NAAG Issues and Research
NEWS FROM ATTORNEYS GENERAL OFFICES
Maine Attorney General G. Steven Rowe?s Office is participating on a committee organized by the Maine Hospice Council to develop a self-study continuing medical education package that addresses end-of-life care issues. In addition to these entities, the committee is comprised of physicians and representatives of the American Cancer Society, the Board of Licensure of Medicine, the Board of Osteopathic Licensure, the Maine Medical Association, and the Muskie School of Public Service.
Maryland Attorney General J. Joseph Curran released a report, ?Prescription for Disaster: The Growing Problem of Prescription Drug Abuse in Maryland?, which recommends that the state establish an electronic prescription monitoring program, increase penalties for distributing pharmaceuticals illegally, and conduct a public outreach and education campaign. General Curran is also asking public input for the possibility of requesting the legislature to act on changing the advance directive forms in the Health Care Decisions Act.
Oklahoma Attorney General Drew Edmondson was one of the speakers at a recent Cato Institute conference on ?Drug Cops and Doctors: Is the DEA Hampering the Treatment of Chronic Pain?? Appearing with Myra Christopher, chair of NAAG’s End of Life Advisory Committee, General Edmondson spoke on the session addressing pain, diversion, and public policy and noted his understanding of the need for a balance between the investigation and prosecution of fraudulent diversion and a doctor’s ability to aggressively treat pain. A video of the conference is available on the Cato Institute webpage. Another speaker on the panel was Ronald Libby who authored the Cato Institute’s study, ?Treating Doctors as Drug Dealers: The DEA’s War on Prescription Painkillers.?
Vermont Attorney General William Sorrell was instrumental in the passage of a new advance directive law that includes greater options for describing end-of-life care than did the earlier legislation. The Vermont Health Department hopes to set up an Internet registry for the directives in about six months.
In Garrison v. Superior Court (Country Villa Belmont Heights Healthcenter), 132 Cal. App. 4th 253, Division 5 of the California Court of Appeals determined that a family member who held a power of attorney for health care for her mother was bound by an agreement to arbitrate disputes over nursing home care. Although the daughter admitted that she had signed several forms while admitting her mother to the healthcare center, she asserted that they had not been explained to her. Furthermore, she argued that, although she held a power of attorney for her mother, it did not giver her the power to make decisions regarding her mother?s constitutional or property rights or to make legal decisions on her behalf. The court distinguished two earlier decisions by noting that the health care power of attorney gave the daughter the ability to make health care decisions and the execution of the arbitration agreements were part of those decisions.
OTHER DEVELOPMENTS OF INTEREST
An important article for all staff in Attorneys General offices concerned with end of life issues is ?Progress to Achieve Balanced State Policy Relevant to Pain Management and Palliative Care: 2000-2003?. It was recently published in the Journal of Pain & Palliative Care Pharmacotherapy and is available on the Pain and Policy Studies Group (University of Wisconsin) website in pdf format.
The Fall 2005 issue of Reform Judaism Magazine has several articles dealing with end of life issues. One article, written by Dr, Mark Washofsky, Professor of Rabbinics at Hebrew Union College ? Jewish Institute of Reform, A Jewish Guide to the Moral Maze of Hi-Tech Medicine, deals with the issue of the moral permissibility of removing artificial nutrition and hydration. At the end of the article, there is a list of resources available for those of the Jewish faith who are interested in learning more about rabbinical teaching on end of life issues.
The September-October issue of AARP Magazine includes an article by Barry Yeoman, titled ?Prisoners of Pain,? which attempts to answer the question of why doctors are not prescribing the medication their patients need for pain relief.
Doctors and nurses at the Birmingham, Alabama, VA Medical Center have developed a checklist for identifying patients whose deaths appear imminent so that a special “comfort care” plan may be developed for them. Dr. Amos Bailey, director of palliative care at the medical clinic, noted that it required an education program to teach doctors and nurses how to change their approach from curing a patient to making a patient comfortable. Kathryn Burgio, the lead researcher of the program developed at the medical center, published an article on the program’s effects, Improving Processes of Hospital Care During the Last Hours of Life, in a recent issue of the Archives of Internal Medicine.
The News Service at the University of Michigan recently published an online story about a video, produced by nurses at the facility, chronicling how employees of the facility worked with Evan Mayday and his wife to support Mr. Mayday?s choices concerning his death. Titled ?Evan Mayday’s Good Death,? the twenty-nine minute video introduces its viewers to Mr. Mayday, a former Navy SEAL, who broke his neck in a diving accident and includes non-scripted interviews of those who cared for him and helped him with his decision to remove his ventilator. The funding for the video came from the University of Michigan Center for Research on Learning and Teaching and several other foundation and private donations. A discussion guide is being developed to accompany the video. Another video is being developed that addresses care of children who are terminally ill.
The current issue of Journal of Palliative Medicine contains a number of articles dealing with end of life issues including one, Palliative Care Needs of Cancer Patients in U.S. Nursing Homes, demonstrating an increasing need for nursing homes to address the palliative needs of their residents, especially the one in ten that have cancer that affects their health status.
Two years ago, the European Court of Human Rights issued a decision in the David Glass case from the United Kingdom, which held that, except where specific limitations apply, the duty to preserve life is absolute and that parental consent is paramount other than in emergency situations. The August 2005 issue of Archives of Disease in Childhood discuses the implication of this decision on clinical practice in the UK. This situation involved parents? refusal to permit palliative care for their severely mentally and physically disabled child whom the hospital staff considered terminal. For information on this case from the family?s perspective and the decisions in the European Court of Human Rights and various UK courts, see http://www.members.tripod.com/davidglass1/. The article and the information in the website raise disturbing questions concerning end of life issues involving severely disabled individuals.
An article in the September 2005 issue of the Journal of the Royal Society of Medicine discusses the United Kingdom’s Human Rights Act of 1998 and its effect on end of life decisions, including the withdrawal of artificial nutrition and hydration and the right of a competent patient to make end of life decisions.
The result of a Dutch study on end of life decisions for children between one and seventeen years of age was reported in the September issue of Archives of Pediatrics & Adolescent Medicine. In an editorial accompanying the article, Dr. Jeffrey Burns and Christine Mitchell of the Harvard Medical School discuss whether the United States has an ethical framework to guide the provision of sedation and analgesia to terminally ill children.
According to an ABC News Report, the Rural Doctors Association of Australia has announced that it will help to run a six-month pilot program to train doctors in rural areas in caring for terminally ill patients.
The September 14, 2005, issue of the Journal of the American Medical Association contains a review of a new book titled End-of-Life Decision Making: A Cross-National Study . The book brings together scholars from twelve countries on five continents who discuss the various social, cultural, and religious factors that contribute to end of life decisions in different countries.
The University of Bath in the United Kingdom has opened a new research center, the Centre for Death and Society. It will focus on research into social attitudes to dying and grief. The opening of the center coincided with an international conference on the social context of death that was hosted at the university in the middle of September. Dr. Glennys Howarth, an editor of the death studies journal Mortality and a professor in the Department of Social and Policy Sciences, is the center?s founder.
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