Hi,
Comments in text.
USM Bish wrote:
>On Fri, Feb 18, 2005 at 09:56:51AM -0800, lakewood at copper.net wrote:
>
>
>>50 state plus the federal government plus US controlled areas
>>adds up to considerable variance is the government's approach
>>to death and life-support. It is a general rulle that an
>>individual should, in advance, declare their wishes regarding
>>life support. This, however, is not necessarily a certainty and
>>is likely to depend more on who assumes or is assigned control
>>over decisions (personal experience here).
>>
>>The obligation placed on Healthcare Practitioners and
>>Facilities is serious since this may result in subsequent legal
>>action during which the Practitioners and Facilities can be
>>involved. The need to performed detailed recording is an
>>unknown as is the need to accumulate and 'bundle' all available
>>Healthcare-related data, making it available to requestors.
>>This 'wrapup' phase can be difficult and can benefit from the
>>introduction and maintenance of EHRs.
>>
>>Unfortunately this is not a clean, precise topic. As an
>>example, a recent case in the state of Florida involved a wife
>>who was 'brain-dead' and whose husband wanted to remove life
>>support. Her parents decided this was inappropriate and took
>>action.
>>
>>A special bill was passed in the state legislature and signed
>>by the governor requiring that life support continue. This was
>>appealed to the highest court the members of which narrowly
>>agreed that this was 'extra-ordinary'. The entire process, I
>>believe, took well over one year before life-support was
>>removed. During that time the Facility along with the
>>Practitioners were handling the situation very carefully.
>>
>>This may seem like an extreme case. It has occurred in other
>>jurisdictions. At least in the US the need to continue
>>recording may not stop when the practitioner decides that
>>'death' has occurred or that 'legal death' has occurred. There
>>may be others who disagreed.
>>
>>My personal belief is that 'death' is final when the body is in
>>its final resting place and there are no outstanding court
>>orders to the contrary. The 'end' for EHRs has to be the final
>>resting place. But I will add a caveat, i.e., there might be
>>some person or entity interested in digging them up and having
>>a look.
>>
>>
>>
>
>Thomas, as stated in my previous mail, I am not quite aware of
>the prevalent US laws. All that I stated are the generally
>accepted objective medical criteria for 'Clinical' (somatic or
>systemic) death and 'Brain' death ('wrap-up' phase criteria).
>These are clear measureable/ demonstratable biological entities.
>
>I suppose there are no legal angles to 99% of all deaths (viz.
>clinical/ somatic/ systemic death). Some difficulties may arise
>in few of the 'brain death' pronouncements, where the stated
>biological criteria may not be fully established. Otherwise,
>there should be no legal issues here too.
>
>If legal and other considerations are to be entertained, a
>pre-requisite would be to define the end points for such
>additional legal criteria ... any proposals in this regard ?
>
>
>
1)The EHRs should indicate the legal entity or individual that has the
authority to render
decisions regarding Healthcare issues during periods of Patient incapacity,
unresponsiveness and unavailability.
2)Competent legal jurisdictions where care rendered, e.g.,
(US+state+county+city)
3)Competent Court where court order issued affecting Patient,
Practitioner, Facility
4)Police Authority or Emergency Medical Team where Patient unresponsive
5)Police Authority where Patient is in custody
6)Additional parties attempting to exercise some authority (see 3 above)
7)(really difficult) Civil Code, Court order or other jurisdictional
order declaring or
permitting an assertion that the Patient is legally incompetent to make
decisions regarding
their welfare.
8)Legal representatives (notified and on retainer)
All this and more is included in the more difficult conflicts.
-Regards!
-Thomas Clark
>Rgds,
>
>Dr USM Bish
>Bangalore
>-
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