Waiting to Speak – Waiting for the Surrogate to Speak

6 years ago Bernard W Freedman, JD, MPH 0
Why Wait The determination of a patient’s capacity to make decisions is based upon her understanding of her disease or illness and the risks and benefits of treatment. If she is unable to articulate a clear understanding it may be determined that she lacks the necessary capacity to make her own decision and is further Read More

Withdrawing Life Sustaining Treatment – Early Withdrawal of Life Sustaining Treatment in Severe Traumatic Brain Injuries, by Bernard W. Freedman JD, MPH

8 years ago Bernard W Freedman, JD, MPH 0
  CDC Statistics Traumatic Brain Injuries On August 29, 2011 the Canadian Medical Association published the findings of a multicenter cohort study evaluating the withdrawal of life-sustaining treatment for patients who had suffered a traumatic brain injury. This study is of particular interest because by the nature of the injury  patients cannot make decisions for Read More

Rationing Medical Care Part II

8 years ago Bernard W Freedman, JD, MPH 0
  Efforts to encourage (or compel) physicians to lie to their patients were faced years ago when “gag clauses” were inserted into contracts between HMO’s and contracted physicians. The gag clause established a contractual obligation on the part of the physician to withhold information regarding treatment modalities that were not within the HMO protocol of Read More

Clinical Bioethics – Rationing – the Ethics of Lying to the Patient – Part I

8 years ago Bernard W Freedman, JD, MPH 0
  Rationing : Withholding Medical Care by Lying to the Patient Rationing of medical care and “triage” are different. Triage prioritizes the use of limited medical resources when resources are insufficient for immediate treatment.  Rationing is the withholding of available care for political/economic reasons. With respect to rationing, therefore, it must be decided whether or Read More

Withdrawing Life Sustaining Treatment -From Conscious, Non Terminal, Incompetent Part II

8 years ago Bernard W Freedman, JD, MPH 0
  Physician Liability: Withdrawing and Withholding Life Sustaining Care From  Conscious, Non Terminal, Incompetent Patients – Part II There are different standards that must be appreciated and respected before a physician can support a decision to withdraw life sustaining treatment from a non terminal and incompetent patient. This scenario requires the highest degree of protection Read More

Survival in Hospital Cardiac Arrest – Challenges for Hospitalists

9 years ago Bernard W Freedman, JD, MPH 0
The September 2010 publication of “The Hospitalist” reviews the overall survival rates for cardiac arrest patients. This article reports that patients frequently have unrealistic expectations and overestimate their chances of survival. Patients predict post-arrest CPR survival at 64%, while the rate is 17%. Most important is that in nearly half of the patients who initially expressed Read More

Mandated Insurance Coverage for Phase I and II Clinical Trials

9 years ago Bernard W Freedman, JD, MPH 0
  At present the Missouri State Senate is considering new legislation (SB 365), which means to provide health insurance coverage for Phase I and Phase II clinical trials for cancer treatment. The law in the state of Missouri presently limits mandated insurance coverage to Phase III and Phase IV clinical trials. Aside from the fact that Read More

New York will pass the Family Health Care Decisions Act

9 years ago Bernard W Freedman, JD, MPH 0
 It has been 17 years since this bill was first introduced.   The New York State Senate will pass the Family Health Care Decisions Act (FHCDA), setting forth clear guidelines for family members and others close to the patient to make medical decisions for incapacitated patients. It will also provide physicians with uniform protocols to follow. Read More