Tag Archives: informed decision making

Distinction without a difference? Guidance from the NCBC

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Last month the National Catholic Bioethics Center posted an article that was meant to guide Catholic clinicians on what to do when a patient or proxy or government requests treatment that the clinician considers to be morally wrong [“Transfer of Care vs. Referral: A Crucial Moral Distinction”]

The subject is important and timely, and I looked forward to reading the piece, but unfortunately it misses the mark when it comes to issues where withholding/withdrawing treatment and palliative care would be involved. Continue reading →

University of Geneva invites Ezekiel Emanuel to make the case for dying at age 75

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Ezekiel Emanuel is taking his I-Hope-To-Die-at-75 road show to Switzerland at the invitation of the University of Geneva, where he will be speaking today.

In an interview with Le Temps, Emanuel emphasized that he is opposed to euthanasia and assisted suicide:  [translation from French with the help of Google Translate]

I am opposed to euthanasia and assisted suicide. I feel that people who want that recourse mainly suffer from depression and fear of losing their dignity; we must first provide them with care and compassion. I will not put an end to my life intentionally. But I will not try to prolong it either! From age 75, I will accept neither predictive tests nor care – except for palliative care that reduces pain. I’ll do no more cardiac tests. I will not take more antibiotics and I will not be vaccinated against the flu. If I have cancer, I will refuse any treatment.

Continue reading →

Scripting the Conversation, Part 2: The provider-patient dialogue

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My last post —  Scripting “the Conversation” — discussed scripted dialogue at the national level.  It demonstrated how a few academics, so-called health policy experts, special interest groups, and foundations can stage a national dialogue — frame a conversation — with the help of their media allies.

The same group of academics and foundations have been at work on the micro level, generating scripts — literally word-for-word scripts — to be used by providers when they encounter difficult situations with patients and families, mostly in the context of patients and families who want life-sustaining treatment. Continue reading →

Another palliative care expert chimes in

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A friend has sent me an editorial from the San Francisco Chronicle concerning the Jahi McMath and Marlise Munoz cases.  The column, “End of life elusive, thanks to tricks of modern science,” was published last Friday, and was written by Jessica Nutik Zitter, MD, MPH.

Dr. Zitter’s editorials seem to be popping up all over the place these days.  See, for Continue reading →

Emanuel: New “independent entity” would save federal dollars by convincing patients to forgo treatments

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In an article just published in the New England Journal of Medicine, former Obama adviser Ezekiel Emanuel (infamous for his “complete lives system”) and Emily Oshima Lee of the Center for American Progress have an idea on how to cut costs:  “share” in patients’ decisions to request expensive treatments by providing patients with “certified” decision aids.  Lee and Emanuel write:

Section 3506 of the ACA aims to facilitate shared decision making. Primarily, it funds an independent entity that would develop consensus-based standards and certify patient decision aids for use by federal health programs and other interested parties.

Not surprisingly, “shared decision making” (as opposed to ordinary decision making), is proven to cut costs:

In 2008, the Lewin Group estimated that implementing shared decision making for just 11 procedures would yield more than $9 billion in savings nationally over 10 years.

The authors suggest that HHS can bypass Congress in making the tools mandatory:

For approaches that provide savings or improve quality of care, implementation can be mandated throughout Medicare without additional legislation.

Lee and Emanuel do not offer specific examples of patient decision aids, but one that comes to mind is a video tool that made news in 2009.  Researchers affiliated with Harvard Medical School, Massachusetts General, and Boston University created a video of a woman with advanced dementia who could not talk or eat.  After viewing the video, almost all dementia patients (96%) declined life-saving treatment, while in the control group (decision-making without the video) only 86% chose to forgo life-saving measures. (Read about the study: Video Images of Advanced Dementia Help Patients Plan Care.  The study and video are online:  Volandes, Angelo E et al. “Video Decision Support Tool for Advance Care Planning in Dementia: Randomised Controlled Trial.” BMJ 2009;338:b2159)

Don’t worry; CMS can get started even without the independent entity in place.  International guidelines are available:

The Department of Health and Human Services could quickly launch pilot programs for shared decision making while it works to standardize and certify decision aids. The International Patient Decision Aid Standards Collaboration has developed evidence-based guidelines for certification indicating that decision aids should include questions to help patients clarify their values and understand how those values affect their decisions . . .

The Center for American Progress urges immediate action.