Former First Lady Barbara Bush Announces Plans to Seek Comfort Care

After battling congestive heart failure and chronic obstructive pulmonary disease, former First Lady, Barbara Bush, has announced that she will no longer seek medical treatment and instead will focus on “comfort care.” Barbara Bush is 92 years old. Her announcement has sparked a debate about end-of-life care and decision-making.

Palliative care experts want to correct any misconceptions that people may have about Mrs. Bush’s decision and specifically want to disprove the “common myth about palliative care [that patients] are being denied medical help.” They explain that palliative care is a patient-centered approach that focuses on reducing a patient’s symptoms and making them as comfortable as possible as they near the end of their lives.

Many praise Barbara Bush for providing an honest perspective on her end-of-life care decision and encourage others to explore their health care options and discuss their wishes regarding palliative care with their health care providers, families and loved ones.

 

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End of Life Care for Individuals with Intellectual Disabilities: Who Decides?

Health care providers must often ask their patients difficult questions about their preferences regarding end of life care. Patients or their legal representatives must ultimately decide how to answer these questions. In some states, however, the answers for patients with intellectual disabilities may be governed by state law rather than patients’ wishes.

Depending on the severity of a patient’s condition, a patient with intellectual disabilities is often deemed to lack capacity to make autonomous health care decisions. Generally, a legal representative is authorized to make health care decisions for such patients. Yet, in some states, the law imposes limitations on the type of decisions a legal representative can make when the patient has an intellectual disability. For example, in New Hampshire, a legal representative of a person with an intellectual disability cannot decline life-sustaining treatment, despite the fact that the patient may have indicated a wish not to receive such treatment. If a legal representative believes that a patient does not wish to receive life-sustaining treatment, the only option to ensure that the patient’s wishes are met is to petition a court to decline treatment, which can be an onerous legal process.

Many advocates for improving patient care believe that such approach can reduce the quality of palliative and end of life care that a patient with intellectual disabilities receives. They argue that states should amend their laws and follow a more patient-centered approach as followed in New York, which recently passed a law that allows legal representatives to withdraw life-sustaining treatment for a patient with intellectual disabilities if there is sufficient evidence to prove that such decision is consistent with the patient’s wishes.

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Will Mississippi’s 15-Week Abortion Law Survive Constitutional Muster?

 

On March 19, 2018, Mississippi Governor Phil Bryant signed an abortion bill into law that some say will likely be overturned. The new law places a ban on abortions after only 15 weeks of pregnancy, making it the shortest gestational age limitation on abortions in the U.S.  The Governor has stated that the law will help make Mississippi the “safest place in America for an unborn child.”  Opponents, however, are arguing that this unprecedented ban is unconstitutional and endangers the health care of women in Mississippi. The Center for Reproductive Rights, among the opponents, is characterizing the law as a “flagrant assault on reproductive rights” and is fighting to have it overturned. Similar laws that have attempted to be passed in other states were all overturned by the court system, which has consistently found that such short gestational age limitations create an undue burden for women seeking to have an abortion and, therefore, violate women’s constitutional right to an abortion.

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“That, With Profound Sadness, Is My Judgment”: High Court in England Rules to Turn Off Infant’s Life Support

Isaiah Haastrup suffered “catastrophic brain damage” at birth due to oxygen deprivation. At 11 months old, the infant was unable to move or breathe on his own, had a low level of consciousness, and did not respond to stimuli. He was placed on a ventilator to help him stay alive. Although Isaiah’s parents wanted to keep him on the ventilator as necessary for his condition to improve, the Hospital where he was being treated believed that his prognosis was weak and improvement was very unlikely. Thus, the Hospital sought legal action to discontinue Isaiah’s life support, despite his parents’ objections.

Justice MacDonald of the High Court in London passed his ruling on the matter with “profound sadness” and held that it was not in Isaiah’s best interest to continue his life-sustaining medical treatment. After the decision, the Hospital stated that it would transfer Isaiah to palliative care and work with and support his parents in ensuring that he obtains appropriate care.

The case echoes that of Charlie Gard who, in July 2017, was also 11 months old, and was terminally ill. His parents wanted to bring Charlie to the United States for an experimental treatment, but the High Courts in London were convinced that his condition would not improve and ordered that Charlie be taken off his ventilator.

 

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Arizona Legislation Raises Constitutional Concerns Regarding Frozen Embryos

After Arizona cancer survivor Ruby Torres divorced her husband, her ability to have children on her own depended on seven frozen embryos she had created with her ex-husband.  Unwilling to financially support a child resulting from one of the embryos, Ruby’s ex-husband opposed her decision to conceive and a family court judge ordered that the embryos be donated to another couple based on a medical agreement that had been signed when Ruby first underwent in vitro fertilization.

New Arizona legislation, SB 1393, could present a solution to the type of challenges that were faced by Ruby and her ex-husband. The bill would remove all financial and parental responsibility from a spouse that does not want a frozen embryo, and would require clinics to store such frozen embryos for 99 years.  While this bill may help women like Ruby use their frozen embryos to have a child, it also raises a number of ethical concerns. Mostly, it could create personal crises-of-conscience for those spouses who do not want a child bearing their DNA to be born with an ex-spouse.  Critics of the bill are calling it a “back-door attempt” to create constitutional rights of personhood for “fertilized eggs, zygotes, embryos, and fetuses.”

 

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Stem Cell Therapies: U.S. Changing Lanes

The U.S. Food and Drug Administration (“FDA”) has been vocal about their efforts to curtail stem cell programs. Yet, in a surprising turn of events, the FDA commissioner, Dr. Scott Gottlieb, and the director of FDA’s Center for Biologics Evaluation and Research, Dr. Peter Marks, have recently co-authored a paper that promotes more accurate research regarding the use of stem cell therapy in medicine. The paper sets forth a detailed plan for assessing the effectiveness of stem cell therapy.

Stem cells have the abilities to mimic other cells in the human body, cells that may not be working properly or at all in patients with various diseases and, therefore, can have significant impacts on the outcome of health. Most promising about Drs. Gottlieb and Marks’ paper is that it opens the door for expanded use of stem cell therapy in the U.S. which was long thought to be closed. In short, it appears that stem cell programs will no longer be given a cold hard “no,” in both the medical and regulatory context.

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Tags: Science, Stem cells, Health, Law, FDA

Dental Inequality: When Medicaid Isn’t Cutting It

The U.S. Medicaid system has a major gap in coverage for dental care. Although states are required to provide dental benefits for children of low-income families that qualify for state Medicaid benefits, the same requirement is not imposed for adult coverage. Even in states where adult dental coverage is included in the state’s Medicaid program, it is often very limited.

Dental care is an essential part of health care that is often overlooked and undervalued. Poor dental hygiene can worsen other pre-existing conditions. Oral infections, for example, can contribute to heart disease and stroke. Advocates are pushing for better dental care coverage as an effort to improve overall public health and wellbeing. Studies have found that when Medicaid covers dental care, the number of dental visits can increase by 22%.

Advocates also worry, however, that as the Trump Administration proposes additional cuts to state Medicaid programs, any possibility of increased dental coverage will be the first to go.

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Tags: Health, News, Dental, Medicaid

The 21st Century Family Tree – Rising Concerns of Ancestral DNA

In recent years, ancestral DNA kits have become increasingly popular, and with decreasing costs these products have become readily accessible. Although the idea of uncovering genetic makeup is tempting to many, bioethicists have concerns about these products.

The potential risks of obtaining and sharing genetic information are not fully disclosed to consumers.  In a study published in the European Journal of Human Genetics, it was noted that the privacy policies of genetic testing companies are “murky” and fail to sufficiently inform consumers that they could receive “unexpected information.” For example, when an unexpected step-brother was identified through “George Doe’s” genetic testing results, the bombshell to the family resulted in the divorce of his parents. As these tests are accessed by more people, bioethicists foresee more “George Doe” stories.

An even greater concern is privacy. Although the companies generally allow consumers to choose whether or not to share their genetic and personal information in information-sharing databases, there is no guarantee that the information of one individual will not be indirectly identified through a relative’s genetic submission. Without appropriate privacy safeguards in place, there are real concerns that “humanity is on the verge of learning a lot of life-altering information that it can’t unlearn.”

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The Costs of Protecting Religious and Conscience Rights in Health Care

President Trump’s new push to have a government-wide enforcement of conscience protections in healthcare may cost the healthcare system over $300 million to implement and an estimated $125 per year to maintain in following years.  The cost to the government is estimated at $900,000 per year.  The “right of conscience” refers to the rights of healthcare professionals to refuse care to patients based on the clinicians’ personal and religious beliefs.

Prior to Trump’s election there was, on average, one complaint filed per year that alleged a violation of conscience and religious rights. Since his election, this number has increased to over 40 complaints each year.  Traditionally, issues of conscience and religious objections have been reserved for healthcare facilities to handle internally. However, some workers claimed that such internal resolutions were often ineffective, and they were forced to participate in certain procedures despite their objections.  The government’s new enforcement efforts raise concerns not only about costs, but about whether they will provide an avenue for doctors to discriminate against patients and deny necessary care on the alleged grounds of conscience and religious objections.

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What Will Your Genome Sequence Say About You?

Scientists have created a handheld device no bigger than a smartphone that is capable of sequencing the human genome in a matter of minutes. The device will allow users, including physicians, hospitals, and individual patients, to quickly decode genomes and apply the results in patient care.

In the short term, the device can promote patient-centered care that is tailored to a patient’s individual needs and genetic composition. However, researchers also hope to use the decoded genomes obtained from the device to better understand how genetic sequencing affects overall public health. Even though the human genome has been successfully decoded, much remains to be learned about various aspects of the genome sequence.

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