today according to the March 12, 2018 Bloomberg's Health Care Daily Report (subscription required). The Report explains

The bill set to be voted on in the House narrowed the Senate-passed version’s definition of who could seek unapproved drugs to “strike the right balance for patients and their safety,” Reps. Greg Walden (R-Ore.), chairman of the House Energy and Commerce Committee, and Michael Burgess (R-Texas), head of the panel’s health subcommittee, said in a joint statement.

If passed, the Senate will have to vote again on the measure or, less likely, form a conference committee to work out the differences, according to a statement from House Majority Leader Rep. Kevin McCarthy (R-Calif.).

I'll report back once we know more.

March 13, 2018 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care | Permalink | Comments (0)

Thursday, March 8, 2018

Young Blood for Anti-Aging?

The subject of this story caught me off guard, having not contemplated it.  Stat ran the story, How a society gala was used to sell young-blood transfusions to baby boomers desperate to cheat death.

The story focuses on a luncheon event in south Florida where audience members were pitched on "[p]aying to participate in a soon-to-launch clinical trial testing transfusions of young blood [which] “offers the greatest potential for everyone in this room to add a lot of healthy years to their life... 'Not only do you get to potentially live longer … but you’re going to be healthier. And some of the chronic problems you have now may disappear.'”  Stat had a number of medical experts review the materials for the clinical trial "and all sharply criticized the study’s marketing, design, and scientific rationale."  Although the final price has yet to be determined, one suggested cost for the treatment was over a quarter of a million dollars.

The article discusses what is involved in clinical trials, other trials with similar goals and general reactions to the proposal.  It is a fascinating article.  It can be used as a jumping off point for a discussion about ageism.

 

 

March 8, 2018 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care | Permalink | Comments (0)