Contextualizing the dead donor rule in an era of voluntary euthanasia
New England Journal of Medicine; by Carter Winberg, Ian Ball, Robert D. Truog; 7/26
Growing acceptance of voluntary euthanasia, which opens the door to death by organ donation, warrants a recontextualization of the dead donor rule and assessment of the ethical principles involved.
Publisher's note: This article was discussed by NPR (A new proposal for organ donation sparks concern; NPR; by Rob Stein; 7/26). Should surgeons be allowed to perform euthanasia by removing patients' hearts and other organs while they're still alive? Doctors try a controversial technique to reduce the transplant organ shortage The idea, dubbed "Death by Organ Donation," would enable euthanasia patients to donate organs for transplantation in a way that would make their organs more likely to be usable. It would also kill them. There are interesting ethical points on both sides of the discussion.

Serious illness and health care threats to personal legacy goals
The Permanente Journal; by Marlaine Figueroa Gray, Matthew P Banegas, Nora B Henrikson; 6/26
High-quality care for people with serious illness requires understanding what matters most. Although goals-of-care conversations may emphasize values and treatment preferences, patients hold goals related to identity, relationships, and legacy; how they wish to be remembered and what they hope to leave behind. Five themes emerged [from the participant interviews]: 1) participants actively planned for legacy, with legacy goals often clarified by serious illness; 2) illness and its care introduced threats to legacy goals; 3) financial strain and insurance coverage were major threats; 4) participants believed their care would differ if teams understood their legacy goals; and 5) participants wanted to communicate their legacy goals to their care teams. Integrating legacy-related conversations into palliative care may enhance person-centered care by addressing identity, relationships, and meaning alongside medical preferences.
Assistant Editor's note: This article summary describes a very important aspect of end-of-life planning. Exploring with patients their legacy goals is as important as discussing their preferences surrounding their care. Including legacy goals as an integral component of goals of care and advance care planning discussions would yield a greater understanding of what kind of care would most honor the patient.

National Health Expenditure Projections, 2025–34: Strong utilization growth initially, legislative impacts later
Health Affairs; by Jacqueline A. Fiore, Andrea M. Sisko, John A. Poisal, Sheila D. Smith, Gigi A. Cuckler, Andrew J. Madison, Sean P. Keehan, Kathryn E. Rennie, and Nicholas J. Feehley; 6/26
By 2034, national health spending is projected to total nearly $9.0 trillion and to represent 20.6 percent of the economy, compared with $5.3 trillion and 18.0 percent in 2024. The rate of national health spending growth during this period is influenced by continued elevated use of medical services and goods through 2026; major legislative changes that affect insurance coverage and spending through 2028; and continued demographic shifts toward public programs, mainly Medicare. The insured share of the population is expected to be 90.5 percent in 2034, compared with 91.8 percent in 2024.

"Reconciling"- conceptualising the grieving process of family members involved in assisted dying: A grounded formal theory
BMC Palliative Care; by Jonathan Bayuo, Prince Kyei Baffour, Elisha Baafi Oduro, Deborah Adedibu; 6/26
While theoretical frameworks for understanding the grieving process are well-established, the advent of assisted dying presents a novel and under-examined context for grief and bereavement. Thus, this study sought to generate a theory explaining the grieving process of family members involved in assisted dying. Reconciling, as a mid-range theory, extends existing grief models by demonstrating that bereavement in assisted dying involves a proactive, ethically charged negotiation of autonomy, suffering, and relational responsibility; dimensions not accounted for in stage-based or oscillation models. The grieving process in assisted dying is best understood as Reconciling, a dynamic, iterative negotiation of autonomy, suffering, love, and loss. Families move through ambivalence, anticipation, transition, and aftermath in ways that blend emotional complexity with profound meaning-making.

Reach of palliative care in Parkinson disease-Progress and gaps after a national team-based implementation project
Neurology in Clinical Practice; by Sandhya Seshadri, Umer Akbar, Peggy Auinger, Nicole Andrea Lessard, Megan Dini, Sally A. Norton, Hillary D. Lum, Jodi Summers Holtrop, Janis M. Miyasaki, Christina L. Vaughan, Benzi M. Kluger; 6/26
While clinical trials demonstrate PC [palliative care] improves quality of life for PWP  [people with Parkinson disease] and carepartners, little is known about the impact of PC on their experiences of receiving care in real-world settings. At COEs [Parkinson's Foundation US-based Centers of Excellence], [surveyed] PWP reported significant increases in non-motor symptom (NMS) assessment ... and pain management ...  Emotional and spiritual needs were addressed more frequently ... Advance care planning (ACP) discussions [and documentation] rose ... Communication ratings and knowledge of PC were high (>85%) and stable across surveys.

Restarting medications after deprescribing in adults discharged from hospital to skilled nursing
JAMA Network Open; by Thomas J. Reese, Sandra F. Simmons, Eduard E. Vasilevskis, Emily K. Hollingsworth, Matthew S. Shotwell, Amanda S. Mixon; 6/26
Question: Among older adults discharged to skilled nursing facilities (SNFs) after hospital-initiated deprescribing, what is the frequency and timing of medication restarts ...? In this cohort study analyzing data from 2 randomized trials with a total of 598 participants, 15.9% of deprescribed medications were restarted. Higher health literacy and longer intervention exposure were associated with fewer restarts, whereas more prescribers, higher number of baseline medications, and fewer pharmacies were associated with medication restarts; restart during the SNF stay was associated with greater 90-day hospital readmissions. Conclusions: In this cohort study, approximately 1 in 6 deprescribed medications were restarted within 90 days, with nearly half occurring soon after SNF discharge. Patient factors and markers of care fragmentation were associated with restart, suggesting that enhancing transitional care and postdischarge support may improve the durability of hospital-initiated deprescribing.

Emotional and ethical impacts on healthcare professionals performing cardiopulmonary resuscitation
American Journal of Hospice & Palliative Medicine; by Patrick J. Macmillan, Susan Hughes, Dumindra Gurusinghe, Allison Go, Chase Lancaster, Iris Price; 6/26
Many studies exist outlining poor outcomes related to cardiopulmonary resuscitation (CPR) administered to patients who are elderly and/or have comorbid medical conditions with sudden cardiac arrest. Studies show only 10% of patients with out-of-hospital cardiac arrest and initial asystole survive until they reach the hospital. Less than 5% survive until hospital discharge with good neurologic function. This study presents data that suggests that there is an association between moral distress and performing CPR on individuals who are elderly with multiple comorbid medical conditions. More than sixty percent of our respondents were challenged emotionally during these types of code situations, and a similar number of healthcare workers felt the code could be considered unethical.

It is not the length of life, but the depth of life.  ~ Ralph Waldo Emerson