Literature Review

Harvard Thinking: Facing death with dignityThe Harvard Gazette, podcast and transcript; moderated by Samantha Laine Perfas; 3/27/24In podcast episode, a chaplain, a bioethicist, and a doctor talk about end-of-life care.

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) .

Why California doesn't know how many people are dying while homelessKQED, by Vanessa Rancano; 3/25/24 The grants manager and his team at Alameda County Health Care for the Homeless knew people were dying on the streets, but they wanted more than anecdotal evidence; they wanted data that could show them the big picture and help them hone their strategies. ... Alameda County’s latest homeless mortality report is now prompting the team to focus on how to extend palliative care services to unhoused people with terminal illnesses. Garlin estimates almost one-fifth of those who died in 2022 would likely have been eligible for hospice care.

Incurable but not hopeless: How hope shapes patients’ awareness of their advanced cancer prognosis The Conversation, by Jean Mathews and Michael Brundage; 3/24/24Hope is defined as the expectation of achieving a future good. Patients with cancer, whether it is curable or not, prioritize cure as their highest hope. ... Previous research indicates that less than half of patients with incurable cancer are aware of their prognosis. This is often attributed to a failure of communication. ... In the context of advanced cancer, the relationship between hope and hopelessness is balanced by acceptance, which can re-direct hope to new goals beyond cure, such as hope for connection with others and enjoyment of daily pleasures. 

Regulatory reference links for home health care, hospice and durable medical equipment National Association for Home Care & Hospice; per email 3/25/24 Includes reference descriptions and links to the following:

My Mother is in Hospice Care Reformed Journal, by Doug Browser; 3/25/24 My 96-year-old mother entered hospice care a few months ago. For a while, it seemed as though she would go on forever, even though we knew that was unlikely. ... [Here’s] the thing, maybe the most striking thing I’ve learned while sitting with my mom over these last few months. Loss of memory can sometimes be a gift. ... I realize that there can be a kind of grace in not remembering a few things. ... We don’t have to go back and revisit any of it. We have this time together. ... And together we are a mom and a son, present in the moment, a moment with a surprising amount of grace. I never expected to get there.

Massachusetts makes paid family leave more accessible, offering services in Spanish, Portuguese New England Public Media, by Elizabeth Roman; 3/22/24... The state passed a law in 2018 which provides paid family and medical leave (PFML) for serious injury or illness whether personal or a family member, as well as time for parental leave, but found that people whose primary language is not English were unaware of, or hesitant, to apply for the services. ... While the state portal for applying for PFML services now has options in various languages, some people are still overwhelmed by filling paperwork out online. ... There are representatives who speak Spanish and Portuguese and the state also works with an interpretation service for many other languages.

AI scribe saves doctors an hour at the keyboard every dayAMA, by Andis Robeznieks; 3/18/24 When a health system rolls out new technology that it insists will make physicians’ lives easier, the announcement is typically met with skepticism. But the use of augmented intelligence (AI)—often called artificial intelligence—has changed that. The Permanente Medical Group’s rollout of ambient AI scribes to reduce documentation burdens has been deemed a success, saving most of the physicians using it an average of one hour a day at the keyboard. ... Refinement of the tool, however, is ongoing. ... For example, one physician mentioned scheduling a patient’s prostate exam, but the AI scribe recorded that the exam had been performed. 

HHS Secretary Becerra: We’re with you on telehealth flexibilities Hospice News, by Jim Parker; 3/21/24 Telehealth flexibilities must become permanent U.S. Health and Human Services (HHS) Secretary Xavier Becerra indicated in a congressional hearing [Wed]. At the end of this year, telehealth flexibilities implemented during the pandemic are slated to expire. In a hearing before the U.S. House Ways and Means Committee Becerra said that HHS was willing to make them permanent. However, he said this would require closer collaboration with state governments. “We’re with you. We can’t allow those flexibilities to expire, and we need to work closer with our state partners, because much of the flexibility that comes from telehealth means being able to go over state lines,” Becerra said.

Physicians often shy away from preparing their patients to dieToday'sHospitalist, by Colleen Poggenburg, MD, MS; 3/22/24 There's beauty in death if we can tolerate looking. ... The beauty in death is the reflections that occur in the weeks, days and minutes prior to it, which together make up a summary of someone’s life. Why then do physicians view this time-honored decline as a series of clustered medical problems, when it really is just someone moving toward death? Are we so concerned about treating just one more condition, and do we actually think it will solve the growing list of medical problems that dying patients have? ... I compared dying to pregnancy to “soften” the description of this decline. Here’s how I see that comparison: ...Editor's Note: The author offers a fascinating, meaningful comparison of physician/patient conversations with someone who is pregant versus someone who is dying. I encourage you to share this article with your clinical leaders (and adapt it for staff), as this model beautifully reframes important conversations that can empower patients and their families.

5 myths about dying that too many people believeThe Hearty Soul, by Maria Sykes; 3/21/24 Myth# 1: I should always stay positive for the sake of my loved one.Myth #2: I should make sure my loved one eats, drinks, and sleeps as normal.Myth #3: I need to prolong my loved one's life as much as possible.Myth #4: It's important to limit the use of painkillers to keep my loved one healthy.Myth #5: If I seek help to care for my loved one, I'm a failure. 

Give generative AI another decade to revolutionize healthcare Modern Healthcare - Opinion, by Keith Figoli; 3/15/24... Generative artificial intelligence is poised to transform healthcare by enabling solutions to effectively address [common patient care] challenges. This cutting-edge technology opens new avenues for innovation in diagnosis, treatment planning, operations efficiency and overall healthcare delivery–and industry leaders are taking notice. A recent survey revealed that 25% of healthcare organizations implemented a generative AI solution in 2023, while 58% plan to adopt one this year. However, the generative AI-driven transformation won’t – and shouldn’t – happen overnight.