Click here to read End of Life Decisions 101, an overview of End of Life Decision Making

ALL TOO often, patients with terminal illnesses turn to the pain medication and counseling of palliative care only after enduring wrenching treatments that have little chance of extending their lives. But what if palliative care began immediately after the diagnosis and while the disease is still being treated? The answer, according to a study at Massachusetts General Hospital, is that patients treated this way enjoy a higher quality of life and live longer. In addition, they are more likely than patients not receiving palliative care to forgo 11th hour therapies. (The Boston Globe)

Legislators have begun to recognize the medical, humanitarian and economic value of helping terminally ill patients and their families navigate treatment options as they approach the end of life. (New York Times)

Juggling a caregiving role with a full-time job is daunting. But it can be even more difficult working during the end stages of a loved one’s life. Some companies are exploring end-of-life initiatives to help their employees manage the ultimate transition. (NPR)

Death has changed over the last century. In 1910, probably as in most of recorded human history, most people died in their own bed at home – whether home was a terrace house, peasant’s cottage or a palace.

Advances in medicine and healthcare through the 20th century dramatically changed the landscape: people were rightly accorded care to the very end of their lives and by the start of this century that meant 58% of all deaths in England took place in hospital. (Guardian)

Every medical study ever conducted has concluded that 100 percent of all Americans will eventually die. This comes as no great surprise, but the amount of money being spent at the very end of people’s lives probably will. (CBS News)

A STRATEGY to improve end of life care should not focus solely on place of death, a health board member has warned.
NHS Lothian has recently rubber stamped its Living and Dying Well in Lothian document, which is aimed at improving the quality of palliative care across the area. (Scotsman)

NEJM (Volume 363, Number 3, July 15, 2010) is now available by subscription only.

Articles Include:

• “Facing the Wild West of Health Care Reform - Donal Berwick, Pioneer” by J.K. Iglehart.
• “Disclosing Industry Relationships - Toward an Improved Federal Research Policy” by E.G. Campbell and D.E. Zinner.
• “The Renaissance in HIV Vaccine Development - Future Directions” by W.C. Koff and S.F. Berkley.
• “The Havasupai Indian Tribe Case - Lessons for Research Involving Stored Biologic Samples” by M.M. Mello and L.E. Wolf, 204-207.
• “Becoming a Physician: The Case for Primary Care - A Medical Student’s Perspective” by I. Ganguli, 207-209.
• “Case 21-2010L A Request for Retrieval of Oocytes from a 36-Year-Old Woman with Anoxic Brain Injury” by D.M. Greer, A.K. Styer, T.L. Toth, C.P. Kindregan, and J.M. Romero, 27-283.
• “Drug Management of Obesity - Efficacy versus Safety” by A. Astrup, 288-290.
• “Trajectories of Disability in the Last Year of Life,” 294-295.
• “Advance Directives and Surrogate Decision Making Before Death,” 295-296.

Archives of Internal Medicine (Volume 170, Number 14, July 26, 2010) is now available by subscription only.

• “Racial Differences in Admissions to High-Quality Hospitals for Coronary Heart Disease” by Ioana Popescu,  Brahmajee K. Nallamothu, Mary S. Vaughan-Sarrazin, and Peter Cram, 1209-1215.
• “Geographic Variation in Carotid Revascularization Among Medicare Beneficiaries, 2003-2006″ by Manesh R. Patel, Melissa A. Greiner, Lisa D. DiMartino, Kevin A. Schulman, Pamela W. Duncan, David B. Matchar, and Lesley H. Curtis, 1218-1225.
  
• “National Quality Forum Performance Measures for HIV/AIDS Care: The Department of Veterans Affairs’ Experience” by Lisa I. Backus, Derek B. Boothroyd, Barbara R. Phillips, Pamela S. Belperio, James P. Halloran, Ronald O. Valdiserri, and Larry A. Mole, 1239-1246.
• “Receipt of High-Quality Coronary Heart Disease Care in the United States All About Being Black or White: Comment on ‘Racial Differences in Admissions to High-Quality Hospitals for Coronary Heart Disease’” by Michelle A. Albert 1216-1217.
• “The Good, the Bad, and the About-to-Get Ugly: National Trends in Carotid Revascularization: Comment on ‘Geographic Variation in Carotid Revascularization Among Medicare Beneficiaries, 2003-2006″ by Ethan A. Halm, 1225-1227.
• “Physicians’ and Nurses’ Experiences With Continuous Palliative Sedation in the Netherlands” by Siebe J. Swart, Tijn Brinkkemper, Judith A. C. Rietjens, Marco H. Blanker, Lia van Zuylen, Miel Ribbe, Wouter W. A. Zuurmond, Agnes van der Heide, and Roberto S. G. M. Perez, 1271-1274.
• “Medical Decision Making at the Individual Patient Level” by Claudia Caroline Dobler and Guy Barrington Marks, 1275.
• “Time Spent on Clinical Documentation: Is Technology a Help or a Hindrance?” by Jacob A. Doll and Vineet Arora, 1276.
  

High-tech medical devices can raise tricky ethical questions — just consider the left ventricular assist device (LVAD). The pricey device essentially takes over the function of the left ventricle, helping a heart to continue beating when it would otherwise fail. But what happens when patients become very, very sick and are essentially being kept alive by the LVAD? Is turning off the device more akin to euthanasia or taking someone off a ventilator? (Wall Street Journal)

Journal of Medical Ethics (Volume 36, Number 8, August 2010) is now available by subscription only.

Articles Include:

• “Acceptability of Offering Financial Incentives to Achieve Medication Adherence in Patients with Severe Mental Illness: A Focus Group Study” by Stefan Priebe, Julia Sinclair, Alexandra Burton, Stamatina Marougka, John Larsen, Mike Firn, and Richard Ashcroft
• “End-of-Life Decisions as Bedside Rationing: An Ethical Analysis of Life Support Restrictions in an Indian Neonatal Unit” by I. Miljeteig, K.A. Johansson, S.A. Sayeed, and O.F. Norheim
• “Defending Human Enhancement Technologies:Unveiling Normativity” by Immaculada de Melo-Martin
• “Normative Consent and Presumed Consent for Organ Donation: A Critique” by Michael Potts, Joseph L. Verheijde, Mohamed Y. Rady, and David W. Evans
• “Between the Needy and the Greedy: The Quest for a Just and Fair Ethics of Clinical Research” by Volnei Garrafa, Jan Helge Solbakk, Susana Vidal, and Claudio Lorenzo

The UK has one of the best systems for end of life care, a global study says. The analysis by the Economist Intelligence Unit looked at access to services, quality of care and public awareness in 40 countries. It found the UK performed particularly well on issues such as obtaining pain killers and quality of support. (BBC News)

Pro-life groups and other critics who are worried about the specter of health-care rationing attacked the recess appointment of Dr. Donald Berwick, a Harvard professor and pediatrician who was sworn in this week as the head of the Centers for Medicare and Medicaid Services of the federal government’s Department of Health and Human Services.

While Berwick’s crusade to improve hospital services has earned national recognition, his past statements of support for health-care rationing and Britain’s government-run system have sparked controversy. (NC Register)

Most people who are dying around the world have inadequate or no access to painkillers, hospice and palliative care, according to a report by the Economist Intelligence Unit on Wednesday. (Reuters)

South Korean doctors will be allowed to remove life support from terminally ill patients after confirming their wish to die, under new medical guidelines on mercy killing. (MSN)

At UCLA Medical Center, which prides itself on caring for critically ill patients, a recent study showed room for improvement in the way doctors manage dying patients — and the findings likely apply to other hospitals as well, the researchers say. (Reuters)

Even at a hospital recognized for managing seriously ill patients, a systematic assessment of clinical measures associated with end-of-life care identified opportunities to improve treatment for those dying in the hospital, according to a report in the June 28 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. (redOrbit)

Harvard Theological Review (Volume 103, Issue 03, July 2010) is now available.

Articles Include:

• “Reintegrating Care for the Dying, Body and Soul” by Michael J. Balboni and Tracy A. Balboni

In a landmark ruling that will make it easier for people to allow relatives and other loved ones to die, Germany’s highest court ruled Friday that it was not a criminal offense to cut off life-sustaining treatment for a patient. (New York Times)

Journal of Medical Ethics (Volume 36, Issue 6, June 2010) is now available by subscription only.

Articles Include:

• “Requested Allocation of a Deceased Donor Organ: Laws and Misconceptions” by J.F. Douglad, and A.J. Cronin, 321.
• “‘(More) Trials and Tribulations’: The Effect of the EU Directive on Clinical Trials in Intensive Care and Emergency Medicine, Five Years After Its Implementation” by Katy Robinson and Peter J.D. Andrews, 322-325.
• “Ethical Quandaries Posing as Conflicts of Interest” by Miguel Kottow, 328-332.
• “Eluana Englaro, Chronicle of a Death Foretold: Ethical Considerations on the Recent Right-to-Die Case in Italy” by Marco Luchetti, 333-335.
• “The Parents’ Ability to Take Care of Their Baby as a Factor in Decisions to Withhold or Withdraw Life-Prolonging Treatment in Two Dutch NICUs” by Sofia Moratti, 336-338.
• “A Theoretical Flaw in the Advance Market Commitment Idea” by Jorn Sonderholm, 339-343.
• “Evaluating End of Life Practices in Ten Brazilian Paediatric and Adult Intensive Care Units” by Jefferson Piva, Patricia Lago, Jairo Othero, Pedro Celiny Garcia, Renato Fiori, Humberto Fiori, Luiz Alexandre Borges, and Fernando S. Dias, 344-348.
• “Medical Decision-Making and Communication of Risks: An Ethical Perspective” by Christof Breitsameter, 349-352.
• “Therapeutic Privilege: Between the Ethics of Lying and the Practice of Truth” by Claude Richard, Yvette Lajeunesse, and Marie-Thérèse Lussier, 353-357.
• “Recruitment of Minority Ethnic Groups Into Clinical Cancer Research Trials to Assess Adherence to the Principles of the Department of Health Research Governance Framework: National Sources of Data and General Issues Arising from a Study in One Hospital Trust in England” by Sylvia Godden, Gareth Ambler, and Allyson M. Pollock, 358-362.
• “Clinician Gate-Keeping in Clinical Research is Not Ethically Defensible: An Analysis” by Kerith Sharkey, Julian Savulescu, Sanchia Aranda, and Penelope Schofield, 363-366.
• “Off-Trial Access to Experimental Cancer Agents for the Terminally Ill: Balancing the Needs of Individuals and Society” by Manik Chahai, 367-370.
• “The Ethical Professional As Endangered Person: Blog Notes on Doctor-Patient Relationships” by Tom Koch and Sarah Jones, 371-374.
  

Patients often opt for more end-of-life care when given detailed circumstances — at odds with responses to a general question, a new study says. (American Medical News)

The idea of a “living will” may sound like you have control over what happens to you if you temporarily or permanently can’t make medical decisions for yourself, but in practice it’s not so clear cut. (CNN)