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Showing posts with label Decision. Show all posts
Showing posts with label Decision. Show all posts
Thursday, July 4, 2013
Sunday, July 8, 2012
Boston Globe opinion piece on decision aids for dying patients on end-of-life care options
Angelo Volandes, MD, a physician at Massachusetts General Hospital, wrote an opinion piece published in the Boston Globe today. He tells the story of a patient dying of cancer, with whom he brought up the topic of end-of-life care options:
“For the next hour I introduced a vocabulary as foreign to her as spondee and trochee were to me. Life-prolonging treatment and CPR, ventilators and intubation, DNR and DNI — terms that she would need to learn quickly. Unfortunately, I was trying to teach her a new lexicon in the midst of the haze of nausea and hospitalization.
Dazed and confused, they looked at me blankly. Words often fail us in medicine. How could I explain these abstract ideas and treatments? Most patients think hospitals and medical interventions look like what they see on television where most survive CPR beautifully; the truth is most people with advanced incurable cancer do not do well with these interventions and often suffer at the end of life.
Finally, I tried a different approach. “Do you mind if we take a walk through the ICU?” I said.
If words failed me, perhaps seeing the intensive care unit would help. Seated in a wheelchair …Helen got a tour of the ICU, where she saw an intubated patient on a ventilator and a patient having a large intravenous line placed. Her decision-making would be informed by what she saw, instead of having to imagine what my terms really meant.
When we arrived back at her room, she looked at me and said, “Words, words, words. . . Angelo, I understood every word that you said — CPR and breathing machines, but I had no idea that is what you meant.”
I was reprimanded by the ICU staff for bringing Helen and her husband on that tour, but I was quickly forgiven. Evidently, many felt, like me, that patients deserve to be educated in order to make informed decisions about end-of-life choices.”
That was years ago when he was a medical resident.
Today, he goes on to explain, he and others use video decision aids to help people think about care options.
Boston Globe opinion piece on decision aids for dying patients on end-of-life care options
Angelo Volandes, MD, a physician at Massachusetts General Hospital, wrote an opinion piece published in the Boston Globe today. He tells the story of a patient dying of cancer, with whom he brought up the topic of end-of-life care options:
“For the next hour I introduced a vocabulary as foreign to her as spondee and trochee were to me. Life-prolonging treatment and CPR, ventilators and intubation, DNR and DNI — terms that she would need to learn quickly. Unfortunately, I was trying to teach her a new lexicon in the midst of the haze of nausea and hospitalization.
Dazed and confused, they looked at me blankly. Words often fail us in medicine. How could I explain these abstract ideas and treatments? Most patients think hospitals and medical interventions look like what they see on television where most survive CPR beautifully; the truth is most people with advanced incurable cancer do not do well with these interventions and often suffer at the end of life.
Finally, I tried a different approach. “Do you mind if we take a walk through the ICU?” I said.
If words failed me, perhaps seeing the intensive care unit would help. Seated in a wheelchair …Helen got a tour of the ICU, where she saw an intubated patient on a ventilator and a patient having a large intravenous line placed. Her decision-making would be informed by what she saw, instead of having to imagine what my terms really meant.
When we arrived back at her room, she looked at me and said, “Words, words, words. . . Angelo, I understood every word that you said — CPR and breathing machines, but I had no idea that is what you meant.”
I was reprimanded by the ICU staff for bringing Helen and her husband on that tour, but I was quickly forgiven. Evidently, many felt, like me, that patients deserve to be educated in order to make informed decisions about end-of-life choices.”
That was years ago when he was a medical resident.
Today, he goes on to explain, he and others use video decision aids to help people think about care options.
Thursday, July 5, 2012
Decision in Costner vs. Baldwin oil cleanup case
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In the New Orleans courtroom clash of Hollywood actors, Kevin Costner is the winner.
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In the New Orleans courtroom clash of Hollywood actors, Kevin Costner is the winner.
A federal jury this evening rejected a claim by the actor Stephen Baldwin and his friend, Spyridon Contogouris, that Costner and a business partner duped them by keeping them uninformed on a multimillion-dollar deal between Costner's company, Ocean Therapy Solutions, and the oil company BP.
Baldwin and Contogouris sold their shares in Ocean Therapy Solutions before it sold cleanup devices to BP for use in the 2010 Gulf of Mexico oil spill.
The pair's lawyer had asked the jury to award them $17 million in damages, according to The Associated Press. But after less than two hours of deliberations, the jury awarded Baldwin and Contogouris nothing.
Costner smiled and shook his attorney's hand after the verdict, later saying, according to AP, "My name means more to me than money and that's why we didn't settle."
Baldwin's attorney, James Cobb, said, "We're disappointed. We thought we proved rather convincingly that these two guys, Mr. Costner and [his business partner, Patrick] Smith, defrauded us. ... The jury saw it a different way but we respect the jury's verdict."
Baldwin, the youngest of the four acting Baldwin brothers, filed a suit in December 2010 against Costner and Smith, over profits from the technology that BP leased for the Deepwater Horizon spill.
Costner's device is a five-ton centrifuge designed to separate water from oil, spit out clean water and save the oil on ships, Smith said in his testimony.
The timeline of the case goes as far back as the production for Costner's film "Waterworld." Costner starred and co-directed the science-fiction film, which tanked at the box office when it was released in 1995.
In the early 1990s, Costner financed and oversaw the development of an oil-and-water-separation technology under the auspices of a corporation owned and managed by him called CINC Inc., an acronym for Costner in Nevada Corporation.
After the April 2010 oil spill, Costner made headlines again marketing his device and snagging a $52 million deal with BP for 32 of his centrifuges.
"It separates oil and water at incredibly high speeds under very difficult conditions," Costner told "Good Morning America's" Sam Champion in 2010.
The devices weren't used to cap the well but were designed to collect oil on the water's surface.
Baldwin has said he was bought out of Costner's company for $500,000 while Contogouris was bought out for $1.4 million.
BP reportedly never used the 32 devices it ordered from Costner's company, according to the U.S. Coast Guard. By September 2010, the well had been sealed with cement and a relief well.
Costner's memorable work includes starring in "The Bodyguard," "Dancing with Wolves" and "Field of Dreams." Baldwin, the younger brother of actor Alec Baldwin, is best known for "Bio-Dome" and playing Barney Rubble in "The Flintstones in Viva Rock Vegas."
The Associated Press and ABC News' Barbara Garcia, Matt Gutman and Sheila Marikar contributed to this report.
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