Brain Death Conflict - Taquisha McKitty,

Taquisha McKitty is being physiologically sustained at Brampton Civic Hospital (Ontario), even though her attending physician (Omar Hayani) issued a death certificate declaring her brain dead over a week ago (on September 20).



McKitty's parents believe the hospital acted too quickly in declaring their daughter dead, and doctors are ignoring what the family believes are responses to �stimulus� including squeezing their hands and moving her thumb when asked to do so.



The family went to court last week and won an emergency injunction temporarily preventing the hospital from removing the respirator that is keeping her alive. That injunction expires today (Thursday, 9/28) when the matter will be back before Superior Court Justice M.J. Lucille Shaw.






Medical Ethics and Treatment Decisions Following Charlie Gard - Journal of Medical Ethics Special Issue Call for Papers

From the Journal of Medical Ethics:



The court case between Charlie Gard�s parents and his Great Ormond Street Hospital medical team attracted international media attention, public protest, and comments from the Pope and US President Trump. Charlie was born with a rare genetic disease, for which there is currently no cure. Charlie�s parents found and crowdfunded for experimental treatment in the US. But his Great Ormond Street doctors argued that his condition had reached a point where such treatment was futile and not in Charlie�s best interests. The case was concluded in July during its second High Court appearance, and Charlie died on July 28, 2017 following withdrawal of treatment. 



At the heart of the disagreement were differing judgements not about medicine, but about medical ethics. The treating UK Doctors, and the US Doctor, Prof Hirano, both agreed that Charlie was unlikely to benefit from Hirano�s treatment. But they differed on whether the uncertain treatment would be in Charlie�s best interests, and whether Charlie�s parents� wishes should be respected. 



What chance of life is worth taking? How much suffering should be imposed on the patient for that chance? How should we act when there is uncertainty about medical facts such as chances of success or the level of suffering? Should the expected level of ongoing disability if the treatment is successful play a part in such decisions? How much weight should be given to the wishes of parents? What is the appropriate normative threshold for overruling parents� wishes. Then there are questions about the process itself. How should disputes about treatment be resolved? Is there a better way to make such decisions? Some further questions raised are listed in �Hard Lessons: Learning from the Charlie Gard Case� 



Submissions engaging with ethical questions raised by the Charlie Gard case (including, but not limited to those listed above) and their implications for future disputes are invited for publication in this special issue. Submitted papers should be up to 3500 words and should be submitted before the deadline of 20th December. Please select the Special Issue �Medical Ethics Following Charlie Gard� when you make the submission. 




Medical Futility Case in Alberta - Darlene Crayne

Several reports have indicated that Canadian ICU clinicians have generally "caved in" to family demands for potentially inappropriate treatment, since the Supreme Court of Canada's Rasouli decision.


But medical futility conflicts still do happen.  One case has been covered by the Canadian media.


THE PATIENT

Darlene Crayne has been in a medically induced coma at Chinook Regional Hospital since Aug. 26 after suffering a heart attack.


THE CLINICIANS

The medical team attending to Crayne has maintained that she has minimal brain function and reached a decision to pull the plug on her ventilator on Saturday, Sept. 23.


THE FAMILY

Crayne�s daughter disagrees, and says she sees promise during her interactions with her mother. But another of Crayne�s children sides with the medical team decision to stop the ventilator.



STATUS

After threatening legal action, the family has now been told Crayne will remain on a ventilator until Wednesday afternoon Sept. 27. The family is planning court action to get more time.  


Call for Abstracts - International Conference on Clinical Ethics Consultation (ICCEC 2018)




Oxford

Abstract submission is now open for the 14th International Conference on Clinical Ethics Consultation (ICCEC 2018), a leading international clinical ethics conference.  There are five themes:


1. Ethical challenges in the clinic: an impetus for research and education - Emerging challenges for clinical ethics include the use of innovative and unlicensed treatments, bedside rationing, and boundaries between health and social care


2. Theoretical foundations and conceptual frameworks of clinical ethics support - Will developing and articulating theoretical foundations for clinical ethics help to strengthen practice? What counts as a theoretical foundation and is it required? How can we foster dialogue between practice and theory?


3. Empirical ethics research: emerging from and informing clinical ethics practice - There are many questions that clinical ethics can pose for researchers. How can we identify and build on examples of high quality research to improve practice?


4. Translating clinical ethics across global contexts - How does clinical ethics practice, research and education translate across cultures and what can we learn from each other to improve our own practice?


5. Translating clinical ethics into advocacy and policy - What role should clinical ethics have in shaping policy at a regional, national or international level on issues such as migrant health, abortion or transplant ethics? Should clinical ethicists act as advocates for patients in the wider health care environment?


Faith and Morality and Medical Aid in Dying

Come to Hamline University on Thursday, October 5 for "Faith and Morality and Medical Aid in Dying."


Rev. Dr. Ignacio Castuera (Trinity United Methodist Church in Pomona, CA) will be speaking from 11:20-12:40 p.m. in Giddens Learning Center Room 110W.


Rev. Dr. Castuera is a graduate of the School of Theology at Claremont and was actively involved in the California End-of-Life Options campaign which culminated in the passage of that state�s medical aid in dying law in 2015. He has a long career advocating for social justice and nonviolence, created a positive religious response to the AIDS pandemic in his community and became the first National Chaplain for Planned Parenthood Federation of America. His book Dreams on Fire: Embers of Hope: From the Pulpits of Los Angeles After the Riots, became one of the top 10 religious books of 1992.


Minnesota Medical Aid in Dying (MAID) - Lessons Learned in Oregon and Colorado

Join me this Friday, September 29 for "Medical Aid in Dying (MAID) - Lessons Learned in Oregon and Colorado."


The purpose of this conference is to provide a forum for thoughtful deliberation about the implementation of medical aid in dying legislation based on lessons learned in Oregon and,more recently, Colorado. The conference will offer suggestions about how health care professionals can achieve the best possible care for seriously ill patients and their families if medical aid in dying is legalized in Minnesota. The goal of this conference is to provide practical information and encourage rational conversations about care options at the end-of-life.







Court Rejects Constitutional Challenge to Texas "Medical Futility" Law

On Friday, a Harris County, Texas trial court rejected a constitutional challenge to the Texas Advance Directives Act.


Judge Bill Burke said it would be "a case of throwing the baby out with the bath water" to repeal the controversial 1999 law, enacted in response to doctors' push to eliminate care that prolongs suffering in terminal patients. 


"It would be a big mistake to throw out a statute in place for nearly 20 years that seems to be working pretty well. . . . If you think the law doesn't provide sufficient protection for patients, go to the Legislature to remedy it."


This ruling was poignant for me as I spent all-day Saturday at the University of New Mexico Law School with appellate judges and professors discussing the need for courts to tackle constitutional challenges to state laws.  






Plaintiff Evelyn Kelly


7 Pathways to Legalize Medical Aid in Dying

Today, I am participating in a law review symposium at the University of New Mexico.  My presentation is "Legal History of Medical Aid in Dying: Physician Assisted Death in U.S. Courts and Legislatures."  



I review 7 pathways to legalize medical aid in dying.  My slides are here.





Lawsuit Challenging Texas' Futile Care Law Goes before Judge


Later today, there is a major
hearing in a lawsuit challenging the constitutionality of the dispute
resolution provisions in the Texas Advance Directives Act.  The Houston
Chronicle
 provides good, balanced background.






have
argued
 (at length) that TADA is unconstitutional.  See also here and here.
Additionally, in a related though separate series of articles (e.g. here) I
have cautioned against giving adjudicatory power to intramural hospital review
committees.  








Plaintiff Evelyn Kelly


Dying in the Americas 2018

Another major end-of-life policy conference is scheduled from March 21 to 25, 2018 outside Las Vegas, Nevada.



Confirmed Keynote Speakers:




  • Dr. Zubin Damania - health care pioneer in new ways of considering healthcare delivery and conversations. ZdoggMD

  • Shanaaz Gokool - CEO, Dying with Dignity Canada, a leading activist in changing Canadian laws

  • Dr. Stefanie Green, Victoria, Canada - a pioneer physician in Canada who has changed her practice from OB-GYN to MAiD, Medical Aid in Dying

  • Caitlin Doughty - "Ask A Mortician," Caitlin is a leader in new ways of thinking about and having conversations on dying

  • Dr. Aroop Mangalik - Physician and author, "Dealing with Doctors, Denial and Death"

  • Faye Girsh - Hemlock Society of San Diego, a pioneer in the DwD movement in the United States

  • Taimie Bryant - Legal scholar, UCLA professor

  • Robert Rivas - Pioneer attorney on RTD in the U.S., FEN General Counsel




Plus panels of bioethicists, physicians and health professionals, palliative care specialists, psychologists, thanantologists, grief counselors, and other health professionals and religious representatives.


UK Drops Judicial Permission Requirement to Stop CANH for PVS patients




Justice Peter Jackson

In contrast to most Western jurisdictions, families and clinicians in the UK needed court permission withdraw nutrition from a patient in a permanent vegetative state.  A new ruling yesterday holds that such permission is no longer required.


So long as (1) relatives agree and (2) it's in the best interests of a patient in a minimally conscious or vegetative state, then clinicians may withdraw all sorts of treatment that will result in the end of someone's life without the permission of a court. Now, nutrition and hydration will be treated the same way.


International Conference on End of Life Law, Ethics, Policy, and Practice (ICEL3) - Belgium 2019

I have been to the first and second International Conference on End of Life Law, Ethics, Policy, and Practice (ICEL1 and ICEL2).  Both included world experts from a wide range of disciplines. I encourage you to plan to participate in the third ICEL in Belgium in 2019.







New Law Limits Doctors' Ability to Invoke DNR without Patient Consent

Todd Ackerman has a solid story in the Houston Chronicle on the background and impact of SB11 in Texas.


"Beginning next April, the right of Texas hospitals and doctors to write unilateral DNRs will be dramatically curtailed under a law signed by Gov. Greg Abbott last month. The law requires doctors and hospitals to notify and get consent from patients or their guardians before implementing a DNR order."


Two quotes from me are - 


"This law probably won't affect that many people, but it's another example of discretion being taken from clinicians and hospitals. . . . That's been a national trend the last five or so years, the health-care profession losing power they used to have, the emergence of a greater culture of patient rights."


"I don't think it's a terrible statute. . . . I'm confident it'll produce some good and some bad - probably some families who want to care for a trisomy 18 child will find less resistance and probably some people for whom a DNR order is highly appropriate will have to undergo CPR. I don't know how to weigh that."


Make Clinicians Feel Legally Safe to Do the Right Thing

I am just back from a marvelous conference on end-of-life law and policy in Halifax, Nova Scotia.  Interestingly, the citadel in Halifax (see center of this map) was originally erected to encourage settlers. Immigrants from England would not come, if they though they were in danger of attack from the French or Colonial Americans.


This seems apt as a metaphor for a theme in the conference. Physicians will not "come" to the healthcare service (e.g. VSED, POLST, MAID), if they do not feel safe from the "attacks" of plaintiffs or regulators. Much of my work is designed to clarify or change the law to reduce this legal uncertainty.







New Symposium on VSED

The Seattle Journal for Social Justice has published several articles flowing from  our October 2016 conference on VSED (Voluntarily Stopping Eating and Drinking). The articles are available for free here.


How Helpful is Voluntary Stopping of Eating and Drinking (VSED) to Avoid Dementia?

Dena S. Davis


Three Barriers to VSED by Advance Directive: A Critical Assessment

Paul T. Menzel


A Good Quality of Death

Phyllis Shacter


Alzheimer�s Disease and Written Directives to Withhold Oral Feedings: Clinical Challenges in New York State

Judith K. Schwarz


Mitchell Hamline Health Law Students Facilitate Advance Care Planning

While I am in Nova Scotia, Mitchell Hamline health law students were in Hastings, Minnesota at the Dakota County Judicial Center with the Mobile Law Network.


Students and faculty were on hand to help residents draw up health care directives. It's another way we're serving the community and giving students real world experience.





Right to Die - Top Legal Developments 2017

The first of two 2018 updates to the legal reference book Right to Die: The Law of End-of-Life Decisionmaking will cover the following new legal developments among others.  




  • The New York Court of Appeals� rejection of both statutory and constitutional challenges alleging that New York laws criminalizing assisted suicide statutes do not and may not apply to medical aid in dying.

  • A major amendment to the Uniform Determination of Death Act that clarifies both which medical criteria are authoritative for determining death by neurological criteria and that clinicians do not need family consent to administer brain death tests.

  • A statute that requires clinicians to obtain patient or surrogate consent before writing a facility-based DNR order.

  • The passage of a new POLST statute in and the material expansion of another.

  • An innovative statute that requires default surrogates to gather information about an incapacitated patient�s beliefs, values, and preferences before making a health care decision.

  • The passage of another statute directing the creation of an electronic registry for health care directives.

  • The passage of statutes in two more states that direct the formation of quality of care and palliative care task forces and that direct health departments to promote both professional and consumer palliative care education.





Call for Submissions - AALS Works-in-Progress for New Health Law School Teachers

The AALS Section on Law, Medicine & Health Care will be holding a workshop session for junior scholars at the upcoming AALS annual meeting in San Diego, Jan 3-6, 2018.  



The AALS Section on Law, Medicine and Health Care is pleased to announce a Call for Papers for a special Works-in-Progress for New Law School Teachers Program. The Section will run the Program at the AALS 2017 Annual Meeting in San Francisco, on Saturday, January 6, 2018 at 3:30 � 5:15 pm.  



This program will bring together junior and senior health law scholars for a lively discussion of the junior scholars� works-in-progress.  Junior health law scholars will submit papers that they expect to submit in the spring 2018 law review submission cycle.  After they briefly present their papers in a concurrent roundtable setting, senior scholars will provide oral comments and critiques.  This new program presents an opportunity for the audience to hear cutting edge health law scholarship by recent members of the academy.



We will limit our selection to two to three papers.



Form & Length of Submission



Eligible faculty members are invited to submit either manuscripts or abstracts dealing with any aspect of health law or policy.  Abstracts should be comprehensive enough to allow the committee to meaningfully evaluate the aims and likely content of the papers proposed.    Papers may be accepted for publication but must not be published prior to the Annual Meeting.



Deadline & Submission Method



To be considered, manuscripts or abstracts and a CV must be submitted electronically to both:

            

Chair, Section on Law, Medicine, and Health Care, Elizabeth Pendo, Saint Louis University School of Law, ependo@slu.edu



Chair-Elect, Section on Law, Medicine, and Health Care, Fazal Khan, University of Georgia School of Law, fkhan@uga.edu



The deadline for submission is September 29, 2017.



Selection & Notification



Papers will be selected after careful review and discussion by the Executive Board of the AALS Section on Law, Medicine, and Health Care.



The authors of the selected papers will be notified by October 13, 2017 and listed by name and paper title in the official program.   If a selected author has only submitted an abstract for review, the author must submit the corresponding manuscript by December 15, 2017.



The Call for Paper participants will be responsible for paying their annual meeting registration fee and travel expenses.



Eligibility



Full-time untenured faculty members of AALS member law schools are eligible to submit papers.  The following are ineligible to submit: foreign and adjunct faculty members, graduate students who are not also enrolled in a qualifying J.D. program, fellows, non-law school faculty, and faculty at fee-paid non-member schools. Papers co-authored with a person ineligible to submit on their own may be submitted by the eligible co-author.


AALS Health Law Award

AALS Health Law Award


The AALS Section on Law, Medicine & Health
Care gives an award to recognize outstanding contributions of law teachers in
the service of health law. 





The award recognizes a wide variety of community
service activities, including: pro bono litigation, legislative advocacy, leading
or consulting on public initiatives, and other public or private
projects.  The service may be local, regional, national or international
in scope.  It is not the purpose of the award to recognize teaching,
scholarship or service other than community service (such as service to the
AALS, academic institutions, or to academia).





Please nominate a colleague (or yourself) for
this award by September 29
th using the attached Nomination Form.  Please submit
completed forms to my email address listed below. Nominators and nominees must
be Section members.






Wisconsin Legislation on Rights for the Terminally Ill

Wisconsin, not exactly the state you would expect to consider legislation extending new rights to the terminally ill.  And you would be mostly right. Except for A.B. 461.


The bill would direct the Department of Natural Resources to "treat an individual as a resident for purposes of determining the person's eligibility for and cost of obtaining a hunting approval" if the individual "is terminally ill and is participating in a hunting-related event sponsored by a charitable organization."


State Constitutional Right to Aid in Dying

In his concurring opinion in Myers v. Schneiderman, Justice Garcia observed that "not a single plaintiff has asserted a successful constitutional challenge to an assisted suicide ban."


This is not strictly true.  There have been several successful state constitutional challenges.  Plaintiffs in Florida, New Mexico, and Montana all secured judgments that the state constitution protects aid in dying.


Admittedly, the Florida and New Mexico judgments weer were later reversed on appeal. But the Montana judgment was neither affirmed nor reversed. 

Israel Stinson Brain Death Lawsuit Continues




Judge Mueller

This week, the Alameda County Superior Court denied the defendants' motion for summary adjudication in the Jahi McMath case.


Meanwhile, over in Sacramento, the U.S. District Court for the Eastern District of California heard oral arguments on those defendants' motion to dismiss the action brought by the family of Israel Stinson against the State of California. 


Attorneys, Kevin Snider, Matthew McReynolds, and Alexandra Snyder appeared for the plaintiff. Attorney, Ashante Norton appeared for defendant Karen Smith.The court took the matter under submission with a formal written order to issue. 


American Nurses Association Supports VSED

Too few medical associations have issued either practice guidelines or policies on VSED. Fortunately, the American Nurses Association issued a favorable position statement this summer. 


The ANA concludes: "VSED at the end of life is used to hasten death, and is a reflection of autonomy and the patient�s desire for control."









New York Rejects State Constitutional Right to Aid in Dying




Sara Myers

This morning, the New York Court of Appeals released an 81-page opinion in Myers v. Schneiderman.  


The court summarized its holding: "Plaintiffs ask us to declare a constitutional right to "aid-in-dying" . . . . Although New York has long recognized a competent adult's right to forgo life-saving medical care, we reject plaintiffs' argument that an individual has a fundamental constitutional right to aid-in-dying as they define it. We also reject plaintiffs' assertion that the State's prohibition on assisted suicide is not rationally related to legitimate state interests."


New York becomes the eighth state appellate court to find that a state's criminal prohibition of aid in dying is constitutional. Trial courts in Florida, Montana, and New Mexico found aid in dying prohibitions were unconstitutional. But none were affirmed. Previous appellate rulings include:




  • California (1992)

  • Michigan (1994)

  • Florida (1997)

  • Colorado (2000)

  • Alaska (2001)

  • California (2015)

  • New Mexico (2016)



No state appellate court has ever found a constitutional right to aid in dying. The Montana Supreme Court never reached the issue because the court found aid in dying was legal under existing statutes. Two federal appellate courts independently found a federal constitutional right in 1996. But they were reversed by the U.S. Supreme Court in 1997. Ongoing litigation continues in Massachusetts, Hawaii, and other states.


Jahi McMath Case Now Headed to a Jury Trial on Whether She Is Now Alive




Alan Shewmon  allowed to testify


Earlier this year, the medical defendants in Jahi McMath's medical malpractice lawsuit filed a motion
to dismiss her claims. They argued that McMath lacks standing to sue for
personal injuries because she was pronounced dead in December 2013.







Yesterday, the Alameda County Superior Court denied those motions for
summary adjudication. "[T]hough Defendants have shown that the
determination of brain death in December 2013 was made in accordance with
accepted medical standards . . . a triable issue of fact exists as to whether
McMath currently satisfies the statutory definition of 'dead' under the Uniform
Determination of Death Act."





"[D]espite the fact that Dr. Shewmon has not performed a formal determination of brain death as addressed in the Guidelines, Defendants have not cited authority that his opinions are of no weight or admissibility in addressing the changed circumstances alleged in the First Cause of Action."





"[W]hile the Guidelines are generally accepted medically, there is some discrepancy between what the Guidelines diagnose and what the statutory definition of death specifies . . .  In re Guardianship of Hailu (Nev. 2015) . . ."




Premortem Cryopreservation Does Not Cause Death

In 1990, Thomas K. Donaldson sued the California Attorney General for the right to an elective premortem cryopreservation. Most cryopreservation is postmorterm. But Donaldson wanted to act before a malignant tumor destroyed his brain.


Unfortunately for Donaldson, the Santa Barbara trial court and an appellate court rejected Donaldson's claims. The courts construed his request as one for assisted suicide. That was a crime in California and the courts found (like state appellate courts everywhere in the USA) that there was no constitutional violation in applying that law to Donaldson's situation.


But why was the case framed as a right to assisted suicide?  The whole point of cryogenic preservation is that sometime in the future, when a cure for Donaldson's disease is found, then his body may be "reanimated." If true, then he would not be brought back from the dead.  Legally, he would have never been dead.  


Since the Uniform Determination of Death Act requires irreversibility, it seems that premortem  cryopreservation does not cause death. Yes. Donaldson's cardiopulmonary functions and brain functions may cease. But that cessation would not be irreversible. Of course, cryopreservation may not work. But it seems that factual predicate was not carefully examined.  


The case was dramatized in a 1990 episode of LA LAW.





Second International Conference on End of Life Law, Ethics, Policy, and Practice

There is less than two weeks until the Second International Conference on End of Life Law, Ethics, Policy, and Practice.  


This is a truly worldwide meeting of leading end-of-life policy and ethics academics and researchers in Halifax, Nova Scotia.  







4 Minutes and 28 Days to a Changed Body!

These days, the board is the most prominent full-body work out, which has helped a large number of individuals worldwide to change their bodies and end up plainly fit. 

This test is outstanding amongst other bodyweight stаtic practices for conditioning and fortifying the center аnd the whole body all in all. 

This exercise fortifies the posterior, consume the stomach fat, conditions the legs and the arms, and rectifies the backs in the meantime. Eve however it might look simple and straightforward, it is a long way from a simple exercise, and gives unbelievable impacts! 

It is like pushups, yet it is static, so they simply tone and limit, don't lessening or increment measure. 

This board challenge goes on for a month, in which you fabricate your stamina and lift your quality levels. Toward the starting, you persevere through the position for just 20 seconds and bit by bit increment the time each and every day. 

When you achieve 4 minutes, which is the last objective, you will be solid and lean, and ready to perform even the most troublesome activities and physical exercises. 

Be that as it may, the impacts of this activity are significantly controlled by the best approach to do it. Consequently, figure out how to play out the board right: 

You should keep the toes and elbows in a line with the abdominal area part, with the back straight. You ought to inhale profoundly, and feel the pressure in the muscular strength. Keep the neck and the head straight, and get the rear end muscles, however keep up adjust by isolating the weight between the elbows and legs. 

At the point when in an appropriate position, simply attempt to bear it insofar as required. 
  1. Dаy 1 – 20 seconds 
  2. Dаy 2-20 seconds 
  3. Dаy 3-30 seconds 
  4. Dаy 4-30 seconds 
  5. Dаy 5-40 seconds 
  6. Dаy 6-rest 
  7. Dаy 7-45 seconds 
  8. Dаy 8-45 seconds 
  9. Dаy 9-60 seconds 
  10. Dаy 10-60 seconds 
  11. Dаy 11-60 seconds 
  12. Dаy 12-90 seconds 
  13. Dаy 13-rest 
  14. Dаy 14-90 seconds 
  15. Dаy 15-90 seconds 
  16. Dаy 16-120 seconds 
  17. Dаy 17-120 seconds 
  18. Dаy 18-150 seconds 
  19. Dаy 19-rest 
  20. Dаy 20-150 seconds 
  21. Dаy 21-150 seconds 
  22. Dаy 22-180 seconds 
  23. Dаy 23-180 seconds 
  24. Dаy 24-210 seconds 
  25. Dаy 25-rest 
  26. Dаy 26-210 seconds 
  27. Dаy 27-240 seconds 
  28. Dаy 28-аs much аs you like or cаn 
The board is an unbelievably hard exercise, despite the fact that it is static. Also, there are another board works out, particular to tone particular body parts, yet the method is as yet the same. 

However, make sure to dependably inhale profoundly, and hold the body in the correct position with a specific end goal to accomplish the coveted impacts. After the 28th day, your body will be completely changed, solid, and conditioned!