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11 results

  • Physician Authority, Family Choice, and the Best Interest of the Child

  • Alister Browne
  • Journal:
    Cambridge Quarterly of Healthcare Ethics / Volume 31 / Issue 1 / January 2022
    Published online by Cambridge University Press:
    20 January 2022, pp. 34-39

  • Two of the most poignant decisions in pediatrics concern disagreements between physicians and families over imperiled newborns. When can the family demand more life-sustaining treatment (LST) than physicians want to provide? When can it properly ask for less? The author looks at these questions from the point of view of decision theory, and first argues that insofar as the family acts in the child’s best interest, its choices cannot be constrained, and that the maximax and minimax strategies are equally in the child’s best interest. He then proposes a guideline according to which the family can demand LST if it is physiologically possible to preserve a life the child can be expected to welcome, and refuse such treatment if it causes suffering that is “more than can be borne” even if an uncompromised life is expected to emerge.

  • 7 - Aid in Dying in the United States

  • Edited by Ben P. White, Queensland University of Technology, Lindy Willmott, Queensland University of Technology
  • Book:
    International Perspectives on End-of-Life Law Reform
    Published online:
    02 December 2021
    Print publication:
    09 December 2021, pp 145-164

  • Summary

    Until Oregon voters approved an aid-in-dying referendum in 1994, no jurisdiction in the United States had given legal approval to aid in dying. Moreover, fourteen years passed before a second state, Washington, legalised aid in dying. Since then, recognition has accelerated. Now, aid in dying is permitted in nine states and the District of Columbia, with nearly one in four Americans living in a jurisdiction that permits the practice. While a right to aid in dying has taken different paths—voter approval, legislative action, or judicial decision—all legalising US jurisdictions recognise the right in the same basic way: patients must be adults with decision-making capacity, must be terminally ill, and must self-administer the lethal dose of medication. This chapter discusses why the different jurisdictions have converged on the same legal framework for a right to aid in dying. In particular, there are key reasons for limiting a right to aid in dying to patients who are terminally ill (i.e., life-expectancy of six months or less). The chapter also discusses the implications of the common legal framework for future evolution of the right to aid in dying in the United States.

  • 12 - International Perspectives on Reforming End-of-Life Law

  • Edited by Ben P. White, Queensland University of Technology, Lindy Willmott, Queensland University of Technology
  • Book:
    International Perspectives on End-of-Life Law Reform
    Published online:
    02 December 2021
    Print publication:
    09 December 2021, pp 250-276
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  • Summary

    This chapter identifies international trends in end-of-life law reform from analysing ten case studies of reform from the United Kingdom, the United States, Canada, Australia, the Netherlands and Belgium. A key finding is that law reform is more likely to succeed when supported by ‘good process’. This includes effective consultation with key stakeholders and engaging with experts. Social science evidence is also increasingly influential in both legislative and judicial reform, particularly in relation to how assisted dying systems can operate safely in practice. Other factors contributing to reform are the support or advocacy of key individuals or groups, shifts in community sentiment, and changes in political composition of parliaments. The chapter also concludes that law reform is ultimately a political exercise. Compromise is often required for a law to pass. This has implications for designing effective end-of-life law, pointing to the need for critical evaluation of both proposed laws and how existing laws operate in practice. The chapter concludes with reflections about the future of end-of-life law.

  • 1 - End-of-Life Law Reform

  • Edited by Ben P. White, Queensland University of Technology, Lindy Willmott, Queensland University of Technology
  • Book:
    International Perspectives on End-of-Life Law Reform
    Published online:
    02 December 2021
    Print publication:
    09 December 2021, pp 1-16

  • Summary

    This chapter establishes why understanding end-of-life law reform is important and notes the constant agitation for legal changes in the field. It describes in broad terms the issues considered in end-of-life law. They include assisted dying (voluntary euthanasia and assisted suicide), decisions about whether to withhold and withdraw potentially life-sustaining treatment and the law that governs palliative care. There are also some ‘new’ end-of-life practices that sit across these topics such as terminal sedation and voluntarily stopping eating and drinking. The chapter also considers the challenges of law reform. Changing law is generally a difficult undertaking but there are number of features of end-of-life law that make this particularly difficult. Finally, this chapter discusses each of the case study contributions to the book and its proposed overall approach.

  • Patient–physician conversations about life-sustaining treatment: Treatment preferences and participant assessments

  • Lone Doris Tuesen, Hans-Henrik Bülow, Anne Sophie Ågård, Sverre Maintz Strøm, Erik Fromme, Hanne Irene Jensen
  • Journal:
    Palliative & Supportive Care / Volume 21 / Issue 1 / February 2023
    Published online by Cambridge University Press:
    07 December 2021, pp. 20-26
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  • Objective

    In 2019, the Danish parliament issued legislation requiring Danish physicians to clarify and honor seriously ill patients’ treatment preferences. The American POLST (Physician Orders for Life-Sustaining Treatment) document could be a valuable model for this process. The aim of the study was to examine patients' preferences for life-sustaining treatment and participant assessment of a Danish POLST form.

    Methods

    The study is a prospective intervention based on a pilot-tested Danish POLST form. Participant assessments were examined using questionnaire surveys. Patients with serious illness and/or frailty from seven hospital wards, two general practitioners, and four nursing homes were included. The patients and their physicians completed the POLST form based on a process of shared decision-making.

    Results

    A total of 95 patients (aged 41–95) participated. Hereof, 88% declined cardiopulmonary resuscitation, 83% preferred limited medical interventions or comfort care, and 74% did not require artificial nutrition. The preferences were similar within age groups, genders, and locations, but with a tendency toward younger patients being more in favor of full treatment and nursing home residents being more in favor of cardiopulmonary resuscitation. Questionnaire response rates were 69% (66/95) for patients, 79% (22/28) for physicians, and 31% (9/29) for nurses. Hereof, the majority of patients, physicians, and nurses found that the POLST form was usable for conversations and decision-making about life-sustaining treatment to either a high or very high degree.

    Significance of results

    The majority of seriously ill patients did not want a resuscitation attempt and opted for selected treatments. The majority of participants found that the Danish POLST was usable for conversations and decisions about life-sustaining treatment to either a high or a very high degree, and that the POLST form facilitated an opportunity to openly discuss life-sustaining treatment.

International Perspectives on End-of-Life Law Reform
  • Politics, Persuasion and Persistence
  • Edited by Ben P. White, Lindy Willmott
  • Published online:
    02 December 2021
    Print publication:
    09 December 2021
  • Much has been written about whether end-of-life law should change and what that law should be. However, the barriers and facilitators of such changes – law reform perspectives – have been virtually ignored. Why do so many attempts to change the law fail but others are successful? International Perspectives on End-of-Life Law Reform aims to address this question by drawing on ten case studies of end-of-life law reform from the United Kingdom, the United States, Canada, the Netherlands, Belgium and Australia. Written by leading end-of-life scholars, the book's chapters blend perspectives from law, medicine, bioethics and sociology to examine sustained reform efforts to permit assisted dying and change the law about withholding and withdrawing life-sustaining treatment. Findings from this book shed light not only on changing end-of-life law, but provide insight more generally into how and why law reform succeeds in complex and controversial social policy areas.

  • Factors associated with surrogate families’ life-sustaining treatment preferences for patients at home or in a geriatric health service facility: A cross-sectional study

  • Fumio Shaku, Madoka Tsutsumi, Asumi Nakamura, Hiroshi Takagi, Takahiro Otsuka, Shuichiro Maruoka
  • Journal:
    Palliative & Supportive Care / Volume 20 / Issue 3 / June 2022
    Published online by Cambridge University Press:
    02 September 2021, pp. 334-341
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  • Objective

    Recently, end-of-life preference in palliative care has been gaining attention in Japan. The Ministry of Health, Labor, and Welfare established the Japanese basic policy in November 2018. Patients’ decision-making is recommended; however, patients with dementia or other disorders cannot make such decisions by themselves. Thus, healthcare providers may contact surrogates and consider their backgrounds for better decision-making. Hence, the preferences of home caregivers’ and geriatric health service facility (GHSF) residents’ families on patient life-sustaining treatment (LST) were investigated.

    Method

    This cross-sectional study involved home caregivers’ and GHSF residents’ families in Japan. We distributed 925 self-reported questionnaires comprising items, such as the number of people living together, care duration, comprehension of doctor's explanations, the Patient Health Questionnaire (PHQ)-9 and Short Form (SF)-8, and families’ LST preference for patients.

    Results

    In all, 619 valid responses were obtained [242 men and 377 women (309 in the HOME Caregivers Group, response rate = 61.1%; 310 in the GHSF Group, response rate = 74.0%)]. LST preference was significantly associated with sex, the number of people living together, care duration, and comprehension of doctors’ explanations in the HOME Caregivers Group but was not significantly associated with the GHSF Group. Furthermore, PHQ-9/SF-8 scores were not significantly associated with LST preference.

    Significance of results

    There were many differences in opinions about LST preference between home caregivers’ and GHSF residents’ families. The results suggested that the burden of nursing care was greater and harder in home caregiver families, and these factors may be related to the LST preference for a patient.

  • End-of-life Decisions for Patients with Prolonged Disorders of Consciousness in England and Wales: Time for Neuroscience-informed Improvements

  • PAUL CATLEY, STEPHANIE PYWELL, ADAM TANNER
  • Journal:
    Cambridge Quarterly of Healthcare Ethics / Volume 30 / Issue 1 / January 2021
    Published online by Cambridge University Press:
    29 December 2020, pp. 73-89

  • This article explores how the law of England and Wales1 has responded thus far to medical and clinical advances that have enabled patients with prolonged disorders of consciousness to survive. The authors argue that, although the courts have taken account of much of the science, they are now lagging behind, with the result that some patients are being denied their legal rights under the Mental Capacity Act 2005. The article further argues that English law does not comply with the United Kingdom’s commitments under the United Nations Convention on the Rights of Persons with Disabilities. Stressing the need for the law to keep in step with advances in science, the article concludes with robust recommendations for improvements, based on the latest research in neuroscience, to the way in which life-sustaining treatment decisions are made. This would mean that the wishes of patients, including those with covert awareness, can be better reflected in best interests assessments.

  • Advances in critical care for the older patient

  • Diane Monkhouse
  • Journal:
    Reviews in Clinical Gerontology / Volume 23 / Issue 2 / May 2013
    Published online by Cambridge University Press:
    06 March 2013, pp. 118-130
    Print publication:
    May 2013

  • As the proportion of elderly people in the general population increases, so does the number admitted to critical care. In caring for an older patient, the intensivist has to balance the complexities of an acute illness, pre-existing co-morbidities and patient preference for life-sustaining treatment with the chances of survival, quality of life after critical illness and rationing of expensive, limited resources. This remains one of the most challenging areas of critical care practice.

  • 19 - The Forgoing of Life-Sustaining Treatment for Children

  • Edited by Geoffrey Miller , Yale University, Connecticut
  • Book:
    Pediatric Bioethics
    Published online:
    07 May 2010
    Print publication:
    23 November 2009, pp 262-284

  • Summary

    This chapter focuses on issues raised when one considers forgoing life-sustaining treatment for a child, a matter complicated by the fact that children are often unable to intelligibly and reliably speak for themselves. It addresses the ethical issues related to the consideration of forgoing life-sustaining treatment in children. The chapter explores how pathological conditions could potentially qualify for the cessation of life-sustaining treatment, and discusses when and how should this occur. Having set forth some of the ethical concerns about forgoing life-sustaining treatment for children, the chapter describes how expert professional panels in pediatrics and bioethics have approached the issues in three English-speaking countries (the United States, Canada, and the United Kingdom). The chapter ends with a sampling of laws and legal decisions from several English-speaking jurisdictions. Moral value judgment is inescapable in this arena, and one must ultimately come to recognize one's own final commitments in any given case.

  • Out-of-Hospital Resuscitation: Have We Gone Too Far?

  • Corita Grudzen
  • Journal:
    Prehospital and Disaster Medicine / Volume 21 / Issue 6 / December 2006
    Published online by Cambridge University Press:
    28 June 2012, pp. 445-450
    Print publication:
    December 2006

  • Americans are living longer and are more likely to be chronically or terminally ill at the time of death. Although surveys indicate that most people prefer to die at home, the majority of people in the United States die in acute care hospitals. Each year, approximately 400,000 persons suffer sudden cardiac arrest in the US, the majority occurring in the out-of-hospital setting. Mortality rates are high and reach almost 100% when prehospital care has failed to restore spontaneous circulation. Nonetheless, patients who receive little benefit or may wish to forgo life-sustaining treatment often are resuscitated. Risk versus harm of resuscitation efforts can be differentiated by various factors, including cardiac rhythm. Emergency medical services policy regarding resuscitation should consider its utility in various clinical scenarios. Patients, family members, emergency medical providers, and physicians all are important stakeholders to consider in decisions about out-of-hospital cardiac arrest. Ideally, future policy will place greater emphasis on patient preferences and quality of life by including all of these viewpoints.