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Life support must continue for noncomatose patient
In a case that was closely watched by the American Medical Association and several physician and patient advocate groups, the California Supreme Court unanimously ruled that life support cannot be withdrawn from patients who are not comatose or in a persistent vegetative state and have left no written instructions about their wishes. The court upheld a lower court ruling in the case that prevented a woman from removing the feeding tube from her severely disabled husband.
Robert Wendland, 49, suffered severe brain damage in a 1993 truck accident. His injuries left him in a "minimally conscious state," unable to walk, talk, eat, or go to the bathroom. In 1995, Rose Wendland, his wife and conservator, refused to consent to reinsertion of his feeding tube. Although he left no written evidence of his wishes, Rose Wendland said her husband had indicated in several conversations prior to his accident that he would want to be allowed to die under such circumstances. However, Robert Wendland’s mother, Florence, and sister disagreed and sued to have food and hydration maintained.
Robert Wendland died of pneumonia on July 17 of this year, but the court decided to rule anyway in order to clarify the law.
In stating the court’s opinion, Justice Kathryn Mickle Werdegar wrote that Rose Wendland’s account of the conversations she had with her husband did not "establish clear and convincing evidence that the conservatee would desire to have his life-sustaining treatment terminated under the circumstances in which he now finds himself."
However, the court noted that its ruling was confined only to a narrow group of people: people who are conscious and who have not left formal, written directions for health care. California state law permits conservators to have the "exclusive authority" to give consent for medical treatment to be performed on the conservatee provided decisions are made in good faith and considering medical advice. Last year, the state legislature amended the law to specifically include health care decisions involving the withholding or withdrawal of artificial hydration and nutrition, though that provision was not in affect when the appeals court made its ruling.
The California Medical Association and the Los Angeles County Medical Association filed amicus curiae briefs with the court in support of Rose Wendland, contending that courts should not interfere in decisions that previously had been left up to doctors and families.
ACP, AMA to oppose physician-assisted suicide
The American College of Physicians has joined the American Medical Association (AMA), American Nurses Association, and The American Geriatrics Society in officially opposing physician-assisted suicide. A paper published in the Aug. 7 issue of the Annals of Internal Medicine says the 90,000-member American College of Physicians (ACP) believes physicians should always look for ways to improve care for the dying.
"Legalization [of physician-assisted suicide] would undermine the patient-physician relationship and the trust necessary to sustain it; alter the medical profession’s role in society; and endanger the value our society places on life, especially on the lives of disabled, incompetent, and vulnerable individuals," the authors wrote. "The ACP-ASIM remains thoroughly committed to improving care for patients at the end of life."
Providing more and better care for pain and suffering, treating depression more aggressively and increasing access to hospice care are essential to help terminally ill patients die more comfortably, the paper stated. Assisted suicide would damage the patient-physician relationship, jeopardize the medical profession’s role of healing, and lessen the value placed on life, according to the paper. The paper emphasized the group’s strong support for a patient’s right to refuse or halt treatment.
Medical journals to adopt anti-censorship policies
In an attempt to crack down on "censorship" of clinical research by large pharmaceutical companies, four of the world’s most prominent medical journals — The New England Journal of Medicine, the Lancet, Annals of Internal Medicine, and the Journal of the American Medical Association — have reportedly decided to jointly adopt a new editorial policy stating they will refuse to publish research funded by drug companies unless they receive written assurances that the authors had complete scientific independence, claims a report in the Aug. 5, 2001 issue of The Washington Post.
A joint editorial, reportedly to be published in September issues of each of the journals, will outline the new requirements. The new policy is designed to address concerns that pharmaceutical companies attempt to block publication of studies that reach conclusions not beneficial to the companies’ products or alter research findings to omit damaging information, the Post reported.
Patients, states to benefit from new rules
U.S. Secretary of Health and Human Services (HHS) Tommy G. Thompson has proposed new regulations to give Medicaid beneficiaries patient protections similar to those contained in proposed congressional "patient’s bill of rights" legislation. The new regulations will guarantee Medicaid beneficiaries access to emergency department care, a second opinion when requested, direct access to women’s health services, and the right to appeal adverse coverage decisions.
In addition, the regulations would prohibit Medicaid managed care plans from instituting restrictions, such as gag rules, on provider-patient communications; and, the regulations would require states to approve of marketing materials used by the plans.
The proposed rule would replace regulations put in place by the Clinton administration and would allow states to have more "flexibility" in deciding how best to provide patient protections and use managed care within Medicaid plans, according to a press released issued by HHS.
The proposed new rule was published in the Federal Register on Aug. 20. The mandatory 60-day comment period will end Oct. 19, and final regulations are expected to be issued around the first of next year.
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