New Case - Arthur Johnson III v. Charlotte Regional Medical Center

On Thursday, 19-year old Florida resident Arthur Johnson III was shot in the head.  He was declared dead and Charlotte Regional Medical Center prepared to harvest his organs consistent with his prior consent.  (Herald Tribune)  But Arthur's parents protested.  They wanted a "second opinion on whether he was actually brain-dead or if he could have recovered."  But the parents were unable to obtain a second opinion and, this afternoon, consented to stopping life support.  Arthur’s parents also objected to the organ procurement.  

As if the case were not sad enough, the Herald-Tribune reports that "Lifelink, the group that handles organ donations in Southwest Florida, typically does not proceed with harvesting if surviving family members object."  Lifelink apparently followed that policy in this case.  Apparently, Arthur had consented to organ donation.  Under Florida law and the law in almost every other state, his parents' consent was not required.  Moreover, the OPO should not allow the parents to "modify, deny, or prevent a donor's wish or intent to make an anatomical gift after the donor's death."  Fla. Stat. Ann. 765.512.

Autonomy at the End of Life - Classic Quote

"Making someone die in a way that others approve, but he believes a horrifying contradiction of his life, is a devastating, odious form of tyranny."

          --  Ronald Dworkin, Life’s Dominion

Addressing Inappropriate Care Provision at the End-of-Life: A Policy Proposal for Hospitals

Carolyn Standley and Brian Liang at California Western School of Law have published "ADDRESSING INAPPROPRIATE CARE PROVISION AT THE END-OF-LIFE: A POLICY PROPOSAL FOR HOSPITALS" in the Michigan State University Journal of Law and Medicine 15 (2010): 137-176.  

This article reviews many of the open issues, though it has two limitations.  First, it appears the article was written over a year ago, making its March 2011 publication a little dated.  Second, it does not grapple with the open issues in a sufficiently detailed manner.  For example, the end of the article offers a model institutional futility policy.  But the final step recommends that "if the disagreement persists after the ethics committee meeting" then the patient should be transferred.  Since such transfers are incredibly hard to find and effect, it seems a model policy really must address that situation.

Winnipeg Health Region Issues Reports on End-of-LIfe Conflict

Yesterday, the Winnipeg Health Region released two reports that examine how achieving consensus between patients (their families and representatives) and health care providers over end-of-life issues can be better supported.  Both reports are available here. 

"End-of-life decisions are personal and difficult," Dr. Brock Wright, WRHA Senior Vice President and Chair of the Regional Working Group, said. "But the vast majority are resolved through consensus. What we're trying to do here is put in place the necessary supports so that everything possible is done to facilitate agreement between families and care providers in the very small number of more complex and contentious situations."

The report produced by the Working Group chaired by Dr. Wright recognizes the College of Physicians and Surgeons of Manitoba's Statement on the topic is binding on all Manitoba physicians, but that broader WRHA policies and procedures that do not conflict with the College Statement, can be established that apply to all WRHA staff, including physicians. (The CPSM's statement is available on the College's website.)

Both reports raise the issue of whether there should be a legislated or internal review process to resolve end-of-life care issues between patients, families and health providers as an alternative to, or intervening step before, pursuing legal action through the justice system.

Minister of Health Theresa Oswald said she considered the suggestion, but thought it more appropriate for the region to put in place the support and resources to avoid disagreements between patients, their families and health professionals.

"Decisions about end of life care are sensitive, personal and best left to patients, their families and their doctors. We believe efforts should be directed to the resources and education that can support those decisions and prevent or resolve disputes between patients, families and health care teams rather than creating an additional legislated panel for patients or families to navigate in what would already be an extremely difficult situation," Minister Oswald said. "Patients' wishes about end-of-life-care should be identified as early as possible, and initiatives currently being implemented by the WRHA will help to clarify and honour those wishes."

Rasouli v. Sunnybrook - Ontario Physicians Must Use CCB to Resolve Futility Disputes

A couple of weeks ago, the Ontario Court of Justice issued its opinion in Rasouli v. Sunnybrook Health Sciences.  I posted a copy of the opinion here.  Some earlier Canadian cases (outside Ontario) held that physicians need not seek patient or surrogate consent to refuse life-sustaining treatment that they deem inappropriate.  The Ontario court rejected this proposition.  Instead, it ruled that Ontario physicians must use the CCB to resolve medical futility disputes.  

Advance Care Planning - Free Video

Loving Conversations: One Family's Story About the Importance of Advance Healthcare Planning 

The American Health Lawyers Association's Loving Conversations video follows a fictional family through the difficult process of making healthcare decisions for a loved one who did not execute an advance directive. Each dramatization is followed by a didactic session where health lawyers answer some of the questions raised in the video. This video will be helpful in facilitating conversations between you and your client or the healthcare provider and her patient.

National Healthcare Decisions Day in Delaware (April 15, 2011)

Designed for healthcare professionals.  (Public program is on April 16th)