AMA Journal of Ethics®

Illuminating the art of medicine

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AMA Journal of Ethics®

Illuminating the art of medicine

Virtual Mentor. December 2013, Volume 15, Number 12: 1011-1112. Full Issue PDF

December 2013 Contents

Medicine’s Role in the “Good Death”

Ethics Poll

In its 1990 decision in the Cruzan case, the U.S. Supreme Court ruled that artificial nutrition and hydration are no different from any other medical intervention, and therefore can be withdrawn from a patient who wishes (or whose surrogate wishes) that life-sustaining treatment be discontinued. The court's position is not accepted by all; many religious authorities, for example, think that withdrawing nutrition and hydration is actively starving the patient, rather than allowing the patient to die from his or her illness. Which of the following best expresses your thinking on the question of withdrawing nutrition and hydration?
It is like any other medical intervention; therefore it can be withdrawn to allow the patient to die from his or her illness.
It is not like any other medical intervention, therefore it should be continued until the patient dies from his or her illness.
It doesn't matter whether it is like any other medical intervention or not, if the patient or surrogate doesn't want it continued, it should be discontinued.
Don’t know.

When physicians prognosticate that a patient has 6 months or less to live, that patient is eligible for hospice care. Yet surveys show that more than 50 percent of patients who spend time in hospice care spend 14 or fewer days. Do you think that it would be better if patients who are expected to die within 6 months spent more than an average 14 days in hospice care?
Yes, because they would have better symptom control and be more comfortable.
Yes, because it is easier on their family members or other caregivers when the patient is receiving hospice care.
No, because once patients accept that they are actively dying, they lose hope, which is more difficult for them and their family members to handle.
Don’t know.

Do you have an advance directive designating a surrogate decisionmaker or stating what sort of care you wish to receive should you become unable to communicate with caregivers?
Yes.
No.

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From the Editor

Dying in the Twenty-First Century
Sophia Cedola and Kenneth Prager
Full Text | PDF
Virtual Mentor. 2013; 15:1013-1016.

Educating for Professionalism

Ethics Cases

Integrating Palliative Care with Disease-Modifying Therapy
Commentary by Craig D. Blinderman
Full Text | PDF
Virtual Mentor. 2013; 15:1017-1021.

When Physicians and Surrogates Disagree about Futility
Commentary by Kenneth Prager
Full Text | PDF
Virtual Mentor. 2013; 15:1022-1026.

Medical Students and Dying Patients
Commentary by Audrey Tan
Full Text | PDF
Virtual Mentor. 2013; 15:1027-1033.

Medical Education

The Flipped Classroom Paradigm for Teaching Palliative Care Skills
Vyjeyanthi S. Periyakoil and Preetha Basaviah
Full Text | PDF
Virtual Mentor. 2013; 15:1034-1037.

The Code Says

AMA Code of Medical Ethics’ Opinions on Care at the End of Life
Full Text | PDF
Virtual Mentor. 2013; 15:1038-1040.

Journal Discussion

Physician Characteristics Influence Referral to End-of-Life Care
May Hua
Full Text | PDF
Virtual Mentor. 2013; 15:1041-1044.

State of the Art and Science

Serious Illness Communications Checklist
Rachelle E. Bernacki and Susan D. Block
Full Text | PDF
Virtual Mentor. 2013; 15:1045-1049.

The Appropriate Use of Increasingly Sophisticated Life-Sustaining Technology
Darryl C. Abrams, Kenneth Prager, Craig D. Blinderman, Kristin M. Burkart, and Daniel Brodie
Full Text | PDF
Virtual Mentor. 2013; 15:1050-1055.

Law, Policy, and Society

Health Law

Legal Constraints on Pursuit of a “Good Death”
Richard Weinmeyer
Full Text | PDF
Virtual Mentor. 2013; 15:1056-1061.

Policy Forum

Legislative Attempts to Improve End-of-Life Care in New York State
Beth Popp
Full Text | PDF
Virtual Mentor. 2013; 15:1062-1068.

Medicine and Society

Whole-Person, Whole-Community Care at the End of Life
Christina Staudt
Full Text | PDF
Virtual Mentor. 2013; 15:1069-1080.

Treatment of Terminally Ill Patients According to Jewish Law
Rabbi Dov Linzer
Full Text | PDF
Virtual Mentor. 2013; 15:1081-1087.

History, Art, and Narrative

History of Medicine

When Medicine Is Powerless
Thomas W. Laqueur
Full Text | PDF
Virtual Mentor. 2013; 15:1088-1091.

Resources

Suggested Readings and Resources
PDF
Virtual Mentor. 2013; 15:1092-1109.

About the Contributors
Full Text | PDF
Virtual Mentor. 2013; 15:1110-1112.