Tagged: Illinois

Illinois Senate approves nation’s strictest medical marijuana law

Image: WikiMedia Commons
Image: WikiMedia Commons

In what is being called the strictest medical marijuana law in the nation, Illinois lawmakers have agreed to legalize the drug for some terminally ill patients.

Only physicians with existing relationships with certain patients could prescribe the drug, and patient background checks are mandatory. Patients would not be allowed to grow their own marijuana or use the drug around minors or in public. “What this would set up is a four-year trial program for patients who have an established relationship with a doctor and who can demonstrate that they need this to ease symptoms and take them out of pain,” WGN-TV reports.

The bill also sets a 2.5 ounce limit per patient per purchase from 60 state regulated dispensaries. Illinois will license about 20 growers.

“This bill is filled with walls to keep this limited,” said Democratic Sen. Bill Haine, The Chicago Tribune reports.

The bill now heads to Gov. Pat Quinn, who has remained tight- lipped about whether he will sign the bill into law,  saying only that he is “open minded” about the issue. Lt. Gov. Sheila Simon, a former prosecutor, said that after meeting with patients, she favored the plan, The Associated Press reports.

“We are embarking here on a way to achieve relief, compassionate relief, consistent with the law (with) a system which avoids abuse,” Haine said. “It’s the tightest, most controlled legislative initiative in the United State related to medical cannabis.” The Senate vote was 35-21, with five more than needed for passage.

“At the end of the day, we’re talking about a plant,” said Sen. William Delgado, a Democrat from Chicago.

But not all lawmakers are pleased with the legislation. ”For every touching story that we have heard about the benefits of those in pain, I remind you today that there are a thousand times more parents who will never be relieved from the pain of losing a child due to addiction, which in many cases has started with the very illegal, FDA-unapproved, addiction-forming drug you are asking us to make a normal part of our communities,” said Republican Sen. Kyle McCarter before the vote. His daughter died in 2006 from a drug overdose.

According to the bill, “Modern medical research has confirmed the beneficial uses of cannabis in treating or alleviating the pain, nausea, and other symptoms associated with a variety of debilitating medical conditions, including cancer, multiple sclerosis, and HIV/AIDS,” citing a 1999 study published by the National Academy of Sciences’ Institute of Medicine.

“Medical marijuana works really well for hospice patients,” said Dr. Matthew R. Sorenson, an associate professor at DePaul University’s School of Nursing. “Based off my research, I think this type of bill has a lot of potential. Marijuana has a lot of benefits for other patients, especially for those suffering from MS or chronic nausea.”

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Pain should not be a symptom of aging, says Rainbow Hospice Medical Director

rainbow_logo

Pain in the absence of disease is not a normal symptom of aging, but is still a daily experience for many older adults, said Dr. Timothy McCurry, medical director of Rainbow Hospice and Palliative Care, at the 15th Annual Aging Well Conference in Evanston, IL.

“As we get older we get more diseases, so we have come to associate aging with pain,” McCurry told a room of seniors gathered at the Three Crowns Park retirement community. “Chronic pain is constant in a lot of people. The data shows 100 million people in the U.S. with such pain.” He suspects arthritis is the most common chronic disease.

Because chronic pain is episodic, clinicians should mind how patients’ pain changes throughout a week and over time. For example, patients suffering from arthritis can exercise to help reduce symptoms. McCurry recommends aerobic and strength regimens. “When you become weak, your muscles become vulnerable to injury- falling and breaking a hip.”

But exercise only does so much, as medication usually accompanies chronic pain. “Sometimes you have to make changes and take medications that are a little stronger, a little strange, but help you be able to do stuff,” said McCurry. He knows many choose not to take medications, and they subsequently become “used to pain.” These seniors have a higher risk of falling and a lesser quality of life.

Sometimes, those suffering from chronic pain hide their pain from clinicians, family and friends. Over time, these patients learn how to better mask their discomfort, unlike patients suffering from sudden and intense acute pain.

“We can help people in severe pain,” said McCurry, noting morphine and other opiodic drugs common throughout hospice. “No chronic patient should be in pain.” But some patients shy away from these treatments out of fear of addiction or social judgements. “Although these pain medications can help you function, these myths are very strong and very scary. But at the same time, the alternative is worse.”

Even though hospice care helps many manage pain, findings show most seniors utilize such care too late.

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Buehler Enabling Garden, an outlet for aged and ill

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Buehler Enabling Garden, an outlet for aged and ill

The Buehler Enabling Garden at the Chicago Botanic Garden provides individuals of all life stages a place to explore nature and reflect.

About twenty miles north from the Chicago Loop, the Enabling Garden is just one portion of the nearly 400 acre living botanic museum. While the other reserves and bigger gardens require lots of walking and even some climbing, the Enabling Garden caters to seniors and to the ill.

Raised potted plant
Raised potted plant

“We try to make this area as accessible as possible,” said Julie McCaffrey, the garden’s media relations manager. Most of the flower beds are raised to both provide easy access to visitors in wheelchairs and so that the elderly do not have to bend down to smell the flowers. Hanging baskets can also be lowered by pulleys.

Less obvious accommodations include smooth paving for wheelchairs, vertical wall gardens and miniature raised water fountains for “sensory enjoyment.”

Guided rails help blind visitors plant
Guided rails help blind visitors feel where to plant

“Many of these same ideas can be adapted in home gardens to create enabling gardens for a lifetime of easy, enjoyable gardening,” the garden Web site states. McCaffrey said some of the hospice patients who visit are inspired to garden at home. “It gives them something to take care of,” she said.

The Buehler Enabling Garden
The Buehler Enabling Garden

Hospice Dreams, a nonprofit that grants wishes to some hospice patients, recently sent an individual to the Enabling Garden. “It is so therapeutic for them to interact with plants and be with family,” McCaffrey said. “It would be great if hospitals started recommending this garden to their patients.”

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POLST form presented at Northwestern Memorial, a seminar from LMM co-founder Mary F. Mulcahy, M.D.

Image: Mulcahy speaking to a group of physicians at Northwestern Memorial Hospital
Image: Mulcahy speaking to a group of physicians at Northwestern Memorial Hospital

“The Illinois POLST form is a step in the right direction,” said Mary F. Mulcahy, a co-founder of Life Matters Media and practicing oncologist at Northwestern University, while lecturing physicians about the form Thursday at Northwestern Memorial Hospital.

In March, the Illinois POLST form was released to the public, an effort headed by the POLST Paradigm and the Chicago End-of-Life Care Coalition. This update to the Illinois DNR advance directive aims to improve the quality of life for patients at end of life.

POLSTs, Physicians Orders for Life Sustaining Treatment, are more detailed than conventional living wills and advance directives. These forms give patients the freedom to indicate preferences regarding resuscitation, intubation, intravenous antibiotics and feeding tubes. Such forms are intended for patients in their last year of life, and they can follow patients across state care settings and direct doctors to provide or withhold lifesaving treatments.

Image: POLST form
Image: POLST form

The form should be adjusted over time to fit each patient’s prognosis. “This is not a one-time thing, as patients progress the form can change,” Mulcahy said. “There should be shared decision-making between physicians and patients.” To be valid, the form must be signed by the attending physician.

In the U.S., the average patient visits the hospital more than 30 times and meets nine different physicians during the last six months of life. These patients could benefit from having their medical wishes written down and on hand; the convenience helps cut through the chaos and confusion prevalent in care settings.

POLST was developed in Oregon in the 1990s, and now 14 states have POLST programs. Twenty-eight states are considering the use of such forms.

“Hopefully this form will change the culture and get people talking and preparing for the end of life,” Mulcahy said.

Palliative care expert Andrew Thurston, M.D., agreed. “I think this is great. My hope for the POLST form is that it will clarify patients’ wishes for their end of life care, and that it helps doctors more effectively communicate with their patients,” said Thurston. “We need more open discussion, and with easier language, this form helps.”

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Illinois POLST form released to public

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End of life questions from Catholics tackled at National Healthcare Decisions Day symposium

On National Health Care Decisions Day, the Integritas Institute for Ethics hosted a symposium to explore the ethical challenges that arise at the end of life. Roman Catholic physician Ely Wesley, a Vanderbilt University pulmonary and critical care specialist, warned fellow doctors at the University of Illinois-Chicago against the hastening of death, a process that he argued breaks both the laws of God and nature.

Wesley speaking to a room of medical professionals about the "double effect"
Wesley speaking to a room of medical professionals about the “double effect”

The physician told a room of medical professionals, graduate students and caregivers that his Catholic faith shapes his medical practice, and that the two are inextricably intertwined. “People in this room know people who are struggling with their faith and putting it into context,” he said. “I have no incentive to hasten death.”

During his lecture, Wesley made numerous references to scriptures, prayers and Catholic teaching about death and dying. “Physicians have an opportunity that a priest does not have, and our mission does not end when medicine is no longer of help,” Wesley said.

“Human life is sacred from its beginning to its end,” Wesley said, pointing to the teachings of Pope John Paul II. Even though death is not “an awful situation,” since it baptizes the faithful to Christ, he argued that hastening death removes the dignity of the ill and aged.

“How can we do a better job for our older people?” he asked, and decried secularism, ageism and the ongoing political debate about assisted suicide.

“Euthanasia is a grave violation of the law of God,” Wesley said, referencing current battles in many states over “Death with Dignity” legislation. “If you’re not religious, then it violates natural law.”

What Wesley called the “double effect” is preferable, he said, for people of faith. “Double effect” is a terminal patient’s death due to excessive pain medication. This type of death is justifiable, Wesley argued, because it does not aim to end life- only to treat pain.

Image: The Pieta, Wikimedia Commons
Image: The Pieta, Wikimedia Commons

“It’s scary” that people can purchase ways out of life, he said, noting the rising use of the “exit hood,” a contraption that allows individuals to inhale helium and end their lives. The public support and national popularity of Dr. Kevorkian- a pathologist convicted of second-degree murder for his role in a case of voluntary euthanasia- is frightening also, Wesley argued.

Caring is an honor, Wesley said, referencing a Michelangelo sculpture depicting Christ’s broken body after his crucifixion in a peaceful Mary’s arms. “Look at Mary’s face in the Pieta.”

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“Death denying” culture unfortunate result of medical innovation, says physician on Healthcare Decisions Day

Advances in medical therapies and technological innovation have led to a “death denying” culture pervading American health care, said Dr. Susie White, an emergency medicine physician at Provena St. Joseph Hospital, during a bioethics symposium at the University of Illinois-Chicago on National Health Care Decisions Day.

National Health Care Decisions Day aims to inspire and educate the public and medical providers about the importance of advance care planning.

White speaking to a room of medical providers, caregivers at symposium on NHCD Day
White speaking to a room of medical providers, caregivers at symposium on NHCD Day

“Many older patients find themselves in a position they never thought they would find themselves in,” White said. “We have gained 30 years in our life expectancy.” Prior to antibiotics and modern therapies, most people died quickly- from infections, malnutrition or fevers.

Now, only 10 percent of Americans die sudden, unexpected deaths, and the sick and dying receive care in hospitals.

These shifts have fueled a “death denying” culture, one in which many wish to suppress or avoid any sign of aging or illness, White said. Families may grow angry at doctors- or even the patient- when treatments fail.

White maintains that palliative care can help patients and their families, and that the relatively recent medical specialty has the potential to reverse this culture of denial. “What we want to do is form a team of doctors, nurses, chaplains, anyone who might be helpful in an individual’s case and help anyone who has a life- limiting disease,” she said. “We want everyone in the family on the same page and smooth transitions.”

Most patients should not begin palliative care during the process of active dying, but rather, much earlier- even at the onset of illness, White said. “Palliative care is not hospice, but is an extra layer of support, that can go along with aggressive treatments,” she said.

The Integritas Institute for Ethics, a program of the John Paul II Newman Center, arranged the symposium, which explored the ethical challenges that arise at the end of life.

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As Americans live longer, organ donations suffer

As Americans are living longer than ever, many elderly would-be organ donors are unable to donate upon their death, according to analysis from executives of Gift of Hope, an organ donation organization in Illinois.

Gift of Hope

As Gift of Hope does not accept organs from those older than 85, with certain cancers, HIV or hepatitis B, many in need of multiple organs are struggling to get them. Although the number of living donors has remained steady over time, the number of donors actually able to donate is shrinking. Therefore, an average 65-year-old in need of a liver and kidney waits much longer for those organs.

“What we’re seeing is more people becoming sicker and getting less health care,” Eric Price, a donation specialist with Gift of Hope told LMM. “Because there is a static number of people donating, there are less organs coming from them.” Price also noted an increase in diabetes and cancer in would-be donors.

The biggest obstacle donation specialists face is finding the best time to request organs from grieving families. Specialists typically make this inquiry in the delicate moments before or after a potential donor’s death.

“There is no good time to ask this question,” Price said. “Families don’t want us coming to them in the hospital asking for their loved one’s organs.” But hospitals have an obligation to notify Gift of Hope of every pending death within a facility, or the institution risks losing Medicare reimbursements. If the individual on the verge of death meets the specifications of Gift of Hope, a donation specialist heads to the hospital immediately.

Sometimes, families are reluctant to donate because they hold out hope for a recovery, Price said. Poor doctor-family communication is another reason why more are not organ donors. “So many doctors do a horrible job of explaining death to families in general, but especially brain death,” Price explained. “I’ve been yelled at and even swung at once when speaking to a family about donating their loved one’s organs.”

A sense of urgency pervades organizations like Gift of Hope. There exists a small time period in which vital organs can be harvested, because they require oxygen and nutrients to survive. It is also difficult to find donors, as only two percent of deaths are eligible for donation. An eligible donor must have died a “brain death” within a hospital (like from a stroke) or the patient’s family has decided to withdraw life-saving support.

Deaths in hospice facilities or at home do not qualify, because organs cannot be harvested if not ventilated properly.

Meanwhile, the transplant waiting list keeps growing. A patient awaiting a kidney transplant in Illinois typically receives one after about five years. There are more than 5,000 people waiting for organs in Illinois. Nationally, that number is more than 100,000.

Gift of Hope executives acknowledge the emotional nature of their work and urge families to think of the positives of organ donation.

“After a family donates, we keep in touch with them,” said Karen Cameron, the Clinical Training Coordinator at Gift of Hope. They connect willing organ recipients and the donor’s family “to help show them the impact of their gift.”

More than five million people have signed up to be donors in Illinois, and more than 70 percent of those whom Gift of Hope approach agree to  donation.

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Hospitals fear Medicare cuts

With “fiscal cliff” negotiations stalling and entitlement cuts and changes pending in Congress, some hospitals fear they’ll be left to fill in gaps left by Medicare cuts. Both President Obama and House Republicans have proposed raising Medicare premiums and savings of at least $400 billion over 10 years.

The New York Times reports: “[T]here is already discussion of cutting special payments to teaching hospitals and small rural hospitals. Lawmakers are also considering reducing payments to hospitals for certain outpatient services that can be performed at lower cost in doctors’ offices,” although final details may not be worked out until next year.

Hospitals already face $155 billion in cuts over a decade as part of the Affordable Care Act, they now must deal with the prospect of losing billions more, the Times reports.

Some hospital executives and provider groups argue large cuts will affect beneficiaries- especially seniors and the poor. “There is no such thing as a cut to a provider that isn’t a cut to a beneficiary,” said Dr. Steven M. Safyer, the chief executive of Montefiore Medical Center.

“It is not particularly honest to say that provider payment reductions won’t affect beneficiaries. They’ll affect staffing, they’ll affect services, they’ll affect access,” Rich Umbdenstock, president of the American Hospital Association, told the Wall Street Journal. ”The cost of care does not go away.”

Illinois’ News-Gazette reports hospital executives already tightening up spending as much as possible to get ready for cuts on the way- either the 2 percent across-the-board sequester or possible debt deal. But they can’t plan for everything, they say.

“It’s hard to know what to be concerned about,” said Craig Sheagren, vice president of finance at Sarah Bush Lincoln Health Center, Mattoon Ill. “It’s kind of like crying, ‘The sky is falling. The sky is falling.’ ”

If no meaningful legislation passes to extend the federal debt limit, Medicare payments to hospitals and doctors will suffer deep cuts anyway, although much less than the current proposals of the President and Speaker Boehner, an estimated $123 billion from 2013 to 2021; doctors will face a 26.5 percent cut in their Medicare fees.

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Dr. Judi Strauss-Lipkin, 69, is the owner and principal of Strauss Financial in Chicago, Ill., and former professor of human resource management at Benedictine University. She spoke to Life Matters Media about her experiences caring for her aging husband. Larry, 87, a retired accountant and WWII veteran, is her husband of 26 years. Larry has suffered bouts with heart failure, Bell’s palsy, COPD and short-term memory loss.

Read the interview at the Good Men Project.

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How POLST forms clarify wishes: Three scenarios

The Physician Orders for Life-Sustaining Treatment (POLST) program, designed to improve end of life care in Illinois, is on its way to implementation. Health care professionals met at Rush University Medical Center this week to discuss the form’s development and strategies for raising public awareness.

Julie Goldstein, M.D., a clinical ethicist and palliative care physician at Advocate Illinois Masonic Medical Center, provided the audience with hypothetical scenarios the POLST program form could remedy.

POLST program forms are more detailed than conventional living wills or other advance directives. They allow people to indicate preferences regarding resuscitation, intubation, intravenous antibiotics and feeding tubes. Such forms are intended for people who are likely in their last year of life.  They can follow patients across in-state care settings and direct doctors to provide or withhold life-sustaining treatment in emergency situations.

The forms aim to more quickly direct doctors to a person’s wishes and eliminate confusion about what patients would want in the case that they are medically incapacitated and unable to communicate their wishes.  The forms provide instructions in the case of a cardiopulmonary arrest (the person has no pulse and is not breathing), the degree of medical intervention they would want in a pre-arrest situation (the person has a pulse and/or is breathing), and whether or not they would want artificial nutrition if their medical illness prevented them from taking in adequate oral nutrition.

How a POLST form could help

A 67-year-old man is sent to the emergency room with chest pain and shortness of breath. He is also confused. The cardiologist says that a cardiac catheterization with angiogram and a stent are needed. The nurse tells the physician that there is a DNR order on his chart. Should the physician send the patient for an angiogram? It’s not clear. 

If that patient had a POLST form that indicates DNR in case of full cardiac arrest but an order for full treatment in a pre-arrest emergency, the physician would immediately know what to do. The patient would be sent for the angiogram.

An 85-year-old man is admitted to the emergency room with severe pneumonia. He’s hypoxic, confused and refusing the ventilator. There is a DNR order on the charts. The physician feels that DNR doesn’t apply to this potentially reversible condition but the nurses disagree. He receives full resuscitation. 

If that same patient had a POLST form indicating no CPR in the case of arrest and a preference for comfort care, the physician and nurses would have clear instructions.  He would not have undergone full resuscitation, but would have been maintained in comfort with noninvasive maneuvers.  .

A 59-year-old woman who is being treated for breast cancer is admitted to the emergency room for sepsis. She is transferred to intensive care and receives oxygen and maximum vasopressors. She has a DNR order on the charts. The staff are concerned that they are violating her wishes.

If she had a POLST form indicating no CPR in the case of arrest but limited interventions in addition to comfort measures, the staff may feel more comfortable treating her as they are doing and spend less time deliberating.

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