Australian Supreme Court Upholds Patient’s Right to “Pull the Plug”

Posted on: August 17, 2009  |   Author: Scott
Filed Under: Bioethics, Disability, Elder Law, Liability & Litigation, Other   |   Leave a Comment

On Friday, August 14, 2009 the highest court in Perth, Australia heard a landmark case brought by a nursing home seeking guidance on whether it can remove the feeding tube keeping a quadriplegic man alive. Chief Justice Wayne Martin of the Western Australia Supreme Court issued the ruling that would prevent Christian Rossiter’s nursing facility from facing criminal liability for complying with his wishes to remove his feeding tube.

Rossiter, 49, was admitted to the Brightwater Care Group nursing facility after a fall at his mother’s home caused his spastic quadriplegia. Rossiger’s mobility is severely limited to only partial movement in his feet and one finger. He is completely dependent upon the Brightwater staff for all aspects of his care; including administering a tube inserted directly into his stomach which provides the nutrition and hydration necessary to sustain his life.

Rossiter continuously asked Brightwater to remove his feeding tube and allow him die. “I am a prisoner in my own body,” Rossiter declared. “I can’t move. I can’t even wipe the tears from my eyes. I have no fear of death—just pain.”

Although Australian law gives patients the right to refuse life-saving treatment, assisting an individual to commit suicide constitutes a crime punishable up to life in prison. While Brightwater did not have a particular view on whether it should or should not comply with Rossiter’s requests, it did not want to be held criminally responsible for removing his feeding tube and providing palliative care.

Chief Justice Martin noted a key distinction in his order stating, “this is a case in which a person with full mental capacity and the ability to communicate his wishes has indicated that he wishes to direct those who have assumed responsibility for his care to discontinue the provision of treatment which maintains his existence.” Chief Justice Martin concluded that as long as Rossiter was given medical advice and understood the consequences of his decision to stop receiving nutrition, Brightwater would not be criminally responsible for providing palliative care or for his death.

Commentary: The plight of the severely injured and disabled can run deep in a world where life can be artificially maintained beyond its “natural” state. With this plight brings complex and controversial issues of law, ethics, and morality. Deeply ingrained therein is the paradox of the health care provider’s duty to provide care and the individual’s right to self-determination. Chief Justice Martin carefully articulated, albeit in his draft opinion, that it is not the place of another to dictate the outcome of an individual fully capable of determining his own course of action. This decision sparks a unique opportunity to explore the end-of-life dynamic within our own country and should be closely watched for further evolution.

CNN.com, August 14, 2009.

Draft Decision

Cost Continues to be the Primary Issue

Posted on: August 17, 2009  |   Author: Colin
Filed Under: Elder Law, HMOs & Health Plans, Healthcare Reform, Medicare, Public Health Policy, Tax & Finance   |   Leave a Comment

Even for someone who sold insurance for 35 years, and loved the business while he was working, the cost of health insurance is troublesome. “Over the years of my career, I saw the coverage get more expensive, but you got less,” said Reynaldo Hernandez, who retired from selling insurance in 2001. By 2007, Hernandez and his wife were paying more than $15,000 annually for insurance premiums, and over $8,200 annually for co-payments, totaling almost $24,000 in medical costs that year. Because of these high costs, the Hernandez’s dropped their coverage, and had to deal with the stress of having no insurance. “It’s a little scary not to … go to the doctor when you think ‘I should have his checked,’” said Janet Hernandez, who also sold insurance before retiring.

Now, the Hernandezes do have health insurance. Reynaldo is old enough for Medicare, but Janet, who is three years younger than her husband, is covered under a private plan. And the costs are adding up again. They currently pay $850 a month for insurance and co-pays, but the deductibles are increasing every year, so the price continues to go up. Reynaldo is considering going back to work just to gain some peace about the rising costs. “I feel very nervous and uneasy about that, and I shouldn’t be. I shouldn’t have to feel that way in my senior years. I should be able to feel secure.”

Commentary: Lost in the current health care debate at times are individual stories that can be quite telling. The above summarized piece is interesting because it shows the effects of high costs for insurance on an individual retiree who happened to sell health insurance for the majority of his professional career. The Hernandez’s circumstance is quite common. However, an important question is: what is the alternative? If a government sponsored “public option” for insurance is created, which now seems increasingly less likely, the costs of that program will be extraordinarily high. In the opinion of this blogger, committing the government to such an increase in spending for the public option does sound fairly daunting in light of the record deficits currently in place. All other arguments aside, including the substantial benefits to be gained, the costs for a public option will be tremendous. For that simple reason, the inevitable cost, many taxpayers are probably, and understandably, apprehensive of reform. The campaign for health reform would benefit if more individual, personalized stories like the Hernandez’s could be shown with specifics as to how a public option would benefit them. With a clearer picture of the benefits, taxpayers might not be as wary of the costs.

Cnn.com, August 4, 2009.

Economic downturn forces tough prescription medication choices for patients

Posted on: October 23, 2008  |   Author: Phillip
Filed Under: Access to Care, Drug & Device, Elder Law, Medicare, Other   |   Leave a Comment

A tracking firm’s analysis between the months of January and August revealed a decrease in the number of prescriptions dispensed between the same period in 2007 and the first eight months of 2008, the first noted negative trend in the prescription drug industry in more than a decade. Faced with tighter home budgets, an increasing number of consumers are incorporating cuts in the amount of prescription medications they use as a part of overall expenditure reductions – drugs are a least priority after food and gasoline for many.

For some this involves extending the life of prescriptions – i.e., taking less than the recommended dosage to delay refilling the order, or even physically splitting pills; for others it involves foregoing the purchase of medication altogether. The problem is especially complicated for those on multiple medications for compound disorders – e.g., diabetes (where insulin cannot be sacrificed, but other medications might be perceived by diabetes patients as “less necessary” – for example cholesterol-reducing drugs). Those Medicare Part D beneficiaries encounter severe difficulties upon reaching the $2,510 “doughnut hole,” notably those whose medications cost thousands of dollars over the course of a few months. Many Medicare recipients find it all but impossible to meet the next approximately $3,000 in drug costs until coverage resumes at $5,726 without some form of subsidization.

The effects of this reduced consumption may be far-reaching according to some public health experts, as those with chronic disorders will experience a worsening of condition and require more costly treatment later. However, others note that “overprescription” has always been an issue within American medicine, driven in part by zealous pharmaceutical producers. Despite drug makers’ and doctors’ opinions that medications are one of the most crucial components in overall treatment of illness, however, patients and their families by this data indeed act according to their own perception of marginal benefits when times are hard. (New York Times, October 22, 2008)

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