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  • Pain
    October 2004 and posted a notice in the Nov 16 Federal Register stating that the document contained incorrect information Some physicians said the new policy statement appeared to criminalize more prescribing activity Most Americans say they would prefer to die at home free of pain and without unwanted medical intervention On Jan 18 another notice was posted notifying the public that the agency was in the process of preparing another document and was seeking comments from physicians and other interested parties about what they wanted the document to include The NAAG letter expressed surprise that the DEA apparently shifted its policy from balancing medical and law enforcement concerns We are concerned that state and federal policies are diverging with respect to the relative emphasis on ensuring the availability of prescription pain medications to those who need them the letter stated DEA spokesman Rusty Payne denied there had been a shift in policy DEA has not changed any policy related to this issue Payne said in an e mail The reason for taking down the FAQs was simply because there was some information that was incorrect DEA has not changed its enforcement emphasis with respect to investigating physicians involved in the illegal prescribing of pharmaceutical narcotics He added that no meeting had been scheduled with the NAAG Most Americans die in a hospital or nursing home Attorney and pain medicine advocate Mary Baluss the director of the Pain Law Initiative in Washington D C said she cheered when she first saw the NAAG letter but then her enthusiasm was dampened somewhat when she saw that attorneys general for 21 states had not signed the letter Edmondson however was satisfied with the signatures the letter received Getting all 50 to sign is pretty near impossible getting three attorneys in a room to agree on something is problematic he said Edmondson s interest in pain treatment stems from his work promoting better end of life care He said that interest was sparked when he attended a bioethics program where he learned that most Americans would prefer to die at home with friends and family free of pain and without unwanted medical intervention Instead he said most Americans die in pain at a hospital or nursing home I was thinking What s wrong with this picture and what can I do about it Edmonson said He formed an end of life care task force in Oklahoma and while serving as the 2002 03 NAAG president selected end of life care as the subject of his presidential initiative There has been an increased focus I believe by medical licensing boards on the undertreatment of pain and with the shift by the DEA doctors are in a tough tough position Edmondson said Anything we can do to lessen that squeeze I believe is helpful and that s the purpose of the letter to the DEA American Medical Association policy states that physicians who appropriately prescribe and or administer controlled substances to relieve intractable pain should not

    Original URL path: http://www.chninternational.com/attorney%27s%20general%20wants%20pain%20expert%20want%20controls.html (2016-02-17)
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  • als iving for today
    Times Published November 7 2004 r Jules Lodish welcomes visitors to the downstairs bedroom of his Bethesda Md home with a robotic greeting that bursts from his computer s speaker Ten years of living with amyotrophic lateral sclerosis or A L S a progressive paralyzing disease have stilled nearly every muscle he types with twitches of his cheek detected by a sensor clipped to his glasses But ask him how he feels about his life and Dr Lodish his eyes expressing the intensity denied to his body responds I still look forward to every day A L S or Lou Gehrig s disease is often described as a kind of living death in which the body goes flaccid while the mind remains intact and acutely aware The prospect of being trapped in an inert body and being totally dependent on others drives many sufferers to suicide When Attorney General John Ashcroft attacked an Oregon law allowing doctor assisted suicide in 2001 a case that is still working its ways through the legal system patients with the disease were among those who supported the law in court But while the legal case and much of the national attention has focused on the issue of the right to die less is known about those patients who want to live and like Dr Lodish will go to extraordinary lengths to do so With adequate medical care patients often can live for years relatively free of physical pain from the disease itself It s more a sort of existential psychic sort of pain said Dr Leo McCluskey a neurologist in Philadelphia who treats many people with the disease As a result patients and their families are forced on a daily basis to take stock of the meaning and quality of their lives and to make repeated decisions about how much is too much With A L S you have a choice about when to stop treatment letting nature take its course said Dr Linda Ganzini a professor of psychiatry at Oregon Health and Science University in Portland who has studied patients making end of life decisions What keeps many patients alive experts say is a sense of having unfinished business perhaps a milestone like getting the last kid off to college said Dr Mellar P Davis a professor of hematology and medical oncology at the Cleveland Clinic Those patients who do best are those who have insurance that covers nursing and medical care allowing them to avoid some of the major health risks associated with the disease and family members who can cover the hours when expert help is unavailable Many patients Dr Ganzini said have deep religious beliefs that help sustain them and they are able to find hope in the future find meaning and tolerate the daily ongoing losses that they are experiencing As Dr Davis put it Quality of life becomes a moving target what was one day an unacceptable quality of life becomes an acceptable quality of life Dr Lodish s body sits limp in a wheelchair and his tongue lolls a machine breathes for him through a tracheostomy tube in his throat He lost the ability to talk more than three years ago he says then jokes but not the ability to be annoying At a time when even business executives fall into the shorthand of teenagers text messages r u going 2 the mtg he refuses to cut corners communicating in eloquent sentences in person and via e mail There are no half measures for Dr Lodish a hematologist and oncologist who devised his own intricately detailed treatment regimen He wrote a 30 page guide for his nurses that sets standards for a sterile environment that go beyond hospital practices rules that have helped him avoid the infections that kill many patients When he could no longer eat he did the research to come up with a recipe for the nutrient blend that flows down his feeding tube even determining that the ingredients were kosher and he typed the two page guide to its preparation twitch by twitch with a special program on the laptop that helps him to choose whole words or phrases from scrolling lists This wire to the world keeps him connected to his family and friends and allows him to remain an important part of their lives He continues to provide medical consultation and now advises patients with A L S and their families on how to organize their own care and use the communication devices he has mastered One irony is with many people I communicate more now than when I was well Dr Lodish said By holding on he said he has been able to see many of life s milestones including the marriages of two of his three children When his older daughter Elizabeth Lester became pregnant with the first grandchild she asked her father to make the official family announcement He still plays the same role for me she said I still consult him on financial matters and other kinds of things Dr Lodish said that his own determination to live comes in part from his long experience in treating cancer patients who often feel that a diagnosis is a death sentence I spent my career getting people to live with their illnesses until they died he said if they weren t cured Now he says My illness has validated my approach to my caring for people His wife Carolyn says she and her husband draw comfort from each other and from family jokes that have worn thin with repetition and age We all say he s a better dancer than he used to be Mrs Lodish said with a tired smile Choosing Death Not everyone with the disease makes the same choice as Dr Lodish Patients with the illness Dr Ganzini said are 25 times as likely to die by doctor assisted suicide as people with other diseases she said Dr McCluskey the neurologist in Philadelphia said that at least 90 percent of patients with A L S decided to die when they could no longer breathe on their own although medical science can extend their lives much longer For many the tracheostomy surgery to implant a breathing tube marks a dividing line between living naturally and being kept alive artificially and introduces serious medical complications and new burdens of care on family members Without a tracheostomy patients lungs stop working on their own The level of carbon dioxide builds up in the bloodstream and the patient goes to sleep Morphine is given to ease suffering and anxiety Within hours sometimes within minutes sleep gives way to coma and coma to death Once a tracheostomy has been performed however a patient who wants to end his life has to make an active decision to turn off the ventilator Dr McCluskey discusses death with every patient he said but the conversations begin in earnest when breathing begins to become impaired and the choices are not so hypothetical After they have come to a decision he revisits the issue again and again giving them opportunities to change their minds Most patients decide that they want a feeding tube Dr McCluskey said but the vast majority turn down a breathing tube Most of those who do request mechanical ventilation leave instructions in advance to turn off the machine if they come to the point that all connection to the outside world ends He calls this the locked in state Dr Lodish has not yet reached that point but he said that when he did he could imagine deciding that he had had enough of living with his illness It would have to interfere with my ability to relate to people he said The crucial element Dr McCluskey said is choice That s what this whole conversation is about to empower people he said even though they are so debilitated and sick they are actually in control Photo missing Dr Jules Lodish is a hemotologist and oncologist living with A L S for 10 years He is not retired Needed for Longevity Dr John R Bach a respiratory expert at University Hospital in Newark said that more patients might choose to live longer if their doctors knew more about the disease and the best treatments and about hope Physicians invariably tell these patients that they have a year or two to live and that there s no hope he said Dr Bach said he encouraged patients to think in terms of the longest possible life with the disease and he has developed techniques to put off the insertion of a tracheostomy tube as long as possible including mechanized girdles that mimic breathing and masks and mouthpieces that keep the air flowing in and out of the lungs Speaking of the withdrawal of medical support Dr Bach said I have nothing against euthanasia for patients who truly want to die But he said you should not allow euthanasia for the first two years because many patients reach an accommodation with the illness Do you know what happiness is Dr Bach says citing a survey that showed patients on ventilators tend to rank their level of satisfaction with life at 5 1 out of a possible score of 7 the average person in the same surveys has a score of 5 5 Happiness is reality divided by expectations Most days Gregory MacDonald faces his disease with his own blend of black humor and commitment and says that he wants to live for years to come Other days he is not so sure A L S has ravaged his once muscular frame He is unable to move from the neck down On one of the recent good days Dr Bach cheered him with the opinion that if his lung capacity remained stable Mr MacDonald could survive without a tracheostomy for another 10 or 15 years He was joyful But an acquaintance who had driven him to see the doctor was incredulous Mr MacDonald recalled that she asked You want to stay like that for 10 or 15 years Absolutely he responded Just a few weeks later however came a bad day He choked on a pill and did not have the strength to cough it up or work it down The panicky and miserable ordeal lasted for nearly an hour and he saw a dwindling existence ahead Is life worth it at all costs he asked If I m exchanging carbon dioxide is that the only criterion A school administrator Mr MacDonald was an energetic outdoorsman before the disease struck him He does not fully buy into his doctor s sunny outlook It s a living nightmare and you can t imagine anything worse he said But from my life experience I can guarantee you that things can always get worse Once an avid guitarist he played finger picking country and blues the first signs of illness came he said when I couldn t play basic things The initial diagnosis in February 2002 was delivered by a doctor who detailed the physical losses to come and eventual death in a clipped clinical monologue that ended with his handing Mr MacDonald a box of tissues and walking out If it weren t for the kids I d have gone off a bridge he says Today he sits in his Tuckahoe N Y apartment on a recliner a 52 year old man who can say with a smile With the exception of a fatal disease I m in almost perfect health He punctuates his conversation with a frequent turn of the head to sip air from a mouthpiece He says that the good days outnumber the bad days but that the bad days can be intense Recently he won a long dispute with his insurance company allowing him 12 hours a day of professional nursing assistance instead of the 4 hours a day of the low skilled care he had before The difference in his quality of life he said has given me a whole new outlook Friends and family including his girlfriend Julia Stephenson and his former wife Catherine Beazer help fill in the hours that his insurance does not cover It is in a sense a family disease Dr Davis of the Cleveland Clinic said Mr MacDonald is tied into the daily lives of his 13 year old son Dylan and his 11 year old daughter Cheyenne whose custody he shares with Ms Beazer Mr MacDonald suffers from the litany of medical problems that come with the disease frozen joints that have to be kept supple through physical therapy swollen toes that weep blood and can easily become infected A hand left resting on his leg over time can cause agony as gravity forces the fingernail into his skin a pain that he says can sometimes be worse than the time on a fishing boat when he accidentally slashed his hand with a gutting knife He still allows himself small treats a martini in the evening Medicinal he says and one cigar a week When he listens to the songs he once played it can evoke a physical memory of playing that strikes him unexpectedly A specific tone in a song a specific cord change can do that can make me quite weepy he said Before his musical ability drifted away he recorded a song that he had written for Dylan and Cheyenne The cassette sits in a safe At the back of Mr McDonald s mind is a grim calculus of life death and pensions He stopped working last spring after completing the school year in a wheelchair and will retire when his months of previous unused sick days run out in January If he should die before retirement his children will receive three years salary as a death benefit Over the next three years the death benefit diminishes and then vanishes Mr McDonald says he wants to be there for his children but he wants to be more than a mere living presence He wants he says a life and a role in their lives that is not only dignified but meaningful If I can t eat and I can t speak quite frankly I can t imagine wanting to entertain that for very long he said But he has trouble envisioning dying When you have so much to live for the thought of it becoming unbearable doesn t it never overshadows the fact that I can t imagine saying goodbye Meaning for Others Finding meaning in life is not only the fundamental challenge for A L S patients said Dr Adele Zinberg a psychiatrist who works with the homeless and who has lived with the disease for seven years A lot of what I do in my work is help people find meaning everyone needs it whether it s through their family or their work or some other cause said Dr Zinberg who can operate a powered wheelchair Everyone has to feel that their life has meaning She says that some patients ask How can I talk to you about my problems when you have your own problems She tells them Mine seem more obvious But we all have our own challenges Dr Lodish counsels other people who have suffered life blows He recalled that a doctor friend recently asked his advice about ways to help a friend who was deeply depressed after a serious automobile accident Much of this boils down to whether or not one can hang on to who one is he wrote in response He said that he was still what he had always been a father a husband a friend In fundamental ways I feel totally unchanged he said Quintessentially I have found that ambulation movement swallowing eating talking breathing and self care are not me They are substantial physical losses but they are not me Source http www nytimes com 2004 11 07 health 07A L S html ex 1100408400 en c7dab0b510b0b967 ei 5006 partner ALTAVISTA1 Many Als Patients Favor Assisted Suicide NEW YORK Sep 30 Reuters A majority of patients with the fatal neuromuscular disease amyotrophic lateral sclerosis ALS or Lou Gehrig s disease say they would consider assisted suicide according to a report in the October 1st issue of The New England Journal of Medicine Many patients would request a prescription for a lethal dose of medication well before they intended to use it report a team of researchers in Portland Oregon led by Dr Linda Ganzini of Oregon Health Sciences University In 1994 Oregon voters approved the Oregon Death with Dignity Act clearing the way for the legal use of physician assisted suicide Delayed by court challenges the Act was finally implemented in 1997 Despite the enormous media coverage surrounding the assisted suicide debate the Portland researchers point out that the level of acceptance of this option among terminally ill ALS patients has not been studied ALS patients face one of the most bleak prognoses of any patient group since their incurable neurological illness triggers a gradual irreversible paralysis ending in death usually within 2 to 3 years of diagnosis The investigators questioned 100 ALS patients as to their opinions regarding physician assisted suicide All of those interviewed had suffered from ALS for an average of nearly 3 years According to the survey 56 patients said they would consider assisted suicide Most of those patients 44 of 56 said they would request a prescription of a lethal dose of medication from their physician if such assistance was legally available Only one patient however would take the medicine immediately the researchers point out Most of the patients would reserve it for future use These findings support the notion that some seriously ill persons gain psychological comfort from knowing that taking a lethal dose of medication is an option The authors found that patients considering assisted suicide were more likely to be male well educated and non religious compared with patients rejecting such an option In

    Original URL path: http://www.chninternational.com/als_iving_for_today.htm (2016-02-17)
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  • Dal neurosurgeon discovers spina
    week in the online edition of the journal was written in collaboration with Dr Andrew Todd and Dr Robert Harley at the University of Glasgow Dr Miles is now a faculty member at the University of St Andrew s in Scotland The research was made possible with funding from the Canadian Institutes of Health Research Dr Robert Brownstone is a member of the Brain Repair Centre a multidisciplinary collaboration linking world class researchers and physicians specializing in groundbreaking treatments and technologies in the field of brain and spinal cord repair He also currently serves as the Faculty of Medicine s Assistant Dean of Research Clinical Departments His work has received funding from the Canadian Institutes for Health Research the Nova Scotia Health Research Foundation Dalhousie Medical Research Foundation Project A L S and the Christopher Reeve Foundation Recently he was the principle investigator on a grant from the Canadian Foundation for Innovation totaling over 5 5 million one of the largest single grants ever received by Dalhousie University For further information contact Ryan McNutt Communications Office Dalhousie Medical School 902 494 1900 ryan mcnutt dal ca Local research team receives 1 6 million to improve pediatric pain management in Thailand Monday March 12 2007 Halifax Nova Scotia A research team led by Dr Allen Finley Professor of Anesthesia and Psychology at Dalhousie University and physician with the IWK Health Centre has been awarded 1 million in funding through the Teasdale Corti Team Grants Program to develop a pediatric pain management program in Thailand The project pairs Dr Finley with Dr Somboon Thienthong Professor of Anesthesiology at Khon Kaen University in Thailand Together they will lead a team in developing a community of practice among provincial and regional hospitals in northeastern Thailand with standardized approaches to ensure the best possible pain prevention and treatment for children At the same time they will also study the process of disseminating information and changing practice which will help develop approaches to control other diseases and conditions in Thailand and in other developing countries Pain is a global health problem and children are more at risk than adults for untreated pain from surgery injury cancer and other disease commented Dr Finley Children in developing countries have less access to pain care than those in Canada Although pain causes immediate and prolonged suffering for both the child and his or her family it is neither expensive nor difficult to prevent or treat most pain We are extremely grateful for this funding opportunity which will allow us to create a program to overcome barriers of attitude and knowledge The approaches developed will not only help children in Thailand but also in Canada and elsewhere in the world The Halifax co investigators on the project include Dr Raza Abidi Dalhousie University Faculty of Computer Science and Paula Forgeron RN MN Clinical Nurse Specialist in Pediatric Pain at the IWK Health Centre The research team at Khon Kaen University includes faculty members from Nursing Pediatrics and Anesthesiology as well

    Original URL path: http://www.chninternational.com/dal_neurosurgeon_discovers_spina.htm (2016-02-17)
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  • end of life care dementia
    in end of life care for patients with dementia The Chicago geriatricians list the barriers to optimal care for such patients and suggest ways to get past them The first hurdle is the unwillingness of physicians and families to think of dementia as a terminal illness Patients with dementia decline slowly with long periods of stability punctuated by sudden declines and partial recovery The proximate cause of death is usually a complication of the dementia such as pneumonia or other infection often triggered by the decreased mobility that comes with advanced dementia A second barrier is the inability of physicians to predict the time of death Medicare and most insurance plans offer hospice benefits only to patients with a life expectancy of six months or less but the median survival for patients with dementia is several years and varies enormously Patient assessment becomes even more difficult as the dementia advances and the patient can no longer describe his or her symptoms or notify caregivers of discomfort A third barrier is the poor fit between dementia and health care financial incentives which reward providers for transferring rapidly declining patients into hospitals where the process of dying is prolonged The only parties who may not be better off from the transfer note the authors are the patient and family The solutions involve education better prognostic tools and changes in the health care system Geriatrics dementia and palliative and end of life care are all under represented in medical school curricula and deserve more attention as the numbers of elderly continue to increase Physicians also need to educate the public to create a baseline of awareness before families have to face these issues directly and make difficult decisions about a loved one Better prognostic tools for patients with dementia and increased access to

    Original URL path: http://www.chninternational.com/end_of_life_care_dementia.htm (2016-02-17)
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  • man's trial for mothers death 2007
    asked why Mrs Lawrimore said they had just learned they had a CD at Carolina First Bank that was worth 65 000 She said Wesley was very nervous and did not want his mother sharing that information with Camlin Camlin said that was the last time she saw Mrs Lawrimore I would call her house and all I got was a message I never got to talk to her or Wesley she said A hard life It s unknown if Lawrimore will take the stand and testify during the trial Since it began he has kept the same pose almost the entire time He sits at the defendant s table with his head down Sometimes he is fidgeting with his hands Other times he appears to be taking notes He has made very little eye contact with the jurors or any of the witnesses That however is not uncommon Those who have known Lawrimore through the years told The Times after his arrest he is quiet and reserved and rarely spoke They said he only held a few part time jobs In interviews with former editor Jesse Tullos of The Times some who knew Lawrimore said he had patterns of alcohol and drug abuse at times during his life The death of his mother was not the first tragedy Lawrimore has had to endure In 2003 his father Charles a former Georgetown County treasurer died In 1984 his half brother committed suicide What s next The trial will resume at 8 30 a m today and the defense is expected to call a doctor as its first witness Lawrimore s attorney Stuart Axelrod told Circuit Court Judge R Knox McMahon that witness could take most of the day He told the judge he may also call other doctors and some of Lawrimore s family to the stand Axelrod has said several times he wants to call one family member in particular Glen Wilson Bryan told the judge he objected because he doesn t see anything relevant Wilson could add to the case If he is called to testify there is likely to be a hearing outside the presence of the jury for the judge to decide if he can take the stand McMahon wanted to hold court on Saturday in order to expedite the trial but because of previous commitments of some jury members the case will likely conclude on Monday Source State rests in neglect case Georgetown Times 2007 Man s trial for mother s death begins Doctor says that neglect could have caused infection Posted on Thu Apr 26 2007 By Kelly Marshall Fuller The Sun News Prosecutors tried Wednesday to convince jurors that neglect not a desire to die at home without medical treatment was the reason for a Kensington woman s death nearly two years ago Janette Lawrimore s doctor testified Wednesday that she didn t have the capacity to make a decision about her medical treatment The trial began this week for Lawrimore s son

    Original URL path: http://www.chninternational.com/man%27s%20trial%20for%20mothers%20death%202007.htm (2016-02-17)
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  • CHN FACT SERIES: Living Wills/Advance Directives
    Dixon Euthanasia No cure for medical madness from faxed correspondence to C Eckstein President CHN dated 18 3 94 used with permission Dr Dixon is a specialist in the care of those dying of cancer and AIDS He is the Medical director of AIDS CARE EDUCATION AND TRAINING ACET in London England ADVANCED DIRECTIVES AND PROXY DECISION MAKERS No one could foresee all future possibilities nor how new medical treatments might change them in years to come No one could possibly document their views on all such eventualities It is probably unlikely that people would update any documents sufficiently regularly The healthy do not make their choices in the same way as the sick An important review of a recent paper from Canada states The authors conclude that an advance Directive prepared by a healthy person is not a valid indicator of the preferences of a similar person when sick This is not necessarily an argument against advance Directives but it is an argument against them having the force of law Our experience is that people change their minds when they become unwell but an earlier advance Directive might still be in force House of Lords HL Select Committee on Medical Ethics Vol II Oral Evidence 18 6 93 110 See also Comment in Bulletin of medical Ethics review March 1993 p 17 on Tierney M C et al How reliable are advance Directives for Health care A study of attitudes of the healthy and unwell to treatment of the terminally ill Annals of the Royal College of Physicians and Surgeons of Canada 1992 25 267 70 Memorandum by the Association for Palliative Medicine Ethics Group A comprehensive review on the subject of advance directives is given in the statement of November 1992 by the British Medical Association BMA The BMA is not in favour of legal enforcement of such documents a view with which we entirely agree From our working practice we would highlight particularly the following points against advance directives being enforceable by law Ambiguity and the Scope for Misinterpretation Whatever care is put into the wordings of advance directives the precise meaning of terms such as terminal illness active treatment and competence will always be open to doubt Pressure on Vulnerable Groups The likelihood of particularly the elderly and chronic sick who feel themselves to be a burden being pressurised into signing advance directives will increase if such documents become legally binding Bias Bias against active treatment inherent in some published advance directives may limit rather than enhance an individuals autonomy Implications for Euthanasia We deplore moves to make advance directives legally binding as part of a gradualist policy to legalise euthanasia We believe that the interests of patients will be best served by resisting attempts to make advance directives enforceable by law House of Lords HL Select Committee on Medical Ethics Vol II 13 6 93 183 Memorandum by the National Council for Hospice and Specialist Palliative Care By the time the directive comes into force

    Original URL path: http://www.chninternational.com/chnfact1.htm (2016-02-17)
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  • Advance directives Doctors may not comply By Helen Fields
    teaching hospitals in California 117 were returned 77 from faculty and 40 from residents In each case the advance directive was contradicted by the situation either the family wanted something else or the doctor thought the patient would be better off with treatments other than what they asked for For example in one case a woman with diabetes on dialysis has had a stroke and can t speak or understand speech and the neurologist thinks she s unlikely to recover Her advance directive asked that she receive full treatment no matter what the prognosis and names her husband to make decisions for her but her husband has asked that dialysis be stopped The doctors had to answer whether they would stop dialysis or continue it What they found Almost two thirds of the time the doctors said they would go against the advance directive Faculty and residents were equally likely to go against a patient s documented wishes What the study means to you Your advance directive may not accomplish what you think it will Caveats Well obviously since the survey was based on hypothetical situations this may not be how physicians actually work and most cases probably aren t

    Original URL path: http://www.chninternational.com/advance_directives_doctors_may_n.htm (2016-02-17)
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  • living wills do not work
    never make it to the bedside left in a file cabinet or safety deposit box And family and doctors often do a poor job of deciphering the patient s wishes even when they have the wills in hand Most people believe that a living will can be written that is effective and that genuinely conveys real information that can be used in making decisions and that is not true said Carl Schneider an expert in medical law at the University of Michigan Law School Since 1990 hospitals have been required in most states to offer all patients the chance to fill out a living will But despite the law and despite several high profile end of life legal disputes most people still don t have living wills Enough The living will has failed and it is time to say so Schneider and colleague Angela Fagerlin wrote in a bioethics journal the Hastings Center Report A better end of life option experts say is to give a trusted loved one the legal authority to make decisions if you become incapacitated Two large studies found more than 70 percent of people would prefer that doctors rely on family rather than living wills in making decisions about their care This has its own problems the designated decision maker may not understand what the patient s wishes are and picking one person to make decisions could cause tension inside a family The stereotypical conflict doctors and nurses say comes when the adult child arrives from out of town feeling guilty he hasn t spent more time with his parent and resists steps to end the parent s life even as a brother or sister who lives nearby says this is what the parent wanted Still experts say designating someone to make decisions allows for more flexibility than living wills Another choice that holds less legal weight but perhaps more influence thoughtful conversations in advance with your regular doctors I sit with patients and ask then not what treatments are important to you but what defines quality of life Morrison said What would be a fate worse than death for you What makes life worth living The questions have become more acute as medical advances have given doctors unprecedented ways to prolong life At the same time a series of high profile legal disputes over whether to end medical treatment have prompted more people to consider putting their wishes explicitly into writing This fall the Florida Supreme Court struck down a law that reconnected the feeding tube of Terri Schiavo 40 who was severely brain damaged 14 years ago The dispute pits her husband who says she wouldn t want to live this way against her parents who want to keep her alive Schiavo did not have a living will But doctors don t always follow a patient s instructions even when they are clear Sometimes the document doesn t accompany the patient Or the doctor fears litigation or simply disagrees with a patient s

    Original URL path: http://www.chninternational.com/living_wills_do_not_work.htm (2016-02-17)
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