Voluntary Euthanasia — Implications for Organ Donation

Ball, Ian; Sibbald, Robert; Truog, Robert D.

doi:10.1056/nejmp1804276

Cited by 26 publications

(57 citation statements)

References 4 publications

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“…This quality improvement initiative evaluated which ACE admissions yielded the greatest value and found the largest reductions in LOS and cost in patients with the greatest comorbidity scores (frequently referred to as "high need, high cost"). 23,24 Based on prior literature, we had anticipated that moderate risk patients would show the maximum benefit. 15,25 In contrast to our findings, a University of Alabama (UAB) ACE program subgroup analysis using the CMS Case Mix Index (CMI) found a cost reduction for patients with low or intermediate CMI scores but not for those with high scores.…”

Section: Discussionmentioning

confidence: 99%

An Acute Care for Elders Quality Improvement Program for Complex, High‐Cost Patients Yields Savings for the System

Brennan

Knee

Leahy

et al. 2019

Journal of Hospital Medicine

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BACKGROUND: Acute Care for Elders (ACE) programs improve outcomes for older adults; however, little is known about whether impact varies with comorbidity severity. OBJECTIVE: To describe differences in hospital-level outcomes between ACE and routine care across various levels of comorbidity burden. DESIGN: Cross-sectional quality improvement study. SETTING: A 716-bed teaching hospital. PARTICIPANTS: Medical inpatients aged ≥70 years hospitalized between September 2014 and August 2017. INTERVENTION: ACE care, including interprofessional rounds, geriatric syndromes screening, and care protocols, in an environment prepared for elders MEASUREMENTS: Total cost, length of stay (LOS), and 30-day readmissions. We calculated median differences for cost and LOS between ACE and usual care and explored variations across the distribution of outcomes at the 25th, 50th, 75th and 90th percentiles. Results were also stratified across quartiles of the combined comorbidity score. RESULTS: A total of 1,429 ACE and 10,159 non-ACE patients were included in this study. The mean age was 81 years, 57% were female, and 81% were white. ACE patients had lower costs associated with care ranging from $171 at the 25th percentile to $3,687 at the 90th percentile, as well as lower LOS ranging from 0 days at the 25th percentile to 1.9 days at the 90th percentile. After stratifying by comorbidity score, the greatest differences in outcomes were among those with higher scores. There was no difference in 30-day readmission between the groups. CONCLUSION: The greatest reductions in cost and LOS were in patients with greater comorbidity scores. Risk stratification may help hospitals prioritize admissions to ACE units to maximize the impact of the more intensive intervention.

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Section: Discussionmentioning

confidence: 99%

An Acute Care for Elders Quality Improvement Program for Complex, High‐Cost Patients Yields Savings for the System

Brennan

Knee

Leahy

et al. 2019

Journal of Hospital Medicine

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“…This is why three North American healthcare professionals have argued recently that it might be ethically preferable to ignore the dead-donor rule if patients want to die by euthanasia and to donate their organs. In a paper published in the New England Journal of Medicine, the authors propose that allowing consent to "death by donation" can give these people a "why to die" and thereby give them a sense of meaning about their deaths (Ball, Sibbald, and Truog 2018). This proposed justification inverts German philosopher Frederic Nietzsche's famous statement, "If a man has a 'why' to live, he can get by with almost any 'how,'" to "If a man has a 'why' to die, he can get by with almost any 'how.'"…”

Section: What Issues Does Death By Donation Raise?mentioning

confidence: 99%

Does It Matter How We Die? Ethical and Legal Issues Raised by Combining Euthanasia and Organ Transplantation

Somerville

2019

Linacre Q

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If, in jurisdictions with legalized euthanasia, obtaining organs for transplant from euthanized people is allowed, must their organs be taken only after death or should euthanasia be allowed to be performed by removal of vital organs? Asked another way, if “Donation after Death” is practiced, why not “Death by Donation?” The article addresses two questions. First, “What issues does connecting euthanasia and organ donation raise?” They include dealing with uncertainty regarding the definition of death, defining what constitutes conscientiously objecting healthcare professionals' involvement in euthanasia, and whether connecting euthanasia and transplantation makes conflicts of interest for healthcare professionals unavoidable. Additional issues raised by death by donation include breach of the “dead-donor rule”; what would constitute informed consent to it; and what impact its acceptance would have on important foundational societal values, especially respect for human dignity and human life. The second question is “Why might some people who agree with euthanasia and even organ donation after death by euthanasia find death by donation ethically unacceptable?” Considerations again include its harmful impact on upholding respect for human dignity and human life and that the “wisdom of repugnance” could be informing these people's reaction. It is concluded that in order to avoid serious breaches of ethics, organ transplantation and euthanasia should not be linked in any way.

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“…Recently, the New England Journal of Medicine (NEJM) published an article [12] by two Canadian physicians and an ethicist from Harvard Medical School, who contended it might be ethically preferable [13] to ignore the dead donor rule if patients declare they want to die in order to donate their organs. While literally "giving yourself " to others might seem commendable at first glance, let's discuss three downstream considerations to abandoning the dead donor rule.…”

Section: Unintended Unavoidable Consequencesmentioning

confidence: 99%

Death by organ donation: euthanizing patients for their organs gains frightening traction

Ely

2019

Intensive Care Med

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Voluntary Euthanasia — Implications for Organ Donation

Cited by 26 publications

References 4 publications

An Acute Care for Elders Quality Improvement Program for Complex, High‐Cost Patients Yields Savings for the System

An Acute Care for Elders Quality Improvement Program for Complex, High‐Cost Patients Yields Savings for the System

Does It Matter How We Die? Ethical and Legal Issues Raised by Combining Euthanasia and Organ Transplantation

Death by organ donation: euthanizing patients for their organs gains frightening traction

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