Latest news with #endoflife
BBC News
a day ago
- Business
- BBC News
Sheffield St Luke's Hospice budgeting for £537k deficit
A hospice which offers end-of-life care is budgeting for a deficit in the current financial year of over half a million pounds on its running costs of more than £14m, a report has Luke's Hospice in Sheffield faced a financial deficit of about £537,000 for 2025-26 despite fundraising efforts, according to its most recent Quality Account remained "a lot of uncertainty around funding and support" for the 20-bed in-patient hospice in Whirlow, the report the document added that "thanks to careful financial planning, diverse income streams, and strong cost controls, we remain confident in our ability to keep St Luke's sustainable for the future". According to the Local Democracy Reporting Service, the report said rising staff costs continued to be "a big challenge, especially as NHS pay rises impact the wider job market"."The National Living Wage, rising National Insurance costs and the general increased costs of running our services all impact our finances," it said."Our NHS South Yorkshire Integrated Care Board funding for 24-25 was 23%, with the remaining 77% being raised through our own activity, such as fundraising and retail." 'New strategy' St Luke's, which in 2024 won a Care Quality Commission overall rating of "outstanding", provides end-of-life and palliative care to almost 1,800 people a year and supports their families and well as its in-patient centre, the hospice provides care to people in their own homes or care homes, accounting for 88% of its the Quality Account report, Jo Lenton, the hospice's new chief executive and chief nurse, said: "This year, we launched our new strategy for 2025-29, which will help us address some of the challenges our communities will face in the coming years, while also strengthening St Luke's sustainability in light of increasing pressures on multiple fronts."Our new strategy centres around a new vision of a world where patients and families facing terminal illness don't feel alone, and receive the care and support they need to make the most of precious time, and experience a good death."The report is expected to be discussed by Sheffield City Council's health scrutiny sub-committee on 5 June. Listen to highlights from South Yorkshire on BBC Sounds, catch up with the latest episode of Look North
Washington Post
2 days ago
- Health
- Washington Post
Women sue Kansas over law that disregards end-of-life wishes during pregnancy
Three women and two doctors are suing Kansas over a law that nullifies a person's decisions about end-of-life care if they are pregnant in what appears to be the first such lawsuit since the Supreme Court overturned Roe v. Wade and a constitutional right to abortion. The women, one of whom is pregnant, argue that preventing pregnant people's advance medical directives from being acted upon violates their rights to personal autonomy and equal protection under the Kansas Constitution, according to a petition filed Thursday in a state district court. All states have laws allowing people to create advance directives spelling out their wishes for medical care when they can no longer make those decisions themselves. A majority of those laws limit choices about care if a patient is pregnant. While some states base the restrictions on whether the fetus is already viable or the possibility of a live birth if the pregnancy is allowed to continue, Kansas is one of about 10 states that invalidate advance directives for pregnant patients regardless of the gestational age of the fetus. Such restrictions have been in place for decades and rarely challenged in court. But scrutiny of end-of-life laws surged this month after news emerged from Georgia about a brain-dead pregnant woman whose family said she was kept on life support to obey the state's abortion ban. The case raised complicated questions about how end-of-life decision-making powers and abortion bans can coexist in a post-Roe era — and whether they should. The women bringing the Kansas lawsuit say the state's pregnancy exclusion wrongfully negates the 'deeply personal' health-care decisions they have specified in their advance directives if diagnosed with a terminal condition while pregnant. The state's law 'unjustly, discriminatorily, and categorically disregards their clearly expressed end-of-life decisions' when they are pregnant, the lawsuit says. The physicians participating in the suit allege that the law's lack of clarity has made them uncertain of what treatment they can provide, exposing them to civil and criminal liabilities. Emma Vernon, the plaintiff who is pregnant with her first child, said that under Kansas law, she would not 'get the peace of mind a living will is meant to provide.' According to the lawsuit, Vernon has specified in her declaration that if she is diagnosed with a terminal condition during her pregnancy, she would accept life-sustaining treatment only if 'there is a reasonable medical certainty her fetus will reach full term and be born with a meaningful prospect of sustained life and without significant conditions that would substantially impair its quality of life.' 'I am no less capable of planning my medical care simply because I am pregnant,' Vernon said in a statement Thursday. 'I know what is best for me.' The five plaintiffs are being represented by attorneys from Compassion & Choices, a group that advocates for access to physician-assisted dying, and If/When/How, a legal reproductive justice nonprofit. They are also represented by a Kansas law firm led by Pedro L. Irigonegaray, who served as an attorney for George Tiller, a Kansas doctor who performed late-term abortions and was killed by an antiabortion extremist in 2009. The lawsuit asks the court to bar the Kansas Attorney General's Office and state Board of Healing Arts, which oversees health-care professionals, from enforcing the pregnancy exclusion. It also names the district attorney of Douglas County, where the lawsuit was filed, as a defendant. None of the defendants immediately responded to a request for comment Thursday. Advance health-care directives in Kansas have two parts: a durable power of attorney and a declaration. The power of attorney allows patients to designate another person to make decisions, including about life-sustaining measures, when they no longer can. The declaration is a patient's living will, in which they can state whether they would want life support — such as a ventilator or feeding tube — withheld or withdrawn if they develop a terminal condition. Patients must complete one of these before they sign their directive, making it legally binding. But the declaration 'shall have no effect during the course of the qualified patient's pregnancy,' Kansas law states. Such a restriction calls into question 'the enforceability of the directives of all Kansans capable of pregnancy,' the lawsuit says, adding that it undermines their equal protection rights by 'subjecting them to a lesser standard of care than that afforded all other patients.' The last time the issue was cast significantly into a national spotlight was more than a decade ago, before the fall of Roe, when the family of a brain-dead pregnant woman brought it to court in a harrowing, high-profile Texas case. In 2014, Marlise Muñoz was around 14 weeks pregnant when she was declared brain-dead, but doctors acted against her wishes and refused to take her off life support, citing the state's advance directive law. As in Kansas, advance directives in Texas have 'no effect' if a patient is pregnant, according to state law. Muñoz's husband said she told him and her parents that she did not want to be kept on life support, though it does not appear that she formally signed a document. But for months, she was kept on a ventilator until a judge ordered the hospital to remove her from it. The judge also ruled that the advance directive law did not apply because she was dead and could not be a 'pregnant patient.' By then, the hospital had already acknowledged in court documents that the fetus was not viable. Exclusions like those in Kansas and Texas reflect 'many states' public policies in favor of preserving fetal life,' said Nina Kohn, a law professor at Syracuse University. With Roe struck down, advance directive restrictions for pregnant patients could be seen as a stronger tool for states interested in protecting fetuses, Kohn said, describing the notion as 'constitutionally problematic.' In 2018, four Idaho women brought a lawsuit, also backed by Compassion & Choices and If/When/How, challenging that state's pregnancy exclusion. A federal judge ruled in 2021 that the exclusion was unconstitutional and that requiring advance directives to be voided for pregnant patients violated their First, Fifth and 14th amendment rights. Since Roe, abortion-related legislation has largely been left to the states. Across the country, advocacy groups have used ballot initiatives for constitutional amendments to restrict or enshrine abortion protections at the state level. In 2022, voters in Kansas rejected a proposed amendment that would have allowed state lawmakers to enact a near-total ban. If future challenges over patient rights at the end of life were to be filed, Kohn said, they would raise questions about what laws — federal or state — would be at play. 'The experience of being pregnant in America is going to increasingly look very different in different states,' she said.
Medscape
2 days ago
- Health
- Medscape
Hospitalists Should Champion Hospice as ‘Life With Dignity'
If anyone can put a positive spin on the end of life, it's Charles Vialotti, MD, director of Hospice Care at Holy Name Medical Center's Villa Marie Claire in Bergen County, New Jersey. Violotti, who at the age of 80 lives at the 20-bed Villa Marie Claire to serve its residents full-time, says the hospice industry needs hospitalists' help with sort of a rebrand, one that will almost certainly have a positive effect on patient and family satisfaction. 'Providers used to stress offering people death with dignity. And if you think about that, who is ever going to choose anything that offers death? Death in any form is still death,' Vialotti said. 'So, we really like to focus on offering people life with dignity, giving people back choice, giving them the option to structure their final days, weeks, or months the way they would most like to see it happen.' Charles Vialotti, MD Vialotti said that when patients come to his facility, they receive state-of-the-art care, plus the opportunity to spend time surrounded by loved ones, family, and friends in an environment that is comforting, calming, and soothing. Plus, patients can take advantage of opportunities like learning a new hobby and enjoy social interactions both on their own and with their loved ones. While hospice facilities like Vialotti's give patients full-time residential care, home hospice programs also give patients the opportunity to spend time in an environment that's comfortable and familiar, surrounded by family and friends — if they know about it, and are made aware that hospice isn't just 'going home to die.' 'I think too often we focus on the negatives, on stopping treatment, stopping interventions, stopping medications that we've become reliant on,' Vialotti said. 'Instead of that, we really have to talk about all the positive aspects of what this option can mean.' Shoshana Ungerleider, MD Hospitalists remain a critical member of the hospice education team, even though the vast majority of today's hospitals have at least some sort of palliative care staff to educate patients nearing the end of their journey, said Shoshana Ungerleider, MD, founder of the nonprofit End Well. The hospitalist has worked to build a relationship with the patient, one they can use to demystify hospice, she said. 'Given that hospitalists are that main touchpoint for patients — beyond nursing care, at least — I think if we can encourage the hospital-based clinicians to frame hospice not as giving up but shifting the focus from prolonging life at any cost to really maximizing comfort and quality of life, that will go a long way,' Ungerleider said. Clearing Up the Confusion Hospice care first came to the United States from England in the 1970s, and decades later, there's still a lack of knowledge surrounding this form of care among patients and their lay caregivers — and some doctors, too. 'Even as healthcare workers, even as hospice workers, we don't always realize that people don't know what they don't know,' said Julie McFadden, RN, a hospice nurse and online educator better known as 'Hospice Nurse Julie' to her 1.7 million followers on TikTok. 'It's not really built into our healthcare system to educate and talk to families.' Julie McFadden, RN 'This happens a lot in healthcare: We tend to stick to our lanes,' McFadden, the author of Nothing to Fear: Demystifying Death to Live More Fully , said. 'Like, well, we wouldn't tell the patient that they were dying because they have an oncologist, and the oncologist will tell them, and maybe, maybe the nephrologist knows something. Everyone's kind of stuck, unbeknownst to themselves.' So, for hospitalists, with their position closest to the patient, now is an important time to do a refresher on hospice, given the aging of the Baby Boomer generation. Ungerleider said that doctors should place an emphasis on the fact that hospice is not the absence of care; it is active care — it's just a shifting of the focus. 'We want hospitalists to be clear on what the hospice team is composed of (and) how they are able to support and not support families,' said Ungerleider, also the host of the Before We Go and TED Health podcasts. 'I think demystifying that process, offering it early as a meaningful option, I think patients are more likely to engage with it earlier and then hopefully benefit from it more fully.' As Ungerleider noted, early admission to hospice — as quickly as possible after cessation of treatment — is shown in the clinical literature to actually extend the length of patients' lives and enhance families' satisfaction with the way their loved one has spent their final days. The 2007 study 'Comparing Hospice and Nonhospice Patient Survival Among Patients Who Die Within a Three-Year Window,' led by Stephen R. Connor and published in the Journal of Pain and Symptom Management, reported that patients who chose hospice lived an average of 29 days longer than those who did not, while 'Early Palliative Care for Patients with Metastatic Non–Small Cell Lung Cancer , ' a 2010 study led by Jennifer S. Temel and published in The New England Journal of Medicine, showed that patients admitted to hospice early lived 2 months longer and also had better quantitative quality of life. Across the board, families involved reported being less stressed and had lower depression scores. Don't Overpromise, Though Hospice is a great solution for many patients, but it isn't the right solution for everyone. When asked what she'd most want to make sure hospitalists know about hospice, hospice nurse and educator McFadden emphatically said it would be that hospice — home hospice, that is — does not provide round-the-clock care. 'A lot of times families will come in, they have an elderly mom who could no longer take care of herself, there's a bunch of issues, she had a fall, etc. The family wants comfort care, so the hospitalist is like, great, let's refer to hospice. The family says we won't be able to take care of her, and a lot of times the people in the hospital think it's okay — hospice will take care of that,' McFadden, who was an intensive care unit nurse before getting into hospice, said. 'We won't. We can't. So, they get home, the family's like, wait, but the doctors in the hospital said you guys would do the care.' In the case of geriatric patients, generally speaking, because of the way Medicare is structured, families or other lay caregivers are responsible for the day-to-day caregiving even when the patient is in hospice. Plans vary from service to service, but generally, home hospice services will include a weekly visit from skilled nursing, plus a certain number of hours per week of care from a nursing assistant to cover bathing, tidying, bed changes, and other support. Hospice staff is always available by phone, 24 x 7, should the patient have an issue. 'We try to help the family understand how to provide the care and steps to do each task, but we won't provide it,' McFadden explained. Even so, she'd advise patients and their families to choose the option of hospice if possible. 'Hospice is there to help you die a natural death at home. To me, I feel like if you get to die a death on hospice, you are lucky.' Don't Let the Good Stand in the Way of the Perfect Hospice may not be a perfect solution for everyone, but data showed that it is a very good one, both for patients and their families. 'The best care that you can offer a patient who is no longer a candidate for effective medical intervention is focusing on the patient as a human being, an individual, focused on humanity and care and not the science of medicine,' said Vialotti. 'Instead of treating their disease, treat them as a human being. Find out what they want. Find out what they would like this part of their journey to look like and then offer them the support that enables them to experience that.' Hospice makes that kind of journey possible but is only available for patients if they're made aware of it. Hospitalists have an important role to play in raising awareness about this option when applicable and in accurately and compassionately delivering information about its efficacy and what it entails.
Daily Mail
4 days ago
- General
- Daily Mail
Cabinet minister breaks ranks to condemn assisted dying legislation - warning chaotic process means it hasn't been properly scrutinised
A senior Cabinet minister has warned that assisted dying laws are being rushed through Parliament with too little time for proper scrutiny. Shabana Mahmood, the Justice Secretary, said there was a 'curtailed' debate in the House of Commons over what would be 'such wide societal change'. The Terminally Ill Adults (End of Life) Bill aims to allow terminally ill adults in England and Wales - with less than six months to live - to legally end their lives. MPs continued their scrutiny of the legislation - a private members' bill being spearheaded by Labour 's Kim Leadbeater - earlier this month during an almost five-hour debate in the Commons. This saw critics claim the Bill does not include enough protections and was being hurried through Parliament. Ms Mahmood, an opponent of the legislation, has now added her voice to those criticisms ahead of a planned further debate on the Bill next month. This is despite Cabinet ministers having previously been warned to steer clear of public debate on the issue, as the Government attempts to maintain a neutral stance. The Justice Secretary said the process had 'shown the inadequacies' of using a private members' bill to bring forward assisted dying laws. 'My views [on assisted dying] are well known,' Ms Mahmood said when speaking to The Times last week. 'They haven't changed between second reading and the debate we had last Friday and what will happen when we get to third reading. 'I do think that this process has shown the inadequacies of private members' bills as a vehicle for such wide societal change. 'I know they have worked in the past. I can see why campaigning backbench MPs will think, 'If we were able to do this for abortion for example a few decades ago we can use the same mechanism now'. 'But there are huge implications here and the debate that we're having is curtailed, it is short. We saw that last Friday. I don't think it's the right thing to do.' Last year, Labour peer Charlie Falconer sparked fury by claiming ministers should not 'impose' their religious beliefs on others over assisted dying. He hit out after Ms Mahmood, the first Muslim to become Lord Chancellor, said she would vote against Ms Leadbeater's Bill ahead of its first reading in the Commons in November. Lord Falconer said there were 'religious and spiritual reasons' for Ms Mahmood's opposition to the Bill. But his intervention prompted an angry backlash among Ms Mahmood's fellow MPs, as well as from religious leaders. The Bill's current stage – known as report stage – will continue on June 13, when further debate will take place in the Commons. If time allows on that day it is possible a third reading could take place, giving MPs another vote to either approve or reject the overall Bill and decide whether to send it on to the House of Lords.
Associated Press
4 days ago
- Health
- Associated Press
France's National Assembly to vote on long-debated bill legalizing end-of-life options
PARIS (AP) — France's lower house of parliament, the National Assembly, is voting Tuesday on a bill to allow adults with incurable illness to take lethal medication, as public demands grow across Europe for legal end-of-life options. Tuesday's vote, expected in the late afternoon, is a key legislative step on the contentious and long-debated issue. If approved by a majority of lawmakers, the bill will be sent to the Senate for further debate. The proposed measure defines assisted dying as allowing people to use a lethal substance under certain conditions so that they may take it themselves. Only those whose physical condition doesn't allow them to do it alone would be able to get help from a doctor or a nurse. The bill provides for strict conditions To benefit from the newly proposed measure, patients would need to be over 18 and be French citizens or live in France. A team of medical professionals would need to confirm that the patient has a grave and incurable illness 'at an advanced or terminal stage,' is suffering from intolerable and untreatable pain, and is seeking lethal medication of their own free will. Patients with severe psychiatric conditions and neurodegenerative disorders such as Alzheimer's disease won't be eligible. The person would initiate the request for lethal medication and confirm the request after a period of reflection. If approved, a doctor would then deliver a prescription for the lethal medication, which could be taken at home, at a nursing home or a health care facility. In parallel, another bill on palliative care meant to reinforce measures to relieve pain and preserve patients' dignity will also be put to a vote Tuesday. A 2023 report indicated that most French citizens back legalizing end-of-life options, and opinion polls show growing support over the past 20 years. Initial discussions in parliament last year were abruptly interrupted by President Emmanuel Macron's decision to dissolve the National Assembly, plunging France into a months-long political crisis. Months-long debate still aheadA definitive vote on the measure could take months to be scheduled amid France's long and complex legislative process. The National Assembly has the final say over the Senate. Earlier this month, Macron suggested he could ask for French voters to approve the measure via referendum if parliament discussions get off track. Activists supporting the change have criticized the complexity and length of the parliamentary process that they say is penalizing patients waiting for end-of-life options. Many French people have traveled to neighboring countries where medically assisted suicide or euthanasia are legal. The Association for the Right to Die with Dignity (ADMD) has called on French lawmakers 'to respect the French who want the same right that our Dutch, Belgian, Luxembourgian, Swiss, Spanish, Portuguese neighbors have.' French religious leaders issued this month a joint statement to denounce the bill, warning about the 'dangers' of an 'anthropological rupture.' The Conference of Religious Leaders in France (CRCF), which represents the Catholic, Orthodox, Protestant, Jewish, Muslim and Buddhist communities, said the proposed measures risk exerting pressure on older people and those with illnesses or disabilities. Similar talks in the U.K. The debate in France comes as similar talks are ongoing in the U.K., where lawmakers are debating a bill to help terminally ill adults end their lives in England and Wales after giving it initial approval in November. Medically assisted suicide involves patients taking, of their own free will, a lethal drink or medication that has been prescribed by a doctor to those who meet certain criteria. Euthanasia involves doctors or other health practitioners giving patients who meet certain criteria a lethal injection at their own request. Assisted suicide is allowed in Switzerland and several U.S. states. Euthanasia is currently legal in the Netherlands, Spain, Portugal, Canada, Australia, Colombia, Belgium and Luxembourg under certain conditions.
