Literature Review

Ethics of overtreatment and undertreatment in older adults with cancerBMC Medical Ethics; by Clark DuMontier, William Dale, Anna C. Revette, Jane Roberts, Ameya Sanyal, Neha Perumal, Eric C. Blackstone, Hajime Uno, Mary I. Whitehead, Lewis Mustian, Tammy T. Hshieh, Jane A. Driver, Gregory A. Abel; 7/25This modified Delphi study convened a panel of experts in biomedical ethics and reached consensus that the principles of beneficence, non-maleficence, and autonomy are related to our previously proposed definitions of over- and undertreatment in older adults with cancer. The panel also reached consensus that, in most cases, it is unethical to make a treatment recommendation without (1) formal assessment of patient frailty (e.g., via a geriatric assessment) and (2) the opportunity for a patient to share their values, goals, and/or preferences. The panel did not reach consensus regarding the relationship between justice and over-/undertreatment; however, the panel concluded that justice applies to undertreatment when an oncologist withholds potentially beneficial cancer treatment in an older patient based on their age alone.

How one man’s dying wish was denied by the health care system Synopsi, from MedPage Today; by Caitlin E. Morh, MD; 8/5/25 “This is Dr. Mohr.” I answered a number I didn’t recognize. “It’s Irving,” said the frantic voice. “He collapsed. The paramedics are working on him now.” “They’re doing compressions? Stop! Put the paramedic on the phone!” My father-in-law, Irving, the stoic Danish-American Navy veteran, had been on hospice for 3 months. His POST (physician order for life sustaining treatment) form was on file with the hospice agency and his custodial care facility: DNR/DNI, comfort measures only. ... “I’m Irv’s daughter-in-law. I’m a physician. He’s a DNR, he’s on hospice. Stop doing compressions.” 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 ... I listened to the ACLS algorithm unfold in the background. ...

Tennessee plans to execute inmate amid concerns his heart implant will shock him repeatedly CNN; by Dakin Andone; 8/4/25 Tennessee plans to execute Byron Black on Tuesday for the 1988 murders of a woman and her two young daughters, despite concerns from his attorneys that a device implanted to restore his heartbeat could repeatedly shock him as he’s put to death. The device – an implantable cardioverter-defibrillator, or ICD – is at the center of a court battle that has been unfolding for several weeks. Black’s attorneys want the device deactivated at or immediately before his lethal injection Tuesday morning. If it isn’t, they say the effects of the lethal injection drugs will cause the ICD to shock Black’s heart, perhaps repeatedly, in an attempt to restore it to a normal rhythm. This will cause Black a prolonged and torturous execution, the attorneys argue, violating Eighth Amendment protections against cruel and unusual punishment.Editor's Note: Though this is not a hospice case, this traumatic scenario for persons with implantable cardioverter-defibrillator being repeatedly shocked--even after death--is crucial for the hospice interdisciplinary to know. Clinical, ethical, and legal issues abound. Click here for Shocked at End-of-Life: An Educational Video for Hospice Workers about Implantable Cardioverter-Defibrillators, research published by the Journal of Pain and Symptom Management, May 2024.

Burnout eases for doctors at every career stage as support rises American Medical Association (AMA); by Sara Berg; 7/22/25 Physician burnout is showing promising signs of decline, according to exclusive survey data from the AMA. The analysis reveals that burnout rates have fallen among physicians at every career stage after residency or fellowship training. At the same time, measures of job satisfaction and feeling valued in the workplace are on the rise—an encouraging shift that suggests meaningful progress in efforts to support physician well-being.  ... Nearly 18,000 responses from physicians across 43 states were received from more than 100 health systems and organizations that participated in the AMA Organizational Biopsy® last year. The AMA national physician comparison report—which is exclusive data to the AMA that is not published anywhere else—reflects 2024 trends on six key performance indicators—job satisfaction, job stress, burnout, intent to leave an organization, feeling valued by an organization and total hours spent per week on work-related activities ... 

Telemedicine special registrations for controlled substancesJAMA Health Forum; by Jacob T. Kannarkat, John Torous, Joseph T. Kannarkat; 7/25Since the COVID-19 pandemic, the requirement for in-person evaluation of patients prior to the prescribing of controlled substances via telehealth, as established by the Ryan Haight Online Pharmacy Consumer Protection Act (Ryan Haight Act), has remained provisionally held. The Drug Enforcement Agency (DEA) previously proposed rulemaking to reintroduce the in-person patient evaluation requirement, as some unscrupulous clinicians and companies took advantage of this deregulated environment to overprescribe controlled substances. However, these flexibilities were extended through December 31, 2025, after the public voiced concerns over possible care disruptions in a landscape increasingly dependent on telehealth. Now, the DEA aims to compromise on prescribing flexibility with more practical enforcement measures.

Doctors’ own end-of-life choices defy common medical practice Medscape; by Cristina Ferrario; 7/29/25 A new survey revealed that most doctors would decline aggressive treatments, such as cardiopulmonary resuscitation (CPR), ventilation, or tube feeding for themselves if faced with advanced cancer or Alzheimer’s disease, choosing instead symptom relief and, in many cases, assisted dying. ... The researchers conducted a cross-sectional survey of 1157 physicians, including general practitioners, palliative care specialists, and other clinicians from Belgium, Italy, Canada, the US, and Australia. ... Over 90% preferred symptom-relief medication, and more than 95% declined CPR, mechanical ventilation, or tube feeding. Only 0.5% would choose CPR for cancer and 0.2% for Alzheimer’s disease. Around 50%-54% supported euthanasia in both cases.

Casting hope: A last wish by the water The Citizen, Fayette County, GA; by Compassus Hospice; 7/27/25 For Compassus hospice patient Gerry Higginbotham of Fayetteville, GA, the simple act of casting a line into the ocean had long been a dream—one that felt just out of reach. But thanks to a compassionate care team and the support of the Angel Foundation, that dream became a reality. ... The Hospice Angel Foundation generously covered the cost of lodging near Tybee Island, GA. But transportation and food expenses remained a challenge. That’s when the Compassus Fayetteville hospice team did something extraordinary: they personally donated funds to cover the remaining trip costs, ensuring Gerry and his daughter could make the journey. ... This wasn’t just a trip—it was a moment of peace, purpose and joy for someone who had given so much of himself to others. 

Dignity at risk: hospice care faces critical worker shortage amidst policy challenges ABC WCIV-4 News, Charleston, SC; by Webb Wright; 7/23/25 Officials are giving dire predictions for the future of palliative care and hospice care. There's a rapidly growing need for nurses and healthcare workers in those areas, including home healthcare and nursing home workers. Educators and facilitators in those areas of care are working to prevent a crisis that's expected to peak in less than a decade. By 2033, the number of new projected jobs in this area of healthcare is expected to be more than 820,000, according to the Bureau of Labor Statistics. With a median starting salary of under $35,000, recruiters and workers are scrambling to fill the void sooner rather than later.

6 health systems that faced worker strikes this month MedCity News; by Katie Adams; 7/22/25 Healthcare workers at six health systems across the country have launched strikes in July so far. These healthcare employees cite unsafe staffing levels, low wages and retaliation against union organizers as their main reasons for going on strike. From hospice centers to emergency rooms, frontline healthcare workers across the country have been striking this month to protest what they say are unsafe patient care conditions and poor bargaining behavior. Below are six examples of union activity resulting in a strike — all of which occurred in July.

Systems lean into nurse educator initiatives Becker's Clinical Leadership; by Mariah Taylor; 7/18/25 There is a key driver behind the nationwide shortage of nurses: a severe nurse faculty shortage. To solve both shortages, more systems and nursing programs are creating formal venues to enlarge the nurse educator pipeline. Like the nurse shortage, universities and nursing programs are facing a nurse faculty shortage that has reduced their capacity to accept and train students. Too few nurses are pursuing advanced degrees and becoming educators in the field, according to the American Association of Colleges of Nursing. So systems are developing programs that boost interest and remove barriers for nurses who want to teach. These programs — many of which launched in the last year — range in commitment and scale. Here are a few examples: ...

My mother refused treatment for her breast cancer. Her doctors should have respected her choice. Instead they dismissed her--and criticized me.STAT; by Joy Lisi Rankin; 7/21/25My mother died in January 2007. She told the family that she had breast cancer in 2002. We still don’t know when she knew, or when she had been diagnosed. One thing we did know: She chose not to treat the cancer. In her encounters with health care professionals — doctors, nurses, assistants — during the last years of her life, her choice was met with disbelief and disdain. “Why aren’t you treating your cancer?” “Do you understand what’s going to happen?” “You know you’re going to die, right?” A final thought went unsaid but was clear: “If you’re not going to do what I recommend, I can’t do anything for you.” [Limited access to STAT with three stories per month.]

Effectiveness of an educational intervention in enhancing end-of-life care understanding and decision-making in African AmericansPalliative & Supportive Care; Delicia Pruitt, Megan Reilly, Stephen Zyzanski, Neli Ragina; 7/25AA [African American] patients are more likely than other ethnic groups to choose life-sustaining measures at the end of their lives, leading to patients not receiving care to help them die peacefully. This decision is partly based on lack of knowledge of the available EOL [end of life] care options. An educational tool like the one developed in this study may be helpful and lessen the time of education so that physicians can answer questions at the end of the session and empower individuals and communities to take an active role in creating a culture of wellness at the EOL and decreasing morbidity.

Opinion: My health and my politics walk into a doctor’s office … The Washington Post; by Kim Fellner; 7/16/25 [Note: Access is behind a paid firewall, with an option to set up a temporary free account]... My palliative care doctor and I have almost nothing in common. We’re still learning from each other. ... It began simply enough. By October, my sarcoma had moved from possibly curable to definitively terminal, and, since metastasis to the bones can be painful, my anchor oncologist offered to connect me with a palliative care doctor to help with the physical and conceptual aches and pains of dying. Which seemed like a good thing to do. ... I did not anticipate, however, that the personal and the political would collide in my doctor’s office. ... [Descriptions unfold of significant, conflicted dialogue between (1) this Jewish daughter of holocaust survivors whose life-long vocation was social justice and (2) this Christian palliative care physician who asked about mental health and then dismissed this person's primary concerns that were affecting her dying.] ... Clearly, my doctor and I shared some beliefs about the importance of the palliative approach. ... But as the doctor noted, the best palliative care goes beyond the purely physical to address the more cosmic questions of life and death, and I was uncertain we were well matched as partners for this intimate process. ... I had no idea how to proceed. ... [More descriptions.] ... And that’s where the magic happened. Within a few days, my palliative care doctor sent me back a transparent, thoughtful and moving response. ... Her courage and openness, her willingness to risk a forthright response, have precipitated a remarkable dialogue about what each of us brings into the room, and how we can honor the space and each other once we get there. ... Editor's Note: Whatever one's political or religious stance, this article is sure to spark fireworks—of conflict, dissonance, and, hopefully, powerful insight. I encourage readers to engage with it attentively, attuned to three things: