Literature Review

Ethics at the end of lifeMedicine; by John Idris Baker; 7/24End-of-life care has always been prominent in discussions of clinical ethics. Almost 30% of hospital inpatients are in their last year of life. Doctors frequently encounter people with end-of-life care needs and should to be equipped to respond... Key points:

The real cost of cancer: 49% of patients carry $5K+ in medical debt Becker's Hospital Review; by Ashleigh Hollowell; 5/28/24 ... Now, 47% of cancer patients accumulate debt as a result of their medical needs, The Wall Street Journal reported May 28. ... Some Americans are facing $38,000 or even more in medical debt, the Journal found. Additionally, more cancer patients are filing for bankruptcy, which one study linked to an 80% increased risk of dying. ... A 2024 survey of 1,284 cancer patients and survivors led by the American Cancer Society Cancer Action Network also found that: ...

Antibiotics in end-of-life care NEJM Journal Watch, by Abigail Zuger, MD; 3/27/24Antibiotics often are considered to be among the gentler and more comfort-oriented interventions in end-of-life care, certainly far less aggressive than intubation or last-ditch surgery. ... Still, antibiotics do entail their own costs in the form of toxicities and need for intravenous access, and liberal antibiotic use reliably worsens institutional and community drug-resistance profiles. ... A new review was written for infectious disease consultants but contains specific suggestions that should interest both generalists and other subspecialists caring for dying patients. 

Dr. Kevorkian was convicted of murder 25 years ago today: Examining the mixed legacy of a fighter for patient autonomy Reason, by Jeffrey A. Singer; 3/26/24Today marks the 25th anniversary of Dr. Jack Kevorkian's conviction of second-degree murder for performing euthanasia on Thomas Youk, a Michigan man suffering from amyotrophic lateral sclerosis, or Lou Gehrig's Disease. ... Kevorkian, a medical pathologist, had been defying state laws by engaging in assisted suicide—he claimed to help more than 130 people die— often using machines. But this was different. Kevorkian was not assisting a suicide. Kevorkian videotaped himself injecting Youk with lethal chemicals. He was doing all the work. And despite having received Youk's informed consent, the Michigan Court considered it murder. ... Today, physician-assisted suicide is legal in 11 jurisdictions: California, Colorado, the District of Columbia, Hawaii, Montana, Maine, New Jersey, New Mexico, Oregon, Vermont, and Washington.  ... Autonomous adults have the right to govern their bodies freely, provided they respect the equal rights of others. ... Active and passive euthanasia are grim exercises for physicians like me who decided to become doctors because we wanted to save lives. ... Editor's Note: Read more from this article that provides significant contexts for today's conflicts: historical, legal, medical, ethical, and geographical (USA and international) .

$4.25 million gene therapy for kids becomes world's priciest drug NBC LEX18, by Alex Arger; 3/20/24 A lifesaving gene therapy for children born with a rare and debilitating disease has just been approved by the U.S. Food and Drug Administration. The catch? Its wholesale cost has been set at $4.25 million, making it the most expensive medicine in the world. Orchard Therapeutics announced the hefty price for Lenmeldy Wednesday, two days after the FDA approved the therapy as the only treatment for kids with metachromatic leukodystrophy, or MLD. 

Survey: Nearly half of healthcare workers witness discrimination against patientsMcKnights Long-Term Care News, by Foster Stubbs; 2/20/24Healthcare workers (HCWs) are likely to witness discrimination in their workplaces, according to a new report from the Commonwealth Fund and the African American Research Collaborative. This can contribute to negative health outcomes for patients as well as emotional distress for both patients and healthcare workers.Editor's Note: What Policies and Procedures do you have in place for your hospice interdisciplinary teams,  volunteers, and non-clinical staff? What diversity education and competencies do you regularly require and update? 

Does morphine speed up death at the end of life? What we knowHealthDigest, by Jennifer Anandanayagam; 1/17/24... [Hospice care workers often hear a common concern], if giving morphine to your dying loved actually brings about their death sooner.Quotes from Elisabeth Smith, Hospice of the Chesapeake's Director of Education and Emergency Management

Should patients be allowed to die from anorexia?DNYUZ; 1/3/24The doctors told Naomi that she could not leave the hospital. She was lying in a narrow bed at Denver Health Medical Center. Someone said something about a judge and a court order. Someone used the phrase “gravely disabled.” Naomi did not think she was gravely disabled. Still, she decided not to fight it. She could deny that she was mentally incompetent — but this would probably just be taken as proof of her mental incompetence. Of her lack of insight. She would, instead, “succumb to it.” [Read more of Naomi's story, followed by this examination of palliative care.]The field of palliative care was developed in the 1960s and ’70s, as a way to minister to dying cancer patients. Palliative care offered “comfort measures,” like symptom management and spiritual guidance, as opposed to curative treatment, for people who were in pain and would never get better. Later, the field expanded beyond oncology and end-of-life care — to reach patients with serious medical illnesses like heart disease, H.I.V. and AIDS, kidney failure, A.L.S. and dementia. Some people who receive palliative care are still fighting their diseases; in these cases, the treatment works to mitigate their suffering. [Read more of this discussion of emerging issue.]