December 2006

News from Attorneys General Offices

In mid-December, the Kansas City Regional Home Care Association recognized Missouri Attorney General Jay Nixon for his initiatives in educating Missouri citizens on planning for end-of-life care. General Nixon’s office has distributed more than 60,000 copies of “Life Choices,” a publication written by the office that helps consumers document what choices they would make at the end of their lives if they are unable to speak for themselves. The association presented General Nixon with its annual Noni McCall Award.

Legislative Developments

There has been concern expressed by advocates for nursing home patients about New Hampshire’s new template for living wills. The new form includes an optional clause that reads, “Even if I am incapacitated and I object to treatment, treatment may be given to me against my objection.” The state’s long-term-care ombudsman is concerned that some elders might inadvertently sign away their right to speak up and that nursing homes might use the clause to ignore residents’ opinions on nonmedical matters.

Judicial Developments

  1. The U.S. Court of Appeals for the Fourth Circuit affirmed the conviction of Ronald McIver, D.O., on unlawful distribution of a controlled substance resulting in death and conspiracy to unlawfully distribute a controlled substance. United States v. Ronald McIver, No. 05-4884 (Dec. 5, 2006).

  2. A case in Boston, Massachusetts, illustrates the difficulty hospitals and families confront when religious beliefs and customs conflict with medical judgment and state law. Cho Fook Cheng suffered cardiac arrest after Thanksgiving. Doctors pronounced him brain-dead and said he should be taken off the ventilators and intravenous medications that were keeping his organs functioning. Massachusetts law considers a person dead when brain function ceases. However, the Cheng family practice a form of Buddhism called Jing-Tao-Chung that teaches a person is not considered dead until the heart stops beating. The family sought an injunction requiring the hospital to continue to treat Cheng but reluctantly agreed to let his supply of medicines run out. After Cheng’s death, a Family and Probate Court judge ruled the case was moot, but the family has vowed to continue to pursue its case.

  3. An Italian judge refused the request of Piergiorgio Welby to allow a doctor to remove him from his respirator. Welby suffered from muscular dystrophy. During his illness, he became an active proponent of euthanasia. The court recognized Welby’s right to end medical treatment but would not allow a doctor to participate. Ignoring the court’s decision, an Italian anesthesiologist went to Welby’s home, gave him an intravenous cocktail of sedatives, and removed the respirator. Welby died forty minutes later.

  4. A British judge held that a nursing home may withdraw life-sustaining treatment for a 53-year old woman in a permanent vegetative state. Prior to authorizing the withdrawal, the court ordered that a three-day trial of zolpidem be attempted. Zolpidem has been shown to occasionally “wake up” patients for a short time each day. When the trial treatment yielded no positive results, the court authorized removal of treatment.

Pain Management

  1. The upcoming January 2007 issue of Health Psychology will carry an article reporting the research conducted by Robert Kerns, chief of the psychology service at the VA Connecticut Healthcare System, and his colleagues. The study found that psychological intervention, such as cognitive behavior therapy, was effective in reducing pain in people with chronic lower back pain.

  2. The End-of-Life Updates have recently noted several articles in journals that discussed the efficacy of multi-disciplinary approaches to treating pain. Another such article appeared in the November 2006 issue of the Journal of Pain and Symptom Management written by Wen Ling Peng, M.D., and his colleagues at the Koo Foundation in Taipei, Taiwan. The researchers concluded that the application of a multidisciplinary approach to pain management was effective in controlling the pain for most patients with advanced cancer. The December issue of the journal published the findings of a new study that suggest that effective opioid use poses little risk of hastened death among dying patients.

  3. The Pain and Policy Study Group has announced that its website now offers country profiles that provide standardized information about opioid availability and key policy-related indicators for every country in the world.

  4. In late November, at the annual meeting of the Radiological Society of North America held in Chicago, Jurgen, Lutz, M.D., of Munich, Germany, presented the results of a study he and his team undertook. The researchers used diffusion tensor imaging (DTI) to track the movement of water molecules in patients’ brains. They found that individuals suffering from chronic low back pain had microstructural changes in their brains. The research suggests that chronic pain might be objectively demonstrated through DTI.

  5. The December 14 issue of Nature included an article reporting the results of a study that focused on six individuals living in northern Pakistan that do not feel pain. The British-led research discovered that a mutated gene blocked sodium ions from passing through cellular membranes. Although these individuals do not feel pain, they perceive touch, warmth and cold, pressure, and other sensations. The discovery has the potential to lead to a new focus for developing pain medications.

  6. An article on new technologies offer long-term alternatives to managing chronic pain was published on-line on Herald-dispatch.com. The article noted that one new procedure being used at St Mary’s Medical Center in Huntington, West Virginia, is spinal cord stimulation.

Prescription Drug Diversion

  1. The December 6, 2006, issue of the Orlando Sentinel published an op-ed by Karen Tandy, Administrator of U.S. DEA. In it, she highlighted the case against Dr. Freddie Williams and noted the proposed regulations announced in September.

  2. The Brigham Young University NewsNet website featured an article on OxyContin abuse. Although Utah’s abuse rate is low compared to other states, police statistics show that the abuse rate is growing, along with reported robberies from patients and pharmacists. An article in Florida’s Sun Sentinel in early December, as reported by the Los Angeles Times, opined that, because Florida lacks a system for tracking prescription drugs, it has become a haven for addicts and “pill mills.”

Other Developments of Interest

  1. The December 27 issue of the Journal of the American Medical Association carried a comment regarding the article that appeared in an earlier issue by Kenneth S. Boockvar and Diane E. Meier titled “Palliative Care for Frail Older Adults.” The same issue has an article discussing end-of-life care for homeless patients.

  2. Pope Benedict XVI’s message to be given on February 11, the World Day of the Sick, will include an appeal for the promotion of palliative care for terminal patients. In his message, the Pope wrote: “The Church wishes to support the incurably and terminally ill by calling for just social policies which can help to eliminate the causes of many diseases and by urging improved care for the dying and those for whom no medical remedy is available.”

  3. The request by a Florida hospice to partner with a funeral home to offer burial and cremation services for patients has sparked a controversy in the hospice and palliative care community.

  4. The question of when and how treatment should be withdrawn in the emergency room was addressed in an article in the December issue of the Journal of the Society for Academic Emergency Medicine.

  5. The Center to Advance Palliative Care issued a press release in early December that disclosed its analysis of the latest date released in the 2006 American Hospital Association Annual Survey of Hospitals. The analysis shows that there has been a five-year increase of 96% of the number of hospitals nationwide that provide palliative care programs.

  6. In December, several newspapers reported that implantable defibrillators can interfere with a peaceful death. The article in the Washington Post noted that these devices, although saving the lives of many, can cause painful jolts and prolong suffering in the dying. Some doctors are reluctant to deactivate the implants, feeling that this would be tantamount to active intervention leading to a patient’s death.

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