Literature Review

As ‘right to die’ gains more acceptance, a scholar of Catholicism explains the position of the Catholic Church The Conversation; by Mathew Schmalz; 3/31/25 An individual’s “right to die” is becoming more accepted across the globe. ... Assisted suicide is now permitted in 10 U.S. states and in Washington. In 2025,five more states are set to consider “right to die” legislation. The “right to die” can refer to several means of dying. ... [Descriptions of terms "right to die," "euthanasia," "assisted suicide/dying."] ...

Children as living solid organ donors: Ethical discussion and model hospital policy statementThe Journal of Clinical Ethics; Gyan C. Moorthy, Aidan P. Crowley, and Sandra Amaral' Spring 2025In recent years, more attention has been paid to living donation as a means to reduce the suffering of individuals with end-stage kidney or liver disease. Implicated ethical issues include medical risk and risk of coercion, counterbalanced by improved medical outcomes and the benefits of saving a life. Living donation becomes particularly ethically complicated with the prospect of child donation, given the child’s developing autonomy and uniquely dependent status. We outline four broad ethical considerations pertinent to living child organ donation: (1) beneficence, (2) respect for the family as a moral unit, (3) respect for the child as a person, and (4) justice. We conclude that it can be ethical for a healthy child to donate a kidney or liver lobe to a close relative who has exhausted other options provided that certain protections are put into place.

Hidden battles: Keeping cancer secret Harvard Health Publishing - Harvard Medical School; by Maureen Salamon; post is dated 4/1/25, retrieved from the internet 3/25/25 Some people choose to conceal their diagnosis and treatment. Here's why — and reasons that approach can sometimes backfire. ... [In addition to privacy motives, Cristina Pozo-Kaderman, a senior psychologist at Harvard-affiliated Dana-Farber Cancer Institute] says cancer patients may also wish to:

The marginalizing and dehumanizing of our sickest and oldest Americans ABA - The American Bar Association; by Charles P. Sabatino; 3/19/25 Being old and with a disability ranks high as a target for discrimination in American culture, where ageism and ableism often prevent the public from seeing marginalization as an aberration. ... Summary:

‘Early discussions on what to expect can lessen the strain’ Nursing Times; by Kylie Chaffin; 3/19/25 The article explains the pros and cons of nutrition and hydration at end of life and the several types of artificial nutrition and hydration that can be used, written in a way patients and families can understand. Resources and educational articles, like this one, can also be a great way to introduce new or even more effective ways nurses and care team members can support patients and families when pursuing a palliative approach to their health and wellbeing. My question for readers is, “Should the conversation of end-of-life, hospice and palliative care, and nutritional changes, be initiated sooner rather than later in patients with a terminal diagnosis?”

Hastening death by stopping eating and drinking: Hope Wechkin, Thaddeus Pope, and Josh Briscoe GeriPal Podcasts; by Hope Wechkin, Thaddeus Pope, and Josh Briscoe Eric and Alex have featured discussions about complex bioethical concepts around caring for people at the end of life, including voluntarily stopping eating and drinking (VSED), and multiple episodes about the ethical issues surrounding medical aid in dying (MAID). Recently, discussion has emerged about how these issues intertwine in caring for patients with advancing dementia who have stated that they would not want to continue living in that condition: for those with an advanced directive to stop eating and drinking, how do we balance caring for their rational past self and their experiential current self? Should these patients qualify for medical aid in dying medications? And is there a middle path to provide some degree of comfort while also hastening the end of life?

Assisted Living Facility owner indicted, facing numerous felony charges Knoxville Daily Sun; 3/17/25 ... In June 2024, after receiving a referral from Adult Protective Services, [the Tennessee Bureau of Investigation Medicaid Fraud Control Division (TBI)] special agents began investigating allegations involving Wendy Henley, the owner of Sunset Gardens Assisted Living Facility in Mountain City. ... [Agents] learned that Henley used a patient’s insurance benefits card to purchase items for the facility. In July, ... they discovered that seventeen residents, including two hospice patients, had been left in the care of two juveniles who were not authorized to provide direct patient care. Agents requested an immediate response from the Tennessee Health Facilities Commission and evacuated the facility, transferring the residents to other local facilities to assure their safety and continued care.

Less wealth at death linked to more end-of-life symptoms McKnights Long-Term Care News; by Kristen Fischer; 3/10/25 Older people with less wealth showed a higher burden of symptoms when they approached the end of their lives compared with those who had more wealth, a study found. The report was published in JAMA Network Open on March 6. Investigators looked at data from 8,976 older adults. The team evaluated 12 end-of-life symptoms including difficulty breathing, frequent vomiting, low appetite, difficulty controlling arms and legs, depression, and severe fatigue or exhaustion.Then they correlated symptoms to individuals’ wealth. Wealth was broken into three categories: low wealth was having less than $6,000; medium wealth was having between $6,000 and $120,000; and high wealth was considered having more than $120,000 at the time of death. Of respondents, 22.5% had low wealth, 50.5% had medium wealth and 27.1% had higher wealth. People who had less wealth were more likely to have a higher burden of symptoms compared to those who had more money. Functional impairment, multimorbidity and dementia were factors that affected the association, data revealed.Editor's note: Click here for this important JAMA article, posted in our Saturday Research issue 3/15/25, "Wealth disparities in end-of-life symptom burden among older adults."

At the end of life, doctors’ actions and patients’ wishes may be misaligned, according to a Rutgers Health study Rutgers; by Greg Bruno; 2/28/25 For terminally ill cancer patients, the final days of life are immensely personal, having the choice to continue cancer treatments, or to stop treatments and prioritize a more comfortable passing. What a patient wants, however, isn’t always what they receive, according to a Rutgers Health study published in the journal Cancer. “A patient's end of life is often not a reflection of what they want, but rather, who their oncologist happens to be,” said Login S. George, a health services researcher at the Rutgers Institute for Health, Health Care Policy and Aging Research, and lead author of the national study. “The data doesn’t indicate patient-centered treatment decisions, but rather, more habitual or default ways of treating patients,” says George, who is also a member of the Cancer Prevention and Control Program at Rutgers Cancer Institute, the state’s only National Cancer Institute-designated Comprehensive Cancer Center. ... [Click on the title's link for more statistics, insights, and recommendations.]

Patient put in hospice at 52 celebrates life years after admission, thanks to heart surgery KCTV-5, Kansas City, MO; by Morgan Riddell; 2/27/25 A local man with heart failure who was told numerous times he only had months to live now has a new outlook on life two years later. ... It started in 2023. Sam Edwards, who was diagnosed with ALS after serving in the military, started experiencing new pains. He went to doctors who all determined Sam was just experiencing issues related to ALS. Then, a doctor at the VA Hospital noticed some tests were off and found Sam was experiencing heart failure. What he needed was open heart surgery, but doctors determined the risk of putting Sam on the operation table was too high. Not only was he at risk of having a stroke and dying on the operating table, but his recovery would also be months long and painful. They declined to do the surgery at the VA and suggested Sam go get a second opinion. This is when he was connected with Dr. Michael Gibson.Editor's note: While we in the palliative and hospice field promote earlier admissions to care and elimination of overtreatment, another side of the coin exists. Click on the title's link to read more about this hospice patient who sought out a second opinion. Imagine: the hospice patient is you (at age 52); or a family member; or a best friend. Especially as AI becomes more prevalent in assessing palliative and hospice referrals, we must see the bigger picture and retain human element. 

Charges dismissed against chef accused of trying to kill his Monterey county mother KSBW Action News-8, Monterey, CA; by Felix Cortez; 2/28/25 A popular San Francisco area chef who was arrested along with his sister and charged with trying to kill their mother more than two years ago has had attempted murder charges dismissed against him. “In over 30 years of practice, this was one of the saddest cases I have ever seen and one of the most incompetent investigations by the Monterey County Sheriff’s Department that I have ever seen,” said Juliet Peck, the attorney for James Stolich. ... The mother was terminally ill and lived on a ranch off Highway 68 outside Salinas. “James’ mother’s only wish was to die at home without pain, surrounded by her daughter, son, and pets,” Peck said. But that never happened; Tinker died about a week later in a hospice facility, never to see her children again, because an emergency protective order obtained by the sheriff’s office prevented the children from visiting their dying mother. ... According to court documents, the daughter, Whitney, was the “agent designated to make all health care decisions for her mother,” which included administering medication to help alleviate her mother’s pain. ...The original criminal complaint alleging attempted murder charges said Whitney or a co-conspirator “crushed up pills with a mallet.” A close friend of Tinker was willing to testify that Whitney had no intent to kill her mother but was simply following her mother’s “directive to provide effective and sufficient palliative care even if it hastened her death.”Editor's note: This case raises numerous issues, including but not limited to community education (including law enforcement), Advance Directives, patient and caregiver education and support, MAiD (Medical Aid in Dying) or the End Of Life Option Act (EOLOA) in California, ethics, and the dying process (note that "the mother died about a week later in a hospice facility). 

Leading early conversations about ICD [implantable cardioverter defibrillator] use in end-of-life cancer care  Cancer Network; by Megan Mullins, PhD, MPH; 2/21/25 Earlier and more frequent talks about disabling ICDs with patients receiving end-of-life care and their families may help avoid excessive pain. ... Regarding implantable cardioverter defibrillators (ICDs) in those with fatal cancers, it is critical that patients know what having a device means and how it impacts end-of-life care, according to Megan Mullins, PhD, MPH. CancerNetwork® spoke with Mullins, assistant professor in the Peter O’Donnell Jr. School of Public Health, the Harold C. Simmons Comprehensive Cancer Center, and the Department of Internal Medicine at UT Southwestern Medical Center, about how ICD deactivation prior to end-of-life care could impact clinical practice in patients with advanced cancers. ... She emphasized that device deactivation would allow the body to undergo the natural dying process without unnecessary painful shocks associated with the use of the device.

Daughter indicted for killing mother with morphine in Evans The Augusta Press, Augusta, GA; by Greg Rickabaugh; 2/25/25The daughter of a woman who died in an Evans assisted living home from a fatal dose of morphine has been indicted for malice murder. Rachel Elaine Waters, 41, is expected to surrender this week on murder charges in the death of 74-year-old Marsha Sprayberry Foster, according to Columbia County authorities.An indictment says that Waters administered a lethal dose of morphine on July 12, 2023, while her mother was at the Marshall Pines assisted living on North Belair Road. The cause of death was determined in an autopsy, showing that excessive use of the unprescribed morphine was the reason for her death. Foster had Alzheimer’s disease, and the morphine was reportedly left behind by hospice workers and used by the daughter without authorization.