Literature Review

Is ‘medical aid in dying’ an ethical, moral choice?By Richard Feldman, MD, ColumnistCourier & Press (Evansville, IN)December 11, 2023One of my best friends, Jim, in South Bend died of an unusual intestinal cancer. This experience moved me to explore the issue of “medical aid in dying,” or MAID. Is MAID ethical and moral? Is it the right and justified choice for some individuals? After a time, unfortunately, Jim’s cancer progressed with a vengeance leaving him with extensive intestinal obstructions. Further chemo would be of little help, and further surgery was impossible. Toward the end, my friend couldn’t receive any real nutrition and could only tolerate water. He lost 65 pounds in 10 weeks and was essentially skin over bone. Jim was Catholic and religious. He was a splendid husband and father to his nine children. He worked hard, was responsible, and was a good citizen. He was a good man. The best. When I last saw him, I told him that I envied both his courage and his faith. Jim had no doubt that in passing, he was entering the next phase of his life and that he would be with God. Jim’s character and faith sustained him. His religious beliefs would not allow him to consider anything but a natural death. So, he never would have considered MAID. And of course, it’s not legal in Indiana. ... Although unmanageable symptoms despite optimal hospice care is a reason to utilize MAID, autonomy and maintaining dignity are the primary reasons MAID is chosen. These patients want control, without dependence on others for care. ... MAID is controversial, but dynamic, in the medical community. ... Although it will be a long time before Indiana considers MAID legislation, the majority of the Americans support MAID for terminal illness. Is MAID a slippery slope, an unconscionable act, or a caring act of compassion? Difficult questions.

Norton Healthcare ransomware attack exposes 2.5M peopleHealthcare DiveDecember 11, 2023Norton Healthcare said sensitive data on 2.5 million people was exposed by a ransomware attack in May, the clinic and hospital group said Friday in a data breach notification filed with Maine’s attorney general. Norton Healthcare discovered the cyberattack on May 9, which it later determined was ransomware. The threat actors had access to some network storage devices between May 7–9, but the healthcare group’s medical record system was not compromised, the company said in the filing. An investigation into the attack, which was completed in mid-November, determined names, contact information, Social Security numbers, dates of birth, health and insurance information, and medical ID numbers were compromised. .... [Kentucky-based] Norton Healthcare said it did not make a ransom payment and has not detected any additional indicators of compromise since it began restoring its systems from backups on May 10. The delayed disclosure, seven months after the intrusion was detected, underscores the complicated nature of post-incident investigations. 

Cigna Calls Off Humana Pursuit, Plans Big Stock BuybackWall Street JournalDecember 10, 2023Cigna Group abandoned its pursuit of a tie-up with Humana after shareholders balked at a deal that would have created a roughly $140 billion giant in the health-insurance industry. The companies couldn’t come to agreement on price and other financial terms, according to people familiar with the matter. In the near term, Cigna is turning its focus toward smaller, so-called bolt-on, acquisitions.

Nurses at University Medical Center vote to unionize, a Louisiana firstTimes-Picayune (New Orleans, LA)December 10, 2023LCMC Health’s University Medical Center nurses voted to join National Nurses United, the largest U.S. union for registered nurses, after a three-day vote that ended Saturday night. The union will be Louisiana’s first among health care workers. It is also one of the state’s largest, with 598 eligible members. More than 90% of eligible nurses voted in the election. Of those who voted, 82% voted in favor of the union, according to National Nurses United. ... Officials at UMC acknowledged the union and said they would “continue to work with the National Labor Relations Board and operate consistently with the processes established by the National Labor Relations Act.” ... Next, the union will be certified by the National Labor Relations Board. Negotiations and bargaining on a contract come after that. ... The union includes registered nurses who are full-time, part-time and per diem, along with clinic nurses and nurse practitioners.

Unemployment rate dips to 3.7 percent in NovemberMcKnight’s Senior LivingDecember 11, 2023The national unemployment rate declined from 3.9% October to 3.7% in November, according to the monthly unemployment report from the Bureau of Labor Statistics. ... Additionally, the economy added 199,000 new jobs in November, with gains in healthcare, government and manufacturing. Healthcare added 77,000 jobs, which the BLS noted is above the average monthly gain of 54,000 over the prior 12 months. Nursing and residential care facilities added 17,000 jobs, ambulatory healthcare services gained 36,000 jobs and hospitals gained 24,000 jobs last month.

Aging population requires ‘bold leadership’ to protect human dignity—LeadingAge to House SpeakerMcKnight’s Senior LivingDecember 11, 2023The growing population of older adults requires “bold leadership” to ensure aging with dignity, as well as access to care and support, according to an open letter from LeadingAge to Speaker of the House Mike Johnson (R-LA). The changing demographics and need to support older adults where they live and receive services presents a unique opportunity for Johnson to demonstrate leadership and commitment to “protecting human dignity,” according to the letter from LeadingAge President and CEO Katie Smith Sloan. ... “The US healthcare system is navigating a new and unfamiliar landscape in the wake of the COVID-19 public health emergency,” Sloan wrote. “Three years of sustained stress and increasing workloads have caused a dramatic shift in staffing patterns and an alarming rise in burnout across health professions.”

Maine nursing homes lead in meeting proposed staffing standardsMaine MonitorDecember 10, 2023Maine nursing homes are closer to meeting the Biden administration’s proposed minimum staffing standards than their counterparts in most other states, but recent payroll data show that still fewer than one in 10 are meeting these proposed standards every day. And while some long-term care advocates said the national standards should go further, nursing home industry leaders said it would be difficult for a rural state like Maine to find the workers to meet the required minimums, which could lead to more closures. ... During the second quarter of 2023—from April to June—Maine nursing homes met the proposed minimum care hours from both registered nurses and nurse aides an average of 59 out of 91 days in the quarter, according to analysis from The Maine Monitor, USA TODAY and Big Local News at Stanford University, the latest federal staffing data. ... However, only 8% of Maine nursing homes met both standards on all 91 days of the quarter.

In letter to CMS, lawmakers call for more MA transparencyMcKnight’s Home Care DailyDecember 11, 2023Four senators demanded the Centers for Medicare & Medicaid Services make more data surrounding prior authorizations in Medicare Advantage publicly available. “In the last few years, federal watchdogs have released numerous reports examining concerning trends in MA,” Sens. Bill Cassidy, MD (R-LA), Elizabeth Warren (D-MA), Marsha Blackburn (R-TN) and Catherine Cortez Masto (D-NV), the letter’s signees, said in a statement. “Without publicly available plan-level data ... policymakers and regulators are unable to adequately oversee the program and legislate potential reforms.” The senators specifically requested CMS gather and publish data regarding prior authorization requests, denials and appeals, justifications for denials and the timeliness of prior authorization decisions. 

Memorial tree returns to River Park SquareKREM-TV (Spokane, WA)December 10, 2023Spokane, WA—A holiday tradition is back at River Park Square to give community members a chance to honor departed loved ones. Hospice of Spokane’s memorial tree returned to the shopping center’s third floor Saturday. It’s filled with handwritten messages of remembrance on decorated dove ornaments. Shoppers can stop and fill out and decorate a dove of their own to add to the tree. “It’s a great way for people to remember their loved ones who’ve died, whether recently or a long time ago. It can be part of the grieving process,” said volunteer Beth Priest. 

Disability activists also oppose aid in dyingBy Susie MosherDaily Hampshire Gazette (Northampton, MA)December 9, 2023... For the aged or those with degenerative or chronic diseases, many people in the final stages of life are suddenly, newly disabled without having lived a life managing a disability. Inadequate resources, the lack of emotional support, the physical challenges, the stresses on relatives and caregivers—all are overwhelming. ... We know that, despite good intentions, the state of Massachusetts already has many agencies, policies and programs that are underfunded, not carefully monitored, poorly managed, and understaffed. People with mental illnesses, disabilities, without power, and without a voice are not well served. People with disabilities know how the health care system and our government fails them as they struggle daily to advocate for themselves. Legislators and news outlets would do well to listen to people who face existential challenges day to day. The disability community is advocating for palliative services, not lethal doses. They have experienced the terrifying slippery slope of “quality of life” assessments by professionals. Their testimony advocates for education and support for caregivers, not assisted suicide.

An educator who established Oregon’s first hospice, Joan Buell dies at 90The Oregonian (Portland, OR)December 9, 2023Joan Strong Buell was a woman of many dimensions ... Most important, she was matter-of-fact about death but deeply devoted to transforming the experience of dying—from a traumatic, clinical affair on an uncomfortable hospital cot to a peaceful, dignified occasion in a homelike setting. That conviction is what led her to open what is now known as Hopewell House, the first hospice in Oregon and one of the first in the United States. Joan died on Aug. 19, at the age of 90. A celebration of her life was held in Portland on Dec. 3.

Sen. Jacque—No Patient Left Alone Act advances with bipartisan supportWis PoliticsDecember 7, 2023Madison, WI—Our loved ones would never be isolated from their families and friends again under legislation that cleared a State Senate committee today protecting our right to visit those dear to us in hospitals and care facilities. State Sen. André Jacque (R-De Pere), co-author of the proposal with State Rep. Chuck Wichgers, said research coming out of the pandemic has shown what we have known all along about the damage done to patients and their families by blocking human contact when they need each other most. ... Sen. Jacque said the No Patient Left Alone Act addresses these problems by allowing patients in health care facilities to receive visitors, subject to COVID-19 infections protocols, and to have in-person compassionate care visitation between a resident and any individual the resident requests to relieve physical or mental distress. ... The No Patient Left Alone Act (Senate Bill 257) passed the Senate Committee on Health earlier this morning 0n a bi-partisan 5-1 vote. It must next clear the full Senate and Assembly, and be signed by the Governor, to become law.

100+ Men Red Rock Presented $5,550 Check Donation to Hospice of Pella on FridayKNIA-AM (Knoxville, IA)December 9, 2023Knoxville, IA—100+ Men Red Rock presented a check for just over $5,500 to Hospice of Pella Friday morning. The donation will be used to support the Day of Care Program at Hospice of Pella. The program provides a way for families and friends to give their loved ones a day or days of routine care.