Patient Rights and Healthcare Decision Making after COVID-19: Transformations & Future Directions
Guest speaker Thaddeus Mason Pope discussed how COVID-19 has spurred a renewed focus on protecting patient rights and tackling bigger perennial issues at the intersection of technology and healthcare decision-making. He argued that technological innovation in healthcare communication and decision making is a conspicuous silver lining of the COVID-19 pandemic. Professor Pope considered how COVID-19 has altered the way in which clinicians communicate with patients and how patients make and record healthcare decisions. As a result of many COVID-19 patients losing decision-making capacity, there is a renewed interest in advance care planning. To accommodate this demand and facilitate legal formalities during a time of social distancing, many jurisdictions now permit remote witnessing and remote notarisation. Growing numbers of individuals are supplementing these written documents with video instructions. Beyond advance directives, clinicians are using visually sophisticated decision aids to assure that patients understand the risks, benefits, and alternatives to proposed treatment. Professor Pope questioned whether lawmakers would permit these changes to persist after the pandemic. However, he ultimately concluded that technological tools help increase value-concordant care. “They help assure that patients get the treatment they want and avoid the treatment they do not want. But we need legal reform to guarantee implementation of these innovations after the pandemic ends” Video - https://www.youtube.com/watch?v=qJctSfjtpk4&feature=emb_logo
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Patient Rights and Healthcare Decision Making after COVID-19: Transformations & Future Directions
- 1. Patient Rights and Healthcare Decision Making after COVID-19 Transformations & Future Directions Thaddeus Mason Pope, JD, PhD, HEC-C QUT Global Law, Science and Technology Seminar Series (November 20, 2020)
- 2. Thank you
- 5. • Delight QUT logo
- 6. Introduction
- 11. “We are at war”
- 17. Conveys sense of urgency Turns an issue into the issue
- 21. In what ways has COVID-19 changed how clinicians communicate with patients?
- 22. Ways it changed how patients make & record healthcare decisions?
- 23. Will these changes persist after the pandemic
- 24. Roadmap
- 28. ACP PDA
- 30. World War II
- 37. Penicillin
- 38. • Pait with still today quantas
- 40. • Pait with still today quantas
- 41. • Microwave • Duck tape cavity magnetron
- 44. Bletchley Park
- 45. world’s first programmable digital electronic computer
- 51. “necessity is the mother of invention”
- 53. WWII innovations still used today
- 54. COVID-19
- 55. Same true?
- 61. Telehealth
- 63. • Pic on growth what it is • Not just temporary
- 66. Telehealth
- 72. 1. Get treatment that do not want 2. Don’t get treatment that do want or
- 74. Happens to patients with decision- making capacity
- 76. Cannot tell us what they want and do not want
- 78. Key tool to mitigate value discordant treatment for incapacitated patients
- 82. Before COVID-19
- 88. 99497 99498
- 89. Systematic review of 150 studies 800,000 people
- 97. “Don’t forget, you’re going to die.”
- 100. Media death
- 102. Since COVID-19
- 115. 1000%
- 117. Not just more ADs
- 118. COVID specific
- 123. Innovation
- 127. Who can witness How can witness
- 130. “None of the following persons may act as a witness ... the patient’s health care provider …” Cal. Prob. Code 4674
- 131. ratinale
- 136. • VA flex
- 137. “remove … bar on … employees serving as witness … unnecessary burden to completion of advance directives”
- 138. Flexibility Not only who But also how
- 153. More flexible Who can witness How can witness
- 160. Temporary Permanent
- 162. th
- 163. Video AD
- 170. Validity Meaning
- 171. Validity
- 172. Someone claims patient lacked capacity to complete the AD
- 173. 2020
- 174. Arline Lester 91-yo
- 175. Kyle
- 176. Wants mother removed from life-sustaining treatment per her 1991 advance directive
- 178. Says mother executed a new advance directive on Nov. 13, 2019 and wants to live
- 179. Later in time ADs revoke earlier ADs
- 180. But … is the newer AD valid?
- 181. Did Arline have capacity to complete?
- 182. video helped
- 184. Sumner Redstone 92yo
- 186. September 3 AD names agent “companion”
- 187. Manuela Herzer
- 188. October 16 AD names new agent
- 190. No capacity to execute new AD
- 193. Validity requires not only capacity but also voluntariness
- 194. Someone claims patient coerced to sign AD
- 198. Meaning
- 199. What did the patient want?
- 200. Did she want it under these circumstances?
- 201. Will case J Patient Saf 2017;13: 51–
- 205. Temporary New normal
- 207. Patient clinician AD Video AD
- 208. Clinician patient
- 210. What are PDAs?
- 213. Before encounter
- 215. During encounter
- 216. • Pic of option grid
- 220. 220 Medical care
- 233. 233 Not only for medical care
- 234. 234 Where to live
- 237. Do PDAs work?
- 239. Robust evidence shows PDAs are highly effective
- 240. 130 RCTs
- 244. big benefits
- 245. Improved knowledge
- 246. More accurate expectations more accurate perception of risks
- 250. Less patient anxiety
- 251. 251 Great evidence
- 252. What’s the problem?
- 253. Few clinicians use PDAs
- 256. “More work has been done on SDM in the US than in any other country.”
- 258. “not incorporated in mainstream care”
- 259. Been trying tools Now covid shows New normal
- 261. Temporary Permanent
- 262. Conclusion
- 263. How has COVID-19 changed how patients make & record healthcare decisions?
- 264. Advance directives Allow clinician witness Allow remote witness Allow remote notary More videotaped
- 265. How has COVID-19 changed how clinicians communicate with patients?
- 266. More use of PDAs
- 268. Just as WWII innovations persisted after that war, we must assure these innovations persist after the pandemic
- 269. 269 Thaddeus Mason Pope, JD, PhD, HEC-C Mitchell Hamline School of Law 875 Summit Avenue Saint Paul, Minnesota 55105 T 651-695-7661 C 310-270-3618 E Thaddeus.Pope@mitchellhamline.edu W www.thaddeuspope.com B medicalfutility.blogspot.com