Wednesday, December 10, 2008

Pal-Pourri

NHPCO Lawsuit Dismissed
A DC court has dismissed the National Hospice & Palliative Care Organization's legal injunction against the implementation of the CMS Hospice Wage Index cuts. HospiceGuy @ HospiceBlog and the Hospice Foundation of America blog had already posted this last week. The NHPCO web site has a lot more detailed information regarding their efforts to delay and possibly repeal the cuts. I give them kudos for the advocacy efforts and for providing so much information on their web site.

Physician Assisted Hastened Medical Death is Spreading
Well, I am exhausted posting about this topic since the Washington State voter referendum, and I took a personal vow to take a break from posting about hastened death lest I be stereotyped. But this is a slightly different twist that our field need to be aware of and maybe start having some more discussions at the regional and maybe national organization level. A Montana Judge ruled that a terminally ill man has the right to obtain and take pills to hasten his death if he feels the suffering is unbearable. The patient/plantiff is supported by Compassion & Choices (previously known as the Hemlock Society). The court decision is well written (regardless of which side you are on) and despite a little legal-ese reads as a pretty good ethics and law history review regarding hastened death. The big issue hinges on autonomy and the right to privacy in a doctor-patient relationship as well as a state's role in directing medical services within the state. Medical Futility posts about it here. WSJ Health Blog here. Local Paper Angle here. As always read the comments for some public insight.


Recent Palliative Care Blog Posts
Dethmama is back with one of her time of death posts. You can find beauty in death. She also has another post that many hospice staff have probably experienced. It has a classic tag line: "Watching him (the doctor) leave, I raise my voice, "Why did you order Dilaudid if you weren't going to use it for her pain?"

Dr. RW likes the effectiveness and efficiency of palliative care and had read Dr. Wachter's post, but still questions why anyone would really need a palliative care team. He asks shouldn't all doctors strive to do what palliativists do?

Professor Pope at his blog Medical Futility posts an exchange between a physician and himself regarding unilateral decision making in a futility case with a surrogate decision maker who refused PEG placement and DNAR (DNR) orders despite multiple family meetings. Read the back and forth exchange and try and guess the ending.

Fatigue, the forgotten symptom. Risaden brings it to life in her post on her blog Risa's Pieces.

Ever notice how different ICU's (trauma, surgery, medical, bone marrow, neontal) have different cultures regarding resuscitation attempts? Leo Levy at DNR/DNI discusses some of the differences.

Tim Cousounis at Palliative Care Success postulates that health care reform may not be a good thing for palliative care. Leave him your thoughts and stay tuned as he plans to tell us why he thinks that with future posts.

Insure Blog highlights Tom Daschle's challenge as the new director of Health and Human Services in the Obama Administration. The main point - rationing and end of life care. Is palliative medicine as a field prepared for this amount of attention, and not all of it good if we are perceived as the consolation prize for 'rationed' care.

WSJ Health blog notes the increase use of balance billing by physician groups to recoup costs not covered by insurance companies. I am not aware of any palliative medicine doctors who do this given the usual background in hospice and dedication to provide care regardless of ability to pay. But it does bring up the question if families and patients would balk at balance billing by pallaitive medicine consultations. Would they consider the 2 hour family meeting worth the amount billed? Have any readers (patients or physicians) had a dilemma with this?

Hospice Guy posted about how one for-profit hospice closed in early November. Apparently not too gracefully judging by the comments. Are there more hospices that may be on the verge of closing? Is hospice recession proof? Maybe that is a future post!

The Frontal Cortex blog addresses hallucinations of deceased people by the bereaved
in the weeks after the death. Is it a hallucination or is it real? Poll hospice & palliative care people and your results may vary.

On his blog Running a Hospital, Paul Levy, CEO of Beth-Israel Deaconess Med Center highlighted end-of-life care as noted in the recent Wachter post as well as an article from one of his own physicians about how to honor the patients who have died.

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