Law Commons^™

Removing Obstacles To A Peaceful Death, Kathy L. Cerminara, Barbara A. Noah

Faculty Scholarship

We all will die, but the American health care system often impedes a peaceful death. Instead of a quiet death at home surrounded by loved ones, many of us suffer through overutilization of sometimes-toxic therapeutic interventions long past the time when those interventions do more good than harm. This article proposes revisions to health professional training and payment policy to eliminate as much as possible physical and existential suffering while progressing through the terminal phase of illness. The solution lies in seamless progression from treatment with integrated palliative care to hospice before death, but provider attitudes and payor practices must …

Avoiding Overtreatment At The End Of Life: Physician-Patient Communication And Truly Informed Consent, Barbara A. Noah, Neal R. Feigenson

Faculty Scholarship

This Article considers how best to ensure that patients have the tools to make informed choices about their care as they near death. Informed decision making can help reduce excessive end-of-life care and unnecessary suffering, and result in care that aligns with patients’ well-considered values and preferences. The many factors that contribute to dying patients receiving too much therapy and life-prolonging care include: the culture of denial of death, physicians’ professional culture and attitudes toward treatment, physicians’ fear of liability, physicians’ avoidance of discussions about prognosis, and the impact of payment incentives that encourage overutilization of medical technologies.

Under the …

The (Ir)Rationality Of (Un)Informed Consent, Barbara A. Noah

Faculty Scholarship

This essay considers the problem of over-utilization of medical care at the end of life and the lack of truly informed consent and briefly considers the multiple causes of these phenomena. It then explores the inherent challenges to making informed medical decisions using concepts of Knightian uncertainty, bounded rationality, optimism bias, and other heuristics. The essay concludes that uncertainty inherent in these decisions means that challenges to making truly informed decisions about medical care are even more substantial than physicians acknowledge or patients ever realize. Acknowledging these challenges is the first step to better medical decision making. informed consent has …

A Better Death In Britain?, Barbara A. Noah

Faculty Scholarship

In the United States, patients and physicians often avoid discussing the inevitability of death and planning for it. As a result, opportunities are missed to make choices that comport with patients’ values and preferences. In the absence of such decisions, the default model is to “err on the side of life,” which often results in overtreatment or inappropriate prolongation of life and avoidable suffering. This Article discusses the United States' end-of-life training and care and Britain’s Liverpool Care Pathway as related to end-of-life care availability, quality, and cost. It further sets forth the argument that while the United States' medical …

A Role For Law In Preparing For Death, Barbara A. Noah

Faculty Scholarship

This Article discusses the limits of how end of life law can address threats to patient autonomy. The reluctance of physicians, patients and family to discuss end of life matters and to confront the certainty of death, together with a culture that actively denies the aging process itself, interferes with a patient’s ability to exercise choice as death approaches. Thus, patients often suffer needlessly from the continuation of treatments and life-supportive measures that they would choose to decline if better informed about their choices and the importance of choosing. Advance directives, as a legal mechanism, often fail fully to protect …

Two Conflicts In Context: Lessons From The Schiavo And Bland Cases And The Role Of Best Interests Analysis In The United Kingdom, Barbara A. Noah

Faculty Scholarship

This Essay considers the different approaches to end of life decision making for incapacitated patients in the United States and in the United Kingdom. In the United States, individual patient autonomy is the primary guidepost for making end of life decisions for incapacitated patients. In the United Kingdom, patient preference is openly and deliberately supplemented with a careful consideration of the patient’s best interest. To contrast the two approaches, the Essay focuses on two cases involving patients in permanent vegetative states (PVS) for whom little was known about their respective individual preferences, and it analyzes the differences in conceptualization and …

In Denial: The Role Of Law In Preparing For Death, Barbara A. Noah

Faculty Scholarship

Only approximately 20% of Americans have engaged in any form of advance care planning and, even among older Americans, the process frequently is delayed until an acute illness provides sufficient pressure to act. End of life law, though flawed, offers some opportunity to express individual values and preferences via advance directives of various kinds in order to prepare for death before it is imminent. Yet many people avoid making these preparations because the thought of death is uncomfortable to confront. This Article considers the utility of existing law in preventing and resolving end of life disputes and avoiding over-utilization of …

Symposium: Issues In Estate Planning For Same-Sex And Transgender Couples: Foreword, Jennifer L. Levi

Faculty Scholarship

Despite the sea of change in possibilities for creating lawful relationships for many gay, lesbian, bisexual, and transgender individuals, most jurisdictions do not allow them to marry or enter into any comparable legal status. The vast majority of states either by statute or state constitutional amendment actually prohibit marriage for same-sex couples. And, even when couples can marry or enter into a comparable legal status, they are faced with uncertainty regarding what effect, if any, will be accorded to that status should they travel or move. Given the legal challenges that same-sex couples face, the need for high-quality estate planning …