Compliance With Advance Directives: Wrongful Living and Tort Law Incentives

Modern ethical and legal norms generally require that deference be accorded to patients\u27 decisions regarding treatment, including decisions to refuse life-sustaining care, even when patients no longer have the capacity to communicate those decisions to their physicians. Advance directives were developed as a means by which a patient\u27s autonomy regarding medical care might survive such incapacity. Unfortunately, preserving patient autonomy at the end of life has been no simple task. First, it has been difficult to persuade patients to prepare for incapacity by making their wishes known. Second, even when they have done so, there is a distinct possibility that those wishes will be disregarded or ignored and that a patient whose expressed choice was to refuse life-sustaining treatment will nonetheless be kept alive against his or her will. This problem is only exacerbated by the fact that patients finding themselves in this situation have routinely been denied adequate legal remedies on the grounds that continued life is not a compensable harm. This article rejects that reasoning, and in so doing, takes an important step toward more fully enforcing one\u27s legal and moral right to refuse care at the end of life. The authors argue for recognition of a wrongful living variant of battery in situations where physicians have recklessly or intentionally disregarded or misinterpreted advance directives, and offer guidance on some of the difficult questions relating to damages that have perplexed the courts and commentators in this area. While allowing recovery for wrongful living will not resolve many of the outstanding issues leading to low utilization of advance directives by patients or the need for interpretation of a patient\u27s stated wishes in many circumstances, it will offer significant protection to those who have made their wishes clear

Compliance With Advance Directives: Wrongful Living and Tort Law Incentives

Modern ethical and legal norms generally require that deference be accorded to patients\u27 decisions regarding treatment, including decisions to refuse life-sustaining care, even when patients no longer have the capacity to communicate those decisions to their physicians. Advance directives were developed as a means by which a patient\u27s autonomy regarding medical care might survive such incapacity. Unfortunately, preserving patient autonomy at the end of life has been no simple task. First, it has been difficult to persuade patients to prepare for incapacity by making their wishes known. Second, even when they have done so, there is a distinct possibility that those wishes will be disregarded or ignored and that a patient whose expressed choice was to refuse life-sustaining treatment will nonetheless be kept alive against his or her will. This problem is only exacerbated by the fact that patients finding themselves in this situation have routinely been denied adequate legal remedies on the grounds that continued life is not a compensable harm. This article rejects that reasoning, and in so doing, takes an important step toward more fully enforcing one\u27s legal and moral right to refuse care at the end of life. The authors argue for recognition of a wrongful living variant of battery in situations where physicians have recklessly or intentionally disregarded or misinterpreted advance directives, and offer guidance on some of the difficult questions relating to damages that have perplexed the courts and commentators in this area. While allowing recovery for wrongful living will not resolve many of the outstanding issues leading to low utilization of advance directives by patients or the need for interpretation of a patient\u27s stated wishes in many circumstances, it will offer significant protection to those who have made their wishes clear

The role of open abdomen in non-trauma patient : WSES Consensus Paper

The open abdomen (OA) is defined as intentional decision to leave the fascial edges of the abdomen un-approximated after laparotomy (laparostomy). The abdominal contents are potentially exposed and therefore must be protected with a temporary coverage, which is referred to as temporal abdominal closure (TAC). OA use remains widely debated with many specific details deserving detailed assessment and clarification. To date, in patients with intra-abdominal emergencies, the OA has not been formally endorsed for routine utilization; although, utilization is seemingly increasing. Therefore, the World Society of Emergency Surgery (WSES), Abdominal Compartment Society (WSACS) and the Donegal Research Academy united a worldwide group of experts in an international consensus conference to review and thereafter propose the basis for evidence-directed utilization of OA management in non-trauma emergency surgery and critically ill patients. In addition to utilization recommendations, questions with insufficient evidence urgently requiring future study were identified.Peer reviewe

COVID-19 Outbreak - New York City, February 29-June 1, 2020

New York City (NYC) was an epicenter of the coronavirus disease 2019 (COVID-19) outbreak in the United States during spring 2020 (1). During March-May 2020, approximately 203,000 laboratory-confirmed COVID-19 cases were reported to the NYC Department of Health and Mental Hygiene (DOHMH). To obtain more complete data, DOHMH used supplementary information sources and relied on direct data importation and matching of patient identifiers for data on hospitalization status, the occurrence of death, race/ethnicity, and presence of underlying medical conditions. The highest rates of cases, hospitalizations, and deaths were concentrated in communities of color, high-poverty areas, and among persons aged ≥75 years or with underlying conditions. The crude fatality rate was 9.2% overall and 32.1% among hospitalized patients. Using these data to prevent additional infections among NYC residents during subsequent waves of the pandemic, particularly among those at highest risk for hospitalization and death, is critical. Mitigating COVID-19 transmission among vulnerable groups at high risk for hospitalization and death is an urgent priority. Similar to NYC, other jurisdictions might find the use of supplementary information sources valuable in their efforts to prevent COVID-19 infections