End-of-life decisions left to the treating physician?

The other day my Executive Chairman sent me an interesting article from the NY Times detailing the fact that in France, physicians make the final end-of-life decisions for their patients. From the article:

  • “Doctors in France have long held what, by American standards, might seem unthinkable discretion to make end-of-life choices for people in their care.“
  • “For patients unable to communicate, such decisions fall legally to the physician, who may withdraw treatment or administer care that will end a patient’s life so long as the stated intent is to relieve that patient’s suffering, and not to kill. The opinions of family members and fellow doctors must be heard, the law states, but by no means obeyed.”
  • “…patients and families increasingly say they wish to be more closely involved in end-of-life decisions. And the French doctor’s role as final arbiter of life and death is increasingly being challenged.”

Whereas in the notion of informed patients and patients being actively involved in their care is a new idea in France, in the US, advance medical directives (living will, power of attorney, healthcare proxy) have been around for decades, and all states and the District of Columbia now recognize some type of advance directive. Some states also specifically authorize a Psychiatric Advance Directive.

And, in stark contrast to France, the AMA wants Medicare and other insurers to pay for physicians to educate their patients and assist with creating advance directives. Reportedly some private insurers, as well as some state Medicaid programs, already pay physicians for these types of planning sessions. Physicians can explain the various options and choices from which patients can make their wishes known.

For more information from the AMA, click here.

Donna Vanderpool, MBA, JD – Vice President

As Vice President of Risk Management, Ms. Vanderpool is responsible for the development and implementation of PRMS’s risk management services for The Psychiatrists’ Program. Ms. Vanderpool has developed expertise in the areas of HIPAA and forensic practice, and has consulted, written and spoken nationally on these and other healthcare law and risk management topics. She most recently wrote a chapter concerning the risks of harm to forensic experts for Robert L. Sadoff, MD’s book Ethical Issues in Forensic Psychiatry: Minimizing Harm, (Feb. 2011/Wiley). Ms. Vanderpool received her undergraduate degree from James Madison University, and her MBA and JD from George Mason University. Prior to joining PRMS in 2000, Ms. Vanderpool practiced criminal defense law, taught business and legal courses as an adjunct faculty member at a community college and spent eight years managing a general surgical practice in Virginia.

This blog has also been cross-posted on LinkedIn.

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