Health Care Decision Making

Preventing Overmedicalization During End-Of-Life Care


Preventing Overmedicalization During End-Of-Life Care

The Atlantic published an article in May 2013 by Jonathan Rauch entitled “How Not to Die,” which discussed the problem of over overmedicalization and proposed a solution using educational videos.


According to the article, patients routinely receive unwanted care, especially when the patient is nearing his or her end of life.  The physicians administering these unwanted treatments are not necessarily motivated by any malevolent intent, but are simply determined to save lives, whereas the patient, if fully informed, often focuses on the quality of his or her remaining time.  When physicians recommend treatment based on “highly inaccurate” assumptions of the patients’ goals, the result is unwanted treatment that many say is tantamount to abuse or even torture.


Medical professionals are supposed to hold “The Conversation” with their patients, which would include a meaningful explanation of the patient’s condition and treatment options, as well as a discussion about the patient’s goals and desired treatment.  Evidence indicates, however, that The Conversation happens infrequently, and, when it does take place, is often rushed and loaded with medical jargon, which the patients and families fail to fully comprehend.  Instead, Dr. Angelo Volandes found he could make a stronger, cleaner impression on his patients by showing them treatments, rather than simply trying to describe them.


With this in mind, Dr. Volandes began creating Advanced Care Planning Decisions videos.  There are videos on a range of topics, from CPR to advanced stage dementia, and each video is intended to educate and empower patients about their choices for medical care.  Each film is on average six minutes long, and is meant to be screened on iPads or laptops while in a clinic or hospital room.  The impact is apparent: In a 2009 study, more than 90% of patients chose comfort care after watching a video on cancer treatment, whereas only 22% did so after receiving only a verbal description of such treatment.


The videos are meant to provide clearer information and, more importantly, trigger The Conversation between the patient and medical professional.


These videos are inexpensive and low-tech, and might avert misunderstanding, prevent suffering, improve doctor-patient relationships, and incidentally, save the health-care system a lot of money.  Only a few dozen out of 5,700 hospitals are presently using the videos, though Dr. Volandes hopes their use becomes more prevalent, which he believes will revolutionize end-of-life care.


For more information, and to see a sample video on CPR, go to here.  The full article from The Atlantic may be found here.


Illinois And Civil Unions

Illinois And Civil Unions

Effective June 1, 2011, pursuant to P.A. 96-1513, Illinois will join several other states that permit registration of a civil union between two consenting adults of the same gender.   The law specifically states that a party to a civil union shall be included in any definition of the term “spouse”, “family”, “immediate family”, “dependent” and the like that denote a spousal relationship.    In addition, Illinois will recognize as civil unions similar relationships entered in other jurisdictions (other than common law marriage).  For example, some states recognize “same sex” marriage” or “domestic partnerships.”

From an estate planning perspective, partners in a civil union will receive the same protection as a spouse under the Illinois Probate Act, meaning that a partner will have priority to act as in matters related to intestate death administrations, the same rights as a surviving spouse to inherit intestate property and to claim against the will.

Tax issues will remain in flux.  The Illinois Civil Union Act stands in contrast to the 1996 federal Defense of Marriage Act.  For the time being, there will be continuing issues in connection with the different tax treatment afforded spouses at the federal level than will be available to partners in a civil union registered under Illinois law.

Proposed SB3613 creates “Presumed Consent” for Organ Donation

 Illinois Senator Dale Risinger has introduced a bill that would reverse the current approach to organ donation.  SB3613 would amend the Illinois Anatomical Gift Act to provide that each competent resident of Illinois over age 18 would be presumed, by operation of law… “to have given all of his or her body for any for organ donation purposes”… without the need for consent of any survivor.  Under current practices, an Illinois resident can exhibit his or her consent for organ donation a number of ways: (a) by joining the Illinois First-Person Consent Organ/Tissue Donor Registry ( or 1-800-210-2106) maintained by the Illinois Secretary of State, (b) by so indicating on a valid Illinois Durable Power of Attorney for Health Care form; (c) by otherwise affirmatively complying with the Illinois Anatomical Gift Act.  If the resident has not indicated his or her consent or disagreement regarding organ donation, organ donation could still occur with family consent.  Under the proposed bill, an individual would have to affirmatively opt out of the statutory presumed consent for organ donation.  SB 3613, if passed, would be effective on or after July 1, 2012.  To check on the bill’s status, go to