Digital Commons Network^™

A Qualitative Study Of Key “Regulatory” Factors Influencing Patient Access To Medical Assistance In Dying In Canada, Ruthie Jeanneret, Eliana Close, Jocelyn Downie, Ben P. White

Dalhousie Law Journal

Medical assistance in dying (“MAiD”) was legalized federally in Canada after the landmark case, Carter v Canada (AG), 2015 SCC 5. Bill C-14 introduced a federal legislative framework for MAiD in 2016, which was amended by Bill C-7 in 2021. Some Bill C-7 amendments directly responded to the decision in Truchon c Canada (PG), 2019 QCCS 3792. Other amendments responded to several factors identified as barriers to patient access, including the requirement for two independent witnesses, the 10-day reflection period, and the requirement to provide final consent at the time of administration of MAiD medication. However, emerging literature identifies that …

Dying Well: Hospice Care As A Diminished Promise, Barry R. Furrow

Akron Law Review

No abstract provided.

Protecting Older Adults Who Are Incarcerated: Does The 8th Amendment Work?, Jalayne J. Arias

Health Matrix: The Journal of Law-Medicine

Older adults in prison and within other carceral systems (i.e. jails, parole) are uniquely at risk for elder mistreatment. Emerging research has begun to consider the experiences of older adults within carceral settings, including aging in prison, chronic conditions and medical care, compassionate release, and end-of-life care. This research exposes evidence that prisons and other carceral settings lack resources and services for older adults. Given increased vulnerability and a lack of protective resources, older adults experiencing incarceration may experience disproportional rates and consequences of elder mistreatment. A public health approach to develop tools and resources that would prevent, detect, and …

Not Quite What The Doctor Ordered: The Third Circuit Pulls The Plug On Objective Falsity In United States Ex Rel. Druding V. Care Alternatives, Jenna L. Schaffer

Villanova Law Review (1956 - )

No abstract provided.

End Of Life Uncertainty: Terminal Illness, Medicare Hospice Reimbursement, And The "Falsity" Of Physicians' Clinical Judgments, Jameson Steffel

University of Cincinnati Law Review

No abstract provided.

Faith And/In Medicine: Religious And Conscientious Objections To Maid, Daphne Gilbert

Dalhousie Law Journal

Across Canada, health care institutions that operate under the umbrella of religious traditions refuse to offer medical assistance in dying (MAiD) on the grounds that it violates their Charter-protected rights to freedom of religion and conscience. This article analyses the Supreme Court jurisprudence on section 2(a) and concludes that it should not extend to the protection of institutional rights. While the Court has not definitively pronounced a view on this matter, its jurisprudence suggests that any institutional right to freedom of religion would not extend to decisions on publicly-funded and legal health care. MAiD is a constitutionally-protected option for individuals …

A Qualitative Analysis Of End-Of-Life Healthcare In Tennessee: Politics, Principles, And Perceptions, Erin Mauck

Electronic Theses and Dissertations

The unprecedented growth of the aging population in Tennessee is a significant demographic trend that highlights the necessity for healthcare policy that tackles end-of-life issues. This study examined the perceived quality of end-of-life healthcare in Tennessee, areas that are in need of improvement, policies that have the potential to influence improvements, and the role of politics in end-of-life healthcare policy. It also assessed the support for end-of-life healthcare policy that would advance quality of care and expand end-of-life choices for Tennesseans, while evaluating the policy-making process that legislators employ.

For this study, data were collected using semi-structured, in-depth interviews with …

End-Of-Life Decision Making: Policy And Statutory Progress (2011-2020), Jocelyn Downie, Mona Gupta, L. Wayne Sumner, Joshua Wales

Reports & Public Policy Documents

In 2009, the Royal Society of Canada (RSC) identified a series of urgent scientific and public policy questions. It established a series of five Expert Panels to study the issues and provide recommendations for next steps. It is now timely to revisit the findings of these Expert Panel Reports. What impact have they had? Have their recommendations been implemented? What are the next steps in terms of policy options?

To answer these questions, the RSC is establishing Policy Briefing Committees (PBC) to:

• describe the context, findings, and recommendations of the report;
• track policy developments in relation to the panel’s findings …

The Legal Status Of Deep And Continuous Palliative Sedation Without Artificial Nutrition And Hydration, Jocelyn Downie, Richard Liu

Articles, Book Chapters, & Popular Press

Deep and continuous palliative sedation combined with the withholding or withdrawal of artificial nutrition and hydration (collectively termed “PSs̄ANH”) is an important aspect of high-quality end-of-life care. It is one means of alleviating suffering. Unfortunately, the legality of this practice has been under-researched and PSs̄ANH is not yet appropriately regulated in Canada. In this paper, we explore the legal status of PSs̄ANH where it (1) will not hasten death (Type 1 PSs̄ANH); (2) might, but is not certain to, hasten death (Type 2 PSs̄ANH); or (3) is certain to hasten death (Type 3 PSs̄ANH). It is clear that Type 1 …

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 …

Unbefriended And Unrepresented: Better Medical Decision Making For Incapacitated Patients Without Healthcare Surrogates, Thaddeus Mason Pope

Georgia State University Law Review

The purpose of this Article is to help improve the quality of healthcare decision making for the unbefriended. I hope that this comprehensive and systematic explanation of both the problem and the available solutions will empower both public and clinical policymakers to develop more informed and more circumspect policies and procedures

Unbefriended And Unrepresented: Better Medical Decision Making For Incapacitated Patients Without Healthcare Surrogates, Thaddeus Pope

Faculty Scholarship

How should we make medical decisions for incapacitated patients who have no available legally-authorized surrogate decision maker? Because these patients lack decision making capacity, they cannot authorize treatment themselves. Because they lack a surrogate, nobody else can authorize treatment either. Clinicians and researchers have referred to these individuals as “adult orphans” or as “unbefriended,” “isolated,” or “unrepresented” patients. Clinicians and researchers have also described them as “unimaginably helpless,” “highly vulnerable,” and as the “most vulnerable,” because “no one cares deeply if they live or die.”

The persistent challenges involved in obtaining consent for medical treatment on behalf of these individuals …

Cross-Cultural Dynamics In Palliative Care: The Emerging Canadian Scenario, Chidi Oguamanam

Dalhousie Law Journal

As modern technologies leverage medical sciences, life expectancy is on the rise in Canada, and indeed globally with a remarkable increase in the elderly population in need of health care. The same is true of the diversity of cultural groups who are now patrons and stakeholders in Canada's health care landscape. An emergent feature ofthis landscape is the complexity ofcontexts for negotiating and mediating medical care delivery at the end of life. This paper examines the gaps in regulatory and legal interventions as well as the gaps and opportunities to negotiate the transition to palliative care in cross-cultural contexts that …

Advance Directives: A Case Of Changing Social Norms And Their Legal Implications, Ira Bedzow

Journal of Aging, Longevity, Law, and Policy

No abstract provided.

Mid-Atlantic Ethics Committee Newsletter, Spring 2014

Mid-Atlantic Ethics Committee Newsletter

No abstract provided.

Throwing Dirt On Doctor Frankenstein’S Grave: Access To Experimental Treatments At The End Of Life, Michael J. Malinowski

Journal Articles

All U.S. federal research funding triggers regulations to protect human subjects known as the Common Rule, a collaborative government effort that spans seventeen federal agencies. The Department of Health and Human Services has been in the process of re-evaluating the Common Rule comprehensively after decades of application and in response to the jolting advancement of biopharmaceutical science. The Common Rule designates specific groups as “vulnerable populations”—pregnant women, fetuses, children, prisoners, and those with serious mental comprehension challenges—and imposes heightened protections of them. This article addresses a question at the cornerstone of regulations to protect human subjects as biopharmaceutical research and …

Communicating With Patients And Families About Difficult End Of Life Decisions: A Guide For Medical Providers, Jim Demaine, Joi Murotani Dennett

Hamline Law Review

abstract

The Nursing Home As Part Of The Polst Paradigm, Marshall B. Kapp

Hamline Law Review

abstract

The Making Of A Myth: Unreliable Data On Access To Palliative Care In Canada, Jocelyn Downie, Georgia Lloyd-Smith

Articles, Book Chapters, & Popular Press

Assisted death is now the subject of conversation in the media, in public meetings, and around kitchen tables across the country. A frequent part of many conversations about assisted death law reform is access to quality palliative care in Canada. Throughout the literature and other forms of media, the claim is made that only 16-30% of Canadians have access to palliative care (or, its derivative, 70% are without access). The “16-30%” claim has been widely accepted as a fact. But is it, in fact, true? We are driven to the conclusion that the oft-repeated claim that only 16-30% of Canadians …

Gently Into The Good Night: Toward A Compassionate Response To End-Stage Illness, George P. Smith Ii

Scholarly Articles

End-of-life decision making by health care providers must respect individual patient values. Indeed, these values must always be viewed as the baseline for developing and pursuing patient-centered palliative care for those with terminal illness. Co-ordinate with this fundamental bioethics principle is that of beneficence or, in other words, respect for conduct which benefits the dying patient by alleviating end-stage suffering — be it physical or existential. Compassion, charity, agape and/or just common sense, should be a part of setting normative standards and of legislative and judicial responses to the task of managing death. Aided by the principles of medical futility, …

A Nudge In The Right Direction With A Stick The Size Of Cms: Physician-Patient Communication At The End Of Life, Katherine B. Ledden

Saint Louis University Journal of Health Law & Policy

No abstract provided.

The Role Of Race In End-Of-Life Care, Barbara A. Noah

Journal of Health Care Law and Policy

No abstract provided.

The Role Of Race In End-Of-Life Care, Barbara A. Noah

Faculty Scholarship

This essay focuses on one important aspect of racial disparities that has received comparatively little attention in the legal literature--the existence and causes of racial differences in end-of-life decision making and in the utilization of palliative and hospice care. African Americans and other racial minorities in the United States utilize palliative care and hospice less frequently than white Americans. These minority populations also tend to resist advance care planning and instead opt to receive more life-prolonging care at the end of life, even when quality of life and prognosis are poor. After a lifetime of limited access to health care …

Volunteer Prisoners Provide Hospice To Dying Inmates, Janice A. Cichowlas, Yi-Ju Chen

Annals of Health Law and Life Sciences

No abstract provided.

La Caja De Pandora: Improving Access To Hospice Care Among Hispanic And African-American Patients, Kathy L. Cerminara, Alina M. Perez

Faculty Scholarship

Many patients clinging to hope in the form of potentially curative treatment could benefit from hospice services, but, for the most part, it is not until the patient accepts the finality of his or her condition that the physical, psychological and social benefits of hospice care become accessible to the patient and his or her family. Under current Medicare regulations and other health care payers’ policies, patients must abandon the hope of curative treatment before opting for hospice services. As a result, many terminally ill patients access the services late, sometimes a few hours before death. Scholars have proposed that …

Promoting Public Health Through Clinical Legal Education: Initiatives In South Africa, Thailand, And Ukraine, Tamar Ezer

Articles

No abstract provided.

On Hastening Death Without Violating Legal Or Moral Prohibitions, Norman L. Cantor

Rutgers Law School (Newark) Faculty Papers

While the vast majority of fatally afflicted persons have a powerful wish to remain alive, some stricken persons may, for any of a host of reasons, desire to hasten death. Some persons are afflicted with chronic degenerative diseases that take a grievous toll. Chronic pain may be severe and intractable, anxiety about a future treatment regimen may be distressing, and helplessness may erode personal dignity and soil the image that the afflicted person wants to leave behind.

A dying patient’s interest in hastening death is often said to be in tension with a bedrock social principle that respect for sanctity …

Mid-Atlantic Ethics Committee Newsletter, Spring 2005

Mid-Atlantic Ethics Committee Newsletter

No abstract provided.

Mid-Atlantic Ethics Committee Newsletter, Summer 2004

Mid-Atlantic Ethics Committee Newsletter

No abstract provided.

Managing Advanced Illness: A Quality And Cost Challenge To Medicare, Medicaid, And Private Insurers, Karen Matherlee

National Health Policy Forum

This issue brief examines approaches to delivering and financing health services for persons with advanced chronic illness. It focuses on the nature and structure of the Medicare hospice benefit and its use as a model for Medicaid and other federal programs. The paper also looks at palliative-care approaches along the continuum of inpatient and post-acute services and raises cost, quality, and access issues for end-of-life care. In addition, it provides an overview of coverage through private insurance, including indemnity, point-of-service, and preferred-provider-organization products.