Declining Life Expectancy – Gene Uzawa Dorio, M.D. – Guest Commentary Standard

Declining Life Expectancy Many nations proudly tout “Life Expectancy” as a reflection of healthcare.  In our country, this statistic has continually edged upward due to expanding technology, doctors/patient education, and vibrant emphasis on healthy lifestyles.  A shift is occurring though as this number is destined to decline with hospital administrators, not physicians, making medical decisions impacting those who are the most vulnerable:  Elder seniors in the ICU. These patients have been targeted by unscrupulous business people converting them to palliative care, with a gateway into hospice.  Why would this be financially beneficial to these administrators? Hospitals are paid a fixed…

Death Panels are Alive Standard

In a major medical center in California a 74-year-old patient who suffered a stroke had been in a coma and on a ventilator for one month. There were a variety of complications and comorbidities. According to his physicians the patient was not in a persistent vegetative state, but in a coma. The physicians recommended that the son and surrogate decision maker, consent to withdrawing the vent and allowing his father to die peacefully. His son was also admonished that if he did not consent he would then have 10 days to get his father out of the hospital or his…

Exploiting despair – the death of Jahi McMath Standard

With the onslaught of media coverage of the Jahi McMath case it is time for a public debate on whether or not the loss of upper and lower brain function should determine death.  Brain death is the cessation of any brain activity in the upper brain as well as the lower brain or brain stem. The McMath case should be distinguished from the Terri Schiavo case where only upper brain function was in question. Ms. Schiavo was not determined to be brain dead, but rather a living person in a persistent vegetative state. Brain death is established by numerous objective…

Making Choices Standard

New Year resolutions are sometimes easy to make but hard to keep. Resolutions are choices, choices to live on and to better ourselves. For patients who are critically ill, resolve is often in short supply.  So, to physicians reading this I ask that one of your resolutions this coming year is to speak with patients about their end of life choices and help other physicians do the same. Many physicians are either reluctant to broach the subject, or not very good at discussing these issues, or both. Many feel that they will “cross that bridge when they get to it,”…

The Problem with POLST – Physician Orders for Life-Sustaining Treatment Standard

The Problem with POLST Over the years, informed consent has been given short shrift. There is, however, a growing understanding of the importance of obtaining an actual and legitimate consent before  having a patient accept or reject medical treatment. Autonomy, transparency, respect, dignity, and other similarly recognized human rights are increasingly recognized as legal and ethical requirements. “POLST” (Physician Orders for Life-Sustaining Treatment) however, makes it easy and even inviting to avoid these requirements with the stroke of a pen on a conclusionary form. POLST only makes sense in cases of patients with terminal illnesses, in end stage disease with no…

A Fight Against Providing Informed Consent in SUPPORT- Part II Standard

There have been a number of articles written by well-known physicians and bioethicists expressing great concern over the recent Office for Human Research Protection, OHRP, letter of criticism with respect to the SUPPORT clinical trial. This blog discussed this controversy in the post of May 23, 2013. This controversy has turned dark with efforts to intimidate the OHRP.. Not attractive in the arena of customarily well reasoned debates in the bioethics community. The latest in this saga is a plea signed off on by, as they describe themselves, a group of scholars and leaders in bioethics that was published in…

A Fight Against Providing Informed Consent and The Risk of Randomization in the SUPPORT Clinical Trial Standard

A Fight Against Providing Informed Consent and The Risk of Randomization: Informed Consent in the Surfactant, Positive Pressure, and Oxygenation Randomized Trial (SUPPORT)  by Bernard W. Freedman,JD, MPH     In their article Risk, Consent, and SUPPORT  David Magnus and Arthur Caplan chastise the Office for Human Research Protections (OHRP) for their findings of a failure to provide adequate informed consent as required by federal regulations, in a clinical trial.  The OHRP is right in their position. The underlying clinical trial, Surfactant, Positive Pressure, and Oxygenation Randomized Trial (SUPPORT), published in 2010, sought to evaluate the effects of different levels of…

Waiting for medical records “after discharge” is of no help for decision making Standard

Medical records: Waiting for medical records “after discharge” is of no help.  Reviewing medical records  in the hospital allows the patient and/or a surrogate decision maker to obtain the greatest amount of information possible over the cross section of medical specialties providing care.  It provides a clear picture of the condition of the patient with respect to cognition, pain and prognosis. Review of reports of CT scans, x-rays, and MRI’s can bring a clear picture of improvement and deterioration in the patient’s condition. All of this will ensure that consent is based upon complete information and make it easier for…

Waiting to Speak – Waiting for the Surrogate to Speak Standard

Why Wait The determination of a patient’s capacity to make decisions is based upon her understanding of her disease or illness and the risks and benefits of treatment. If she is unable to articulate a clear understanding it may be determined that she lacks the necessary capacity to make her own decision and is further taken out of the loop of information and adequate and legitimate updates on her condition. Concomitantly, surrogate decision makers are not always available to see the treating physicians and consults, and often get a cursory explanation of the patient’s condition. Physicians remain exceedingly reluctant to…

Failing to Follow Best Practices – Ovarian Cancer Standard

At the 2013 annual meeting on Women’s Cancer by The Society of Gynecologic Oncology (March 9 2012 – Los Angeles) Dr. Robert Bristow, the director of Gynecologic Oncology at the University of California – Irvine presented a retrospective review of the medical records of 13,321 women with ovarian cancer, diagnosed from 1999 through 2006 in California. The study determined that only 37% of the care provided to this cohort adhered to the guidelines set forth by the National Comprehensive Cancer Network setting forth specific surgical procedures and chemotherapy. In women that received the specified protocol, 35% survived at least five years where…