Media Watch 541

Attached is the current issue of Media Watch (#541).

Of particular Interest:

Refusing treatment prior to becoming incapacitated: Supported decision-making as an approach in advance directives

EUROPEAN JOURNAL OF HEALTH LAW | Online – 21 November 2017 – While the normative logic behind advance directives (ADs) remain straightforward, as instruments of law they are not always effective because of questions about their validity and applicability. It is on this basis that this article attempts to resolve the legal intricacies on ADs refusing treatment prior to becoming incapacitated. The author advances a thesis in support of a modification of an approach known as supported decision-making to facilitate people in making ADs. This approach pre-empts most of the doubts about an ADs’ validity. The argument is founded on the presumption that an AD made using the supported decision-making approach provides a higher degree of assurance about the circumstances surrounding the making of ADs, rendering it more likely to be binding on healthcare professionals. 

Does research improve clinical care?

THE HIPPOCRATIC POST | Online – 28 November 2017 – We can think of the research process as a pipeline, that starts with the question of interest, and ends up with a change in clinical practice. A landmark paper published ... in 2014 showed that this pipeline is dramatically and inherently leaky.1 Of the billions invested each year in biomedical research, the authors estimated that a staggering 85% may be wasted: it never has a chance of improving patient care. These leaks occur at five main stages: 1) Because the wrong question is asked; 2) Because the wrong methods are used; 3) Through inefficient and burdensome regulation; 4) Through incomplete publication of research findings; and, 5) Because published research findings are not usable in practice. The importance of research in improving the quality of end-of-life-care we provide was recognised by Dame Cicely Saunders, the founder of the modern hospice movement, who pioneered research in the 1960s into the safety of opioids (such as morphine) for people close to death. The volume of research carried out in palliative care has increased since Cicely Saunders’ pioneering studies, but what do we know about its value? Let’s consider the first leak in the pipeline: what constitutes the wrong research question? Aren’t all research questions of value? The answer, sadly, is no. If a research question is asked, to which there is already a reliable answer, then repeating this study is of little benefit to patients. Similarly, if a research question is considered of little importance to patient and families, then resources would arguably be better spent elsewhere. And of course, asking low priority research questions means that high priority questions may be ignored. This was illustrated by the Neuberger Review into the Liverpool Care Pathway which showed the terrible consequences of national policies that are not backed up by appropriate evidence from research.2 

     1. ‘Reducing waste from incomplete or unusable reports of biomedical research,’ The Lancet, 2014; 383(9913):267-276. 

     2. ‘Review of Liverpool Care Pathway for Dying Patients,’ Department of Health, July 2013. [Noted in the 22 July 2013 issue of Media Watch (#315, p.6)]