Exploiting despair – the death of Jahi McMath

5 years ago Bernard W Freedman, JD, MPH 0
With the onslaught of media coverage of the Jahi McMath case it is time for a public debate on whether or not the loss of upper and lower brain function should determine death.  Brain death is the cessation of any brain activity in the upper brain as well as the lower brain or brain stem. Read More

Making Choices

5 years ago Bernard W Freedman, JD, MPH 0
New Year resolutions are sometimes easy to make but hard to keep. Resolutions are choices, choices to live on and to better ourselves. For patients who are critically ill, resolve is often in short supply.  So, to physicians reading this I ask that one of your resolutions this coming year is to speak with patients Read More

The Problem with POLST – Physician Orders for Life-Sustaining Treatment

6 years ago Bernard W Freedman, JD, MPH 1
The Problem with POLST Over the years, informed consent has been given short shrift. There is, however, a growing understanding of the importance of obtaining an actual and legitimate consent before  having a patient accept or reject medical treatment. Autonomy, transparency, respect, dignity, and other similarly recognized human rights are increasingly recognized as legal and ethical Read More

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 – Rasouli Decision: We don’t need permission to withdraw life sustaining care

7 years ago Bernard W Freedman, JD, MPH 0
    On December 22, 2011, the Supreme Court of Canada agreed to hear the case of Cuthbertson and Rubenfeld versus Hassan Rasouli. The appellants, Drs. Brian Cuthbertson and Gordon Rubenfeld) are Mr. Rasouli’s physicians.    . The question before the court is whether physicians must seek approval from a legislatively created board of review before 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

Withdrawing Life Sustaining Treatment – End of Life Care: the Doctor-Patient Relationship A Refusal to Communicate

8 years ago Bernard W Freedman, JD, MPH 0
  The New England Journal of Medicine recently published an article entitled: “ The Palliative Care Information Act in Real Life,” (NEJM 364;No.20 May 2011), regarding a New York statute that requires a physician to have discussions of end of life treatment options with the patient when the patient is “terminally ill.” Alan Astrow MD and 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