The lede:

Orlando, Fla. — Nearly all hospitals have ethics committees to help resolve dilemmas facing physicians, patients and families, especially regarding end-of-life care. Yet surveys have found the typical ethics consultation service handles only three cases a year.

When should ethics services be consulted? Who should sit on ethics committees? Should they tell doctors and patients what to do, or just offer advice?

The whole shebang.

The lede:

Orlando, Fla. — Physicians who refer patients for services at facilities in which they have a financial interest should disclose the conflict to patients, according to ethical guidelines on physician self-referral adopted at the AMA Interim Meeting in November.

The new ethics policy goes beyond restrictions laid out in federal anti-kickback laws and regulations, and declares that physicians must put patients first when making referrals. In addition to disclosing self-referrals, doctors should assure patients that their ongoing care is not in jeopardy if they decide to refuse recommended referrals.

The whole shebang.

The lede:

Orlando, Fla. — A Joint Commission standard on disruptive behavior could lead to “arbitrary and capricious enforcement” against physicians, the AMA House of Delegates warned.

Delegates at the Interim Meeting directed the AMA to seek a one-year moratorium on the new standard, slated to take effect Jan. 1, 2009, to allow organized medical staffs time to change their bylaws to comply with the rule. The house also adopted policy advocating that medical staffs develop their own conduct codes and investigation and appeals procedures.

Delegates directed the AMA to update its 2000 policy on disruptive behavior and work with the commission, the Federation of State Medical Boards and other entities to develop an appeals process for physicians charged with bad behavior. The AMA also will work with these groups to “develop a definition of disruptive behavior by a physician to include the actions that would rise to the level of true abusive behavior.”

The whole shebang.

The lede:

Fourteen years after a slight majority of Oregon voters made their state the first to allow physician-assisted suicide, a Washington ballot initiative nearly identical to Oregon’s law was approved with 58% of the vote.

“It was a resounding win,” said Peg Sandeen, executive director of the Portland-based Death With Dignity National Center, whose political action committee raised more than $615,000 for the ballot fight. “That’s a trouncing any sort of politician would be glad to win anyplace.”

The group’s board plans to meet in November and December to analyze which state to target next.

“We really believe this is a people’s movement,” Sandeen said. “The legislatures are still afraid” of physician-assisted suicide. She predicted it will take two to three years to mount another state ballot drive. Planning for Washington’s physician-assisted suicide ballot measure, Initiative 1000, began in 2005.

The whole shebang.

The lede:

Three of the country’s top-10-selling drugmakers have pledged to publicly disclose their financial relationships with physicians. The move comes ahead of bipartisan congressional legislation, the Physician Payments Sunshine Act, that would mandate such reporting. The bill is widely expected to pass in some form next year.

Eli Lilly and Co. in September said by the second half of 2009 it would report payments to its physician speakers and advisers. By 2011, the Indianapolis-based drugmaker would publicly report all physician compensation that exceeds $500 a year, including food, entertainment, gifts, travel and continuing medical education, as specified in the Sunshine Act.

“Physicians perform some extremely valuable services for not only Lilly but for the entire pharmaceutical industry, and you hate to have that relationship diminished by questions of possible distrust about that relationship,” said Eli Lilly spokesman Ed Sagebiel.

The whole shebang.

The lede:

A new California law requires physicians and health care organizations to provide terminally ill patients with “comprehensive information and counseling” about their legal end-of-life care options upon request.

The measure — known as the Terminal Patients’ Right to Know End-of-Life Options Act — says such patients have a right to be told about hospice care and advance directives, and their right to refuse life-sustaining treatment and to continue treatment while receiving palliative care. Patients also must be informed of their “right to comprehensive pain and symptom management at the end of life,” including “clinical treatments useful when a patient is actively dying.”

The law, which backers said is the first of its kind nationally, was supported by the California Medical Assn. after it was substantially changed. Gov. Arnold Schwarzenegger signed the bill Sept. 30; the law takes effect Jan. 1, 2009.

The whole shebang.

The lede:

The proportion of hospitals with palliative care programs has more than doubled since 2000 to 53% of all facilities with more than 50 beds, according to a study in the October Journal of Palliative Medicine.

But the prevalence of hospital-based palliative care varies widely by state, and about 310,000 seriously ill patients a year lack access to such specialized care, said R. Sean Morrison, MD, co-author of the study and an accompanying state-by-state report card.

The whole shebang.