Literature Review

New ACP paper provides ethical guidance amid controversies and changing practices in organ transplantation American College of Physicians (ACP), Philadelphia, PA; Press Release; 10/28/25 The American College of Physicians today issued a position paper on ethical considerations surrounding organ transplantation, saying the needs of the donor patient and family must be prioritized and the process should be trustworthy and transparent. “Ethical Issues in Organ Transplantation: A position paper from the American College of Physicians” was published in Annals of Internal Medicine.  It clarifies the duties and roles of care teams of prospective donor-patients, recipient-patients, and organ procurement teams, reaffirming that end-of-life decision making for prospective donor-patients must center on their best interests independent of organ donation potential. ... “This guidance is relevant to all involved in organ transplantation and particularly to internal medicine physicians who advise their patients about advance care planning and organ donation, caring for them prior to organ transplantation,” said Jason M. Goldman, MD, MACP, President, ACP. 

Post-biographical dignity in the age of artificial intelligence: Narrative, ePROMs and ethical challenges in end-of-life care Palliative & Supportive Care; by Abel García Abejas, David Geraldes Santos, Helder Mota-Filipe, Àngels Salvador Vergés; 10/27/25 Significance of results: End-of-life care in the age of AI must move beyond autonomy-focused ethics to encompass the narrative, relational, and posthumous dimensions of dignity. A critical, philosophically informed ethics is essential to prevent depersonalisation in digitally mediated care.

Should an AI copy of you help decide if you live or die? Doctors share top concerns of AI surrogates aiding life-or-death decisions. Ars Technica; by Ashley Belanger; 10/20/25 For more than a decade, researchers have wondered whether artificial intelligence could help predict what incapacitated patients might want when doctors must make life-or-death decisions on their behalf. It remains one of the most high-stakes questions in health care AI today. But as AI improves, some experts increasingly see it as inevitable that digital “clones” of patients could one day aid family members, doctors, and ethics boards in making end-of-life decisions that are aligned with a patient’s values and goals.

New Mexico nurse assistant charged with hospice fraud, misconduct Hospice News; by Holly Vossel; 8/29/25 A federal grand jury in Bernalillo County, New Mexico, has indicted a certified nurse assistant for their alleged involvement in a hospice fraud scheme. Potential sentencing includes more than two decades of imprisonment. April Guadalupe Hernandez, 27, was an employee of Luna Del Valle Hospice, LilyCare of New Mexico and Hospice De La Luz. She allegedly assumed the identities of hospice nurses and illegally provided care to patients, according to a statement the New Mexico Department of Justice (NMDOJ) released on Wednesday. Hernandez is charged with 19 counts of misconduct including allegations of identity theft, elder abuse, nursing without a license and Medicaid fraud, among other charges.  

Fed action toward medical journals is “dangerous,” ethicist saysMedscape; by Arthur L. Caplan; 8/26/25Not so long ago, a letter was sent by a federal prosecutor to a journal editor that I think raises issues that ought to be not partisan and not political, but that physicians and physician researchers have to make clear they oppose... [The editor] got this letter that basically said the US attorney was asking, how does your journal handle “misinformation and competing viewpoints,” among other things... This is a fundamental misunderstanding of what journals are about. As I hope all of you watching understand, journals are aimed at medical people, at researchers, and at people who work in healthcare. They’re not the modality for educating the public... Medical journals - whether you read them or whether you use them to disseminate your research, findings, or clinical experience - ought to be removed from government intrusion.

New York indicts two under the state's new deed theft law; how to protect your home Consumer Affairs; by James R. Hood; 8/11/25 New York Attorney General Letitia James has announced the indictments of two people accused of orchestrating a brazen deed theft targeting an elderly widow in Kew Gardens Hills while she was receiving end-of-life hospice care in her home. Deepa Roy, 68, of Manhattan, and Victor Quimis, 39, of Queens, allegedly forged the signature of Mrs. Renuka Bherwani to unlawfully transfer ownership of her home — which she had owned for nearly four decades — first to themselves, then to Quimis’s company, Hunter Studios & Developer Corp. 

Terri Schiavo’s legacy: When to ethically stop life support Medscape; by Arthur L. Caplan; 8/30/25 Hi. I’m Art Caplan. I'm at the Division of Medical Ethics at NYU Grossman School of Medicine in New York City. Twenty years ago this month, from the time I'm talking with you, in March 2005, a young woman named Terri Schiavo was allowed to die. It was one of the most controversial, and probably the most important, end-of-life-care cases ever to unfold in the United States. ... Do we have to make a more precise diagnosis of permanent vegetative state before we get into arguments about what to do next? I do believe also that it's important, if you are dealing with someone who's terminally ill or has a serious illness, to get the discussion going early about who's in charge. We still have fights between husbands, families, sisters, and cousins coming in about who has veto power or decision-making power. The earlier we can establish who it is that the patient wants to speak for them if they can't, the better. 

Hospices navigating ethically complex end-of-life situations Hospice News; by Holly Vossel; 7/25/25 The final stages of life can be filled with challenging, nuanced situations for some patients and their families. Ensuring goal-concordant care and autonomous end-of-life decision-making requires careful ethical, legal and operational considerations. Staff education and proactive policy development are important for hospices to harness in complex situations, according to Jeanne Chirico, president and CEO of the Hospice & Palliative Care Association of New York State (HPCANYS). A number of difficult life circumstances can limit hospices’ ability to provide patients with care that is in line with their wishes, Chirico indicated. Hospices need to have a firm understanding of the possible ethical and legal limitations that staff may encounter, as well as establish procedures that help address them. 

Family of brain-dead mom, Adriana Smith, inspires Georgia bill to protect pregnant patients BET*; by Jasmine Browley; 7/7/25 During a memorial to Adriana Smith, state Rep. Park Cannon unveiled new legislation aimed at giving patients and their families more control over Georgia's severe abortion law. ... Smith's case received global attention due to its unique and contentious circumstances. On February 9, Smith began complaining about headaches. The young nurse and her mother sought assistance at two separate hospitals before being discharged with medicine but no CT scan. A week later, Smith was discovered unresponsive at home, and on February 19, she was formally pronounced brain-dead and placed on life support. Her mother, April Newkirk, told WXIA that doctors at Emory Hospital claimed they couldn't legally examine any additional choices. ... In June, a few days after doctors performed an emergency cesarean surgery to prematurely deliver her baby, the young mother of two was taken off life support. ... Smith's son Chance, born at six months, weighed only one pound and thirteen ounces.  ... Cannon's proposed new law would have returned control of Smith's end-of-life care to her family, who were not consulted before physicians put her on life support to save her six-week-old fetus. ... Adriana's Law would take precedence over Georgia's LIFE ACT, ...

Bioethicists must push back against assaults on diversity, equity, and inclusionThe American Journal of Bioethics; by Nancy S. Jecker, Arthur Caplan, Vardit Ravitsky, Patrick Smith, Kayhan Parsi, Sandra Soo-Jin Lee, Faith Fletcher, Mildred Cho, Keisha Ray; 6/25Nine leading bioethicists, including Hastings Center President Vardit Ravitsky, call for bioethics to affirm its core commitment to justice and act against the dismantling of diversity, equity, and inclusion. In an editorial published in the American Journal of Bioethics, they highlight the current administration’s broadside attack against diversity, equity, and inclusion in higher education, the federal government, and the private sector. “Years of research and data gathering have shown that removing barriers facing marginalized groups improves population health and promotes health justice,” they write.

How long was Adriana Smith on life support? Brain‑dead nurse's baby delivered by C‑section Enstarz; by David Unyime Nkanta; 6/18/25 The 31-year-old nurse was declared brain dead early in her pregnancy—her baby was born via C-section nearly four months later, sparking legal and ethical debate. Adriana Smith, a 31‑year‑old nurse in Atlanta, was declared brain dead in mid‑February after suffering serious blood clots in her brain. Despite devastating diagnosis, she remained on life support for nearly four months—a decision doctors said was legally necessary under Georgia's strict abortion laws. This rare case of maternal somatic support—keeping a brain-dead woman alive to deliver a baby—is highly unusual. On 13 June, doctors at Emory University Hospital performed an emergency c‑section, delivering a boy they named Chance, weighing just 1 lb 13 oz (around 830 g). ... Smith's mother, April Newkirk, described the ordeal as 'torture,' saying: 'I see my daughter breathing, but she's not there.' The family maintain that they were never allowed to make treatment decisions, a situation that has deeply distressed them and prompted calls for change. 

'Just support her': Brittany Maynard's husband says medical aid in dying helped him grieve USA Today; by Madeline Mitchell; 6/15/25 Some patients find comfort in medical aid in dying, which allows individuals with six months or less to live the option to obtain a medicine that can help them die peacefully at a time of their choosing. It's not considered euthanasia – which is when someone administers a lethal drug – because the patient takes the medicine themselves. Medical aid in dying is legal in 11 states and in Washington, DC. “A lot of patients really express this desire to shield family members from the agony of watching them die, and potentially having them witness a really traumatic or a really burdensome death," said Anita Hannig, an anthropologist and author of the book "The Day I Die: The Untold Story of Assisted Dying in America." Some caregivers say medical aid in dying helped in their grieving process, too. One thing (Compassion & Choices’ Jessica) Empeño, (Americans United for Life’s Catie) Kelley and Hannig agree on: When a patient asks to die, it's crucial to ask questions about their pain levels, comfort and mental health. Not every patient can or wants to move to one of the 12 jurisdictions that allow medical aid in dying. Moving can be expensive, and some patients don't have the physical ability or time to move. The best thing caregivers can do, Empeño said, is to advocate for their loved one and plan for their death. Ask questions about what the patient wants when they are dying, like if they want visitors in those final moments and who should make final decisions if the patient can't themselves. Guest Editor’s Note, Mark Cohen: Medical Aid in Dying is not going away. This article makes the point that the things that hospices do best—empathetic listening, asking thoughtful questions to guide patients in their healthcare decision-making—can benefit patients and families on both sides of this policy question. For a related article, see this column by Dan Diaz supporting removal of the sunset provision in California’s End of Life Options Act: “Husband of Brittany Maynard: Let’s make medical aid in dying permanent”; Sacramento Bee, 6/3/2025.

My dad had an Advance Directive. He still had to fight to die Newsweek - My Turn; by Maggie Schneider Huston; 8/26/24, published in our newsletter 8/27/24My mom died peacefully. My dad died 72 days later, angry at the doctors for ignoring his wishes. ... Dad had heart surgery on December 20, 2023. An hour after the surgery ended, his vital systems started shutting down. A cascade of interventions, one after another, kept him alive. Four days later, he said: "Put me on hospice." The doctor dismissed this request, rolling his eyes and saying: "Everyone on a ventilator says that." On Christmas Day, my father asked for hospice again. He was in pain. He knew his recovery would be long and ultimately futile. He would never have an acceptable quality of life again. ... Dad's care team insisted palliative care was the same as hospice care, but he knew the difference. He wanted hospice care. Finally, they reluctantly agreed and called for a social worker to make arrangements. It wasn't necessary. Once they removed his treatment and relieved his pain, he died five hours later. ... Editor's Note: This article is not about Medical Aid in Dying (MAiD). It is about honoring Advance Directives, person-centered care with communications and actions related to "palliative" vs. "hospice" care. Pair this with other posts in our newsletter today, namely "Improving post-hospital care of older cancer patients."