Chilean Girl With Illness Changes Mind About Euthanasia

Chilean Girl With Illness Changes Mind About Euthanasia

Posted on Friday, March 27th, 2015 at 8:24 pm by lifemediamatters

An ailing Chilean girl who made a public plea for permission to end her life has had a change of heart, according to her father.

Fredy Maureira told the Associated Press on Sunday that his 14-year-old, daughter, Valentina, has changed her mind after meeting people who responded to her plea to be euthanized in order to end her suffering from cystic fibrosis (The Associated Press via USA Today).

High Nursing Home Bills Drive Up Long-Term-Care Insurance Rates

Posted on Friday, March 27th, 2015 at 8:16 pm by lifemediamatters

Thirty years ago, insurance companies had the answer to the soaring cost of caring for the elderly. Plan ahead and buy a policy that will cover your expenses.

Now, there’s a new problem: Even insurers think it’s unaffordable (SF GATE).

What Is Palliative Care, Anyway?

Posted on Friday, March 27th, 2015 at 8:15 pm by lifemediamatters

Millions of Americans with a serious illness could benefit from palliative care, but many people know little about it and often confuse it with end-of-life care, or hospice. Below are answers to frequently asked questions to help you learn more about and understand this important health care service (The Huffington Post).

Words Matter: Physician Assisted Suicide Is NOT Physician Aid In Dying

Posted on Thursday, March 26th, 2015 at 10:23 am by lifemediamatters

The classic Hippocratic Oath, translated by Heinrich Von Staden, requires a new physician to swear to the following oath:

And I will use regimens for the benefit of the ill in accordance with my ability and my judgment, but from [what is] to their harm or injustice I will keep [them]. And, I will not give a drug that is deadly to anyone if asked [for it], nor will I suggest the way to such a counsel.

A 1964 translation by Louis Lasagna, Dean of the School of Medicine at Tufts University, rephrases the classic oath to say:

I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of overtreatment and therapeutic nihilism. I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.

A 12th-century Byzantine manuscript of the Oath. Courtesy WikiMedia Commons

A 12th-century Byzantine manuscript of the Oath. Courtesy WikiMedia Commons

Physician-assisted suicide is now legal in Oregon, Washington, Vermont, Montana and New Mexico. It is under consideration in 13 other states. Along the way, the terminology has moved from “physician-assisted suicide” (PAS) to “physician aid in dying” (PAD). “Suicide” has traditionally conjured up a vision of premature death prompted by despair, impaired judgment and the like. As a result, several professional organizations have objected to the use of the term “suicide,” articulating that this word does not describe those opting to exert control over their end of life under the laws allowing this deliberate choice.

I argue that the true paradigm for physician aid in dying is palliative care, and that physician-assisted suicide is just that- suicide. Palliative care reflects and delivers on the Hippocratic Oath, among the oldest binding documents in history. For those who are terminally ill, it is “physician aid in dying” in its purest sense. Palliative specialists do not send patients on their way with lethal medication which- if following legal requirements- must be self-administered. Palliative specialists do not ask patients to respond to their condition alone; palliative care is patient-centered and collaborative.

Palliative care is specialized medical care for those with serious illnesses. It focuses on providing patients with relief from symptoms and stress of serious illness, and it is not restricted to those with diagnoses of six months or less to live. Its goal is to improve the quality of life for both the patient and his or her family.

Palliative care includes a multidisciplinary team of doctors, nurses and others who work together with other providers to provide an extra layer of support to meet personal goals and goals of care, assuring that pain is always managed. A patient is not required to forego curative treatments to receive palliative care; palliative services maintain patient autonomy and control over individual destiny but they do not include killing oneself.

Surveys indicate that 91 percent of those opting for assisted suicide do so to gain control; only 30 percent choose this route due to pain. My earlier article, Is Autonomy All We Really Want?, explores “the space between,” the dialogical encounter and the isolating, frightening aspects of autonomy. A high quality palliative care team can mitigate that aloneness by accompanying patients shoulder to shoulder, respecting their autonomy and goals while providing warmth, sympathy and understanding. Not only do patients benefit from a higher quality of life, but physicians stay true their vow to “avoid…traps…of therapeutic nihilism.”

I argue that the true paradigm for physician aid in dying is palliative care, and that physician-assisted suicide is just that- suicide.

Words matter. Physician-assisted suicide is equivalent to the facilitation of killing. There is no other way to characterize the act. Physician aid in dying in the context of palliative care supports the chronically ill and dying in a respectful, professionally honored tradition. As Leon Kass, physician and Hertog Fellow at the American Enterprise Institute, states:

In forswearing the giving of poison when asked for it, the Hippocratic   physician rejects the view that patient’s choice for death can make killing him right…the deepest ethical principle restraining the physician’s power is…the dignity and mysterious power of human life itself. A person can choose to be a physician but cannot choose what physicianship means.

Reimburse Doctors For Helping Patients Plan End Of Life Care, Experts Say

Posted on Monday, March 23rd, 2015 at 6:44 pm by lifemediamatters

This piece was first published in Reuters Health. President Randi Belisomo is a contributor.

Physician incentives are needed to improve end of life care in the U.S., health experts said Friday at an Institute of Medicine (IOM) forum.

The forum convened at the National Academy of Sciences to discuss action on the recommendations of the IOM’s seminal fall report, Dying in America.

Victor Dzau

IOM President Victor Dzau

“Our current system is not equipped to deal with these challenges,” said IOM President Victor Dzau, citing a rising number of elderly with multiple chronic illnesses, too few palliative care services to keep pace with demand, and time pressures that keep providers from having conversations with patients about end of life preferences and values.

“We need to make sure that healthcare providers do not shy away from these discussions,” said Senate Aging Committee Chairman Susan Collins (R-Maine). “Until we solve the reimbursement issue, I don’t think we are going to make true progress.”

Senator Mark Warner (D-Virginia) said he regretted his failure to talk with his mother, an Alzheimer’s patient, about the end of life care she desired. He lost the opportunity to have this conversation when she lost her ability to communicate, nine years before her death.

“I was an informed citizen at the time, the governor of Virginia, and yet my family and I didn’t have a full understanding of everything that was before us,” said Warner, indicating that he will reintroduce a measure to create a Medicare and Medicaid benefit for end of life planning.

Dr. Atul Gawande

Dr. Atul Gawande

When people fail to plan for end of life care, they may suffer through ultimately futile, invasive and often unwanted treatments, advocates say. Surgeon and author Atul Gawande detailed the “medicalization of mortality” occurring over the past several decades, noting that the most likely time for Americans to undergo surgery is the last week of life.

“We fail to recognize that people have goals and priorities in their lives we need to serve besides just living longer,” Gawande said. “The way you learn what people’s priorities are is by asking.”

Last year, the Centers for Medicare and Medicaid Services rejected an American Medical Association request to create a billing code for doctors to use when they spend time helping patients plan for future care. Patrick Conway, chief CMS medical officer, said the coding would be considered this year.

If physicians will be reimbursed, work remains to ensure the quality of care patients receive. “Metrics in this area are not easy to develop, but they’re not impossible,” said Christine Cassel, president of the National Quality Forum. “Payers need to know they are paying for the right kind of care.”

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