Medical Futility Blog

Legal Update 2026: Top 10 Legal Developments in Bioethics & Public Health

2026-05-24T02:30:00.000-05:00

Join us in Indianapolis from October 14-17, 2026, at ASBH - the biggest bioethics meeting in the United States.

We continue our decade-plus popular series Legal Update 2026: Top 10 Legal Developments in Bioethics and Public Health. Plus, we will again add an extra session after the panel for extended discussion.

Hemlock Society of San Diego - Choice, Dignity, Control at End of Life

2026-05-23T15:29:50.466-05:00

It was a pleasure to engage with members of the Hemlock Society of San Diego this week. And I was extra lucky to get some face time with Faye Girsh who remains an important and eloquent right to die advocate nearly after 40 years.

The HSSD give a platform to voices and perspectives on end-of-life healthcare that are often not seen or heard in other venues.

Medical Aid in Dying: Evolution and Future of the California End of Life Option Act

2026-05-22T08:41:10.215-05:00

I posted my 600 slides here for today's UCSD Faye Girsh Endowed Lecture on Medical Aid in Dying. This is the Zoom link. There is a separate registration for IRL at UCSD.

Great Ormond Street Hospital Textbook of Paediatric Bioethics and Law

2026-05-22T02:30:00.000-05:00

Oxford University Press has just published Great Ormond Street Hospital Textbook of Paediatric Bioethics and Law.

Thus is the first definitive reference to be produced by a world-leading children's hospital on the medical ethics and law applying to the care of children in a 21st century healthcare environment, exploring the challenges that children, their families, and those looking after them must face.

Healthcare professionals involved in the care of children are faced with controversies about decision-making, including genomics, personalized medicine, gene therapy, transplants, and the transfer of life-sustaining treatments from the ICU to the home. In addition, although patient safety and transparency are improving, recurrent high-profile worldwide institutional and individual failures have led to the need for mechanisms of external accountability and assessment. Open deliberation about the ethical issues increasingly faced in pediatrics and child health, backed by knowledge of the relevant law and considered together with children and their families, is the best solution for all these concerns.

This textbook enables better dialogue about the hard decisions made on a daily basis, considers how new and innovative treatments can be used in an ethical and lawful manner, and discusses when life sustaining therapy should be stopped, not started, or have limits set.

Here is the TOC

Respect or Protect Children and Young People? Healthcare Law in England and Wales, Richard Huxtable
Paediatric Bioethics: Philosophical Foundations, Dave Archard
Decisions to limit treatment in children, Vic Larcher and Joe Brierley
Religion and Medical Ethics, Rev James Linthicum
Innovative therapy in child health, Joe Brierley
Consent and Capacity, Flora Jago
Psychological distress in staff in relation to difficult treatment decisions, Gillian Colville
Moral Distress; what is it & why do we need to take it seriously?, Anne MacNiven
Parents’ participation, Stephanie Nimmo
Ethical Issues in Paediatric Donation & Transplant, David Shaw and Joe Brierley
Key Ethical Issues in Paediatric Anaesthesia, Hugo Wellesley
Key Ethical issues in Paediatric Surgery, Simon Blackburn Robert Wheeler
Key Ethical issues in Paediatric Radiology, Marina Easty and Riwa Meshaka
Key Ethical Issues in Paediatric Nephrology, Stephen Marks
Key Ethical Issues in Paediatric Oncology, Darren Hargrave and Dr Elwira Szychot
Key Ethical Issues in Paediatric Respiratory LTV, NIV, Samiran Ray and Elaine Chan with Colin Wallis (reviewer)
Ethical issues in the management of children with disorders of consciousness (DOC), Sarah Aylett
The Psychosocial contribution to Bioethics in contemporary paediatrics, Phil Marsden & Kirsty Abbas
The Ethical Issues of Genetic Testing in Children, Helen O'Neill
Legal and Ethical Aspects of Child Maltreatment, Alison Steele
Teaching Ethics to the Children’s Hospital’: Principles and Theories of an Ethics Education, Sara Warriach and Simon Blackburn
The Ethics of Surgery in 2025, Paolo De Coppi and Simon Blackburn
The Ethics of Research with Children, Bobbie Farsides and Katherine Wright
Law and Ethics in Paediatric Mental Health, Camilla Parker, Simon Wilkinson and Susan Walker
Televising Paediatric Healthcare, Eleanor Updale
Ethics in the Neonatal Period, Simon Hannam and Zoe Smith
Extracorporeal treatment/Bridging to transplant, Samantha Potter and Timothy Thiruchelvam
Ethics & law in Paediatric Palliative care, Finella Craig, Sophie Bertaud, and Richard Hain
Teenage decision making and the law in England and Wales, Emma Cave
Controversies in Immunisation, Helen Bedford and David Elliman
Conflicts in child health, Victoria Butler-Cole
Gender dysphoria and puberty suppression, Vic Larcher and Joe Brierley
Advocacy for children, Ingrid Wolfe, Raeena Hirve, Rose-Marie Satherley, Sapfo Lignou
Ethical considerations when caring for migrant children, Sarah Boutros, Bryony Hopkinshaw, and Jonathan Broad and Sunanda Bhatia
GPs and the familial duty of care, Mary Lowth
Ethics of the next pandemic, Sam Ray and Joe Brierley
Judging child health law, Fiona Paterson
Second Medical Opinions; use of the Internet and Social Media, Vic Larcher and Joe Brierley
Conclusion, Joe Brierley and Hebe Weir

Peaches Pope (2010 - 2026)

2026-05-21T13:03:33.810-05:00

I blogged about Milo in February 2025. Unfortunately, now just over a year later, we lost Peaches.

Born July 2, 2010, Peaches died this morning, Thursday, May 21, 2026. This is especially difficult because I am in San Diego and unable to engage in traditional grief ceremonies.

I speak and write about critical illness and death all the time. But this still hits hard. Peaches greeted me every morning and every time I came home. And we ended each day with extended head, cheek, and throat petting.

After a battery of tests, the veterinarians put Peaches on hospice in March. So, this was not unexpected. And I am so pleased to have had the last 2 months with Peaches. Knowing that time was limited, we spoiled him extra, buying more food flavors and more toys.

But for the appetite stimulant Mirazapine, we likely would have lost Peaches much earlier. We had grown accustomed to the daily and then every-other-day ritual of rubbing this cream on the inside of his ear.

We were a little conflicted about "forcing" him to eat when his body and mind told him "no." But Peaches still enjoyed all his activities: (a) sitting in the sun, (b) scratch pad, (c) petting, (d) eating, (e) treats, and (f) toys. And he was social. He constantly stayed and came near us and did not retreat and hide until the last 24 hours.

I will miss you Peaches. You had a complete cat life for an Orange Tabby. I hope I was as good a pet parent as I tried and wanted to be.

Advance Directives Work - New Evidence

2026-05-20T08:01:00.000-05:00

Most Americans do not have an advance directive. And most of those advance directives are not available when the patient is admitted and incapacitated. Sadly only a small subset of patients satisfy both these conditions: (1) advance directive completed and (2) advance directive available. But those patients benefit in terms of achieving value congruent care.

A new study in JAGS shows that patients aged ≥ 65 years with EHR-documented advance directives ≥ 6 months before death were less likely to receive potentially burdensome end-of-life (EOL) care within the last 6 months of life (19.9% vs. 26.8%) and less likely to die in the hospital (23.2% vs. 32.1%) compared with those without an EHR-documented AD.

Defending MAID Against Baseless Attacks

2026-05-19T18:09:27.523-05:00

In today's National Post, I respond to charges that MAID is being or might be used to curb elder and health care costs.

“Anything can be abused.”
“And everything is abused.”
“But it’s ridiculous to say any service that you provide would ever be provided at a hundred per cent perfect level. Nothing is.”
“It’s pretty darn safe,” Pope said, noting that there’s “absolutely zero evidence” of MAID being foisted upon people to trim costs.
“The problem is not that we’re hastening people into death to save money; the problem is that we are foisting more and more and more treatment upon people because it benefits the health-care providers, even though it doesn’t benefit the patients."
“The far bigger risk is not letting people die.”

Massive Variability in MAID / VAD Usage

2026-05-19T00:30:00.000-05:00

We know that MAID usage varies from jurisdiction to jurisdiction. It is rarely used in Italy, Germany, and Austria. It is far more commonly used in Canada and the Netherlands. But MAID usage also varies within countries.

For example, usage is significantly higher in British Columbia (5%) and Quebec (7%) than in other Canadian provinces (<4%). In the United States, usage in New Mexico is ten times what it is in New Jersey and Washington, DC. And as this recent Go Gentle 2026 State of VAD Report shows, usage is more than three times higher in Queensland than Victoria.

Dementia VSED Advance Directives - Authorization in State Legislatures

2026-05-18T00:30:00.000-05:00

I have been defending and drafting dementia VSED advance directives. In March 2026, the New Jersey Assembly introduced a bill to authorize these directives. Now, an identical bill has been filed in the Senate.

The Dementia Dignity and Advance Care Planning Act would permit "any competent adult diagnosed with Alzheimer’s disease or another neurodegenerative dementia shall be permitted to execute a Dementia-Specific Advance Directive" in which they can "specify the individual’s wishes regarding ... feeding preferences."

Senator Angela McKnight

Medical Aid in Dying in the United States - 30th Anniversary of Pinnacle

2026-05-17T00:30:00.000-05:00

The legal pinnacle of medical aid in dying in the United States was 30 years ago this spring.

In April and May, 1996, more than a dozen federal appellate judges issued judgments holding that Washington and New York laws criminalizing assisted suicide violated the U.S. Constitution.

In June 1997, the U.S. Supreme Court reversed both Courts of Appeals for the Second and Ninth Circuits. But between mid-1996 and mid-1997, it seemed that medical aid in dying might be treated like contraception and abortion and afforded federal constitutional protection.

Medical Aid in Dying - Upcoming Professor Pope Presentations

2026-05-16T06:58:38.509-05:00

After returning from the giant bolus of engagement on medical aid in dying (MAID) at ICEL5 last month, I have three domestic presentations on MAID in Hawaii, California, and Colorado. The Hawaii End of Life Options webinar just passed. But please join me for these two below.

Faye Girsh Endowed Lecture on Medical Aid in Dying at UC San Diego

TITLE: Medical Aid in Dying: Evolution and Future of the California End of Life Option Act
WHEN: Friday, May 22, 2025 at noon
WHERE: UC San Diego Moores Cancer Center Goldberg Auditorium - or - Zoom
REGISTER: Click here

End of Life Options Colorado 2nd Annual Conference: Empowering End of Life Care: Medical Aid in Dying

TITLE: Legal and Ethical Issues: Current Practice & A View to the Future
ALSO: Check out 17 other sessions by expert speakers
WHEN: Saturday & Sunday, June 6-7, 2026
WHERE: Table Mountain - Golden, Colorado
REGISTER: Click here

Oklahoma Enacts Uniform Health Care Decisions Act

2026-05-15T06:30:17.968-05:00

Legislation modernizing Oklahoma’s laws surrounding advance health care directives and medical decision-making to give patients more control over their care has been signed into law. House Bill 1687 creates the Uniform Health Care Decisions Act of 2025.

The measure updates state law related to health care decision-making, advance directives and surrogate decision-making for individuals who may lose the ability to communicate or make medical decisions for themselves.

Among other amendments, the law clarifies that food and liquids necessary to sustain life may not be withheld unless specifically directed by the patient in their advance directive. It also provides legal protections for health care professionals and institutions acting in good faith under the provisions of the measure,

Like all versions of the UHCDA, the Oklahoma statute permits clinicians and hospitals to refuse compliance with treatment requests. But unlike Delaware and Utah adoptions which have a time-defined transfer periods, Oklahoma has a treat 'til transfer requirement. And Oklahoma limits its UHCDA to comply with its Nondiscrimination in Treatment Act.

MAID in Italy - Difficult but Possible

2026-05-14T07:17:03.402-05:00

Some countries, like Spain, have broad eligibility for MAID but require an onerous and lengthy application process. Others, like the USA, have narrow eligibility for MAID but a more streamlined application process. Then there is Italy.

Italy has the worst of both worlds. Few Italian patients qualify for MAID. And it is difficult and complicated to get approved. The Luca Coscione Association has just reported the latest case of MAID in Italy.

Mariasole, a 63-year-old Tuscan woman suffering from a severe form of degenerative Parkinson's disease, died at her home on May 4th after self-administering the lethal drug provided, along with the equipment, by the Regional Health Service. To obtain respect for her wishes, Mariasole had to undertake a lengthy legal process, which began with the initial request to the Local Health Authority in July 2025 and lasted nine months.

Court Approves "Ceiling of Care" that Excludes "Coercive Feeding"

2026-05-13T07:14:11.076-05:00

The Irish Health Service Executive recently obtained a High Court declaration that they can refrain from "coercive feeding" for P.J., an incapacitated seventy-eight-year-old man.

This is not a case about withholding life-sustaining treatment. Rather, clinicians want to refrain from instituting "invasive and coercive interventions which they regard, in good faith and in accordance with professional ethics, as futile, harmful, and disproportionate." Still, this will likely result in P.J.'s "premature death."

While P.J. lacks capacity, the court looked to a prior document recording P.J.'s wishes. While that document is not a valid advance directive, it remains a "clear statement of the [his] will and preference."

The court ruled that it is lawful for P.J.'s treating clinicians to apply a "ceiling of care" that excludes "coercive feeding, coercive medical treatment, and cardiopulmonary resuscitation."

Judge Emily Egan

French Senate Rejects MAID - But Legislation May Continue

2026-05-12T19:53:58.279-05:00

On Monday, French Senators voted against the right to MAID after a long afternoon of debate (video). Caught between a left wing denouncing the text as too restrictive and a right wing hostile to any legislative change, the compromise proposed by the two rapporteurs failed to gain traction. The continuation of the second reading of the bill on end-of-life care now appears to be in jeopardy.

R.I. Legislative Hearing on MAID Legislation (video)

2026-05-11T00:30:00.000-05:00

While many state legislatures have already closed their 2026 sessions, Rhode Island recently held a hearing on H.B. 7760, the Lila Manfield Sapinsley Compassionate Care Act.

The video is available here. Many of the points and arguments are the same as in >1000 hours of other legislative testimony. But some has been updated to include more recent data and cases.

Virginia Abolishes Crime of Suicide

2026-05-10T00:30:00.000-05:00

Almost all U.S. jurisdictions repealed statutes criminalizing suicide many decades ago. But suicide remained a common law crime in Virginia until recent legislation repealed it effective July 1, 2027.

Of course, like every other state, Virginia still prohibits assisted suicide. "Any person who knowingly and intentionally, with the purpose of assisting another person to commit or attempt to commit suicide, (i) provides the physical means by which another person commits or attempts to commit suicide or (ii) participates in a physical act by which another person commits or attempts to commit suicide shall be liable for damages as provided in this section and may be enjoined from such acts."

VSED Dementia Advance Directives - More Options Available

2026-05-09T00:30:00.000-05:00

I have been presenting and publishing on dementia VSED advance directives. And the message is being received. More individuals are completing these directives. And more are being developed. I updated a list here.

VADSA's directive asks for MAID/VAD - just in case non-contemporaneous requests become a legal option in Australia. In the meantime, the patient directs VSED.

"In the absence of the legal choice of voluntary assisted dying, when at least …….. (specify number) of the following conditions are observed on a recurring basis by personal carers, family, and medical staff, I direct that I have no further medical treatments and no assistance with feeding or hydration."

I am no longer able to recognise my closest family/friends
I have become bowel and/or bladder incontinent
I cannot maintain personal physical cleanliness on my own
I am unable to dress myself without assistance
I am unable to feed myself and require spoon feeding or artificial feeding
I have become wheelchair-bound or bed-ridden and unsafe if I stand up
I am unable to communicate my emotions to loved ones/carers
I become angry, aggressive and/or fearful for no rational reason
I behave in embarrassing or degrading ways alien to my competent personality, such as shouting, threatening or exhibiting other unacceptable behaviors.

The directive then reiterates: "If I am no longer able to feed myself I do not wish to be fed by spoon, through a nasogastric tube or a gastrostomy tube. I wish to be kept comfortable, with high level palliative care and careful management of symptoms such as a dry mouth and eyes."

The directive also specifies what to do if the individual later "appears content or happy" or "shows resistance" to VSED.

Uniform Health Care Decisions Act - 3rd State Adoption

2026-05-08T00:30:00.000-05:00

It looks like Oklahoma will become the third state to adopt the new Uniform Health Care Decisions Act. Both chambers of the legislature passed H.B. 1687, and have sent it to Governor Kevin Stitt.

Delaware and Utah have already adopted the new UHCDA. Hawaii, Nebraska, Nevada, and Virginia have also seriously considered adoption.

Oklahoma Governor Stitt

MAID Misinformation - Response Tools

2026-05-07T19:59:48.410-05:00

A new website is specifically devoted to combatting MAID misinformation.

MAID is one of the most discussed — and misunderstood — areas of healthcare in Canada. Patients, families, healthcare professionals, and the public often encounter claims that are incomplete, misleading, or false.

This resource offers clear, accurate information about MAID and practical support for responding to misinformation. Whether you are answering questions, preparing for a conversation, or trying to understand something you have seen or heard, it can help you find reliable corrections to common MAID misinformation.

The Choice - Film on MAID

2026-05-07T19:35:58.753-05:00

This brief film offers some compelling perspectives on MAID from family member caregivers and from Dr. Sandy Buchman.

Through intimate stories, we witness the early days after a loved one expresses the desire to pass—the uncertainty of what was meant, the need to ask the question out loud, and the weight of hearing the answer. For many, this moment marks a turning point, where caregiving shifts from recovery and comfort to coming to terms with a decision they didn’t make.

As families begin to navigate MAID, caregivers grapple with anticipatory grief, balancing their own emotions with the responsibility of supporting someone they love. Some hold onto hope for more time, while others begin to accept the reality of what lies ahead.

Grounded in lived experience, the episode offers an intimate look at how caregiving transforms in the face of MAID, and the difficult act of letting go.

Care for Unrepresented Patients at End of Life (podcast)

2026-05-07T00:30:00.000-05:00

Providence St. Joseph Health has published a podcast series addressing prevalent issues in clinical ethics. This one is on "Care for Unrepresented Patients at End of Life." This is one of my own top core issues.

Medical Aid in Dying: Evolution and Future of the California End of Life Option Act

2026-05-06T00:30:00.000-05:00

I'm delighted to deliver the third annual Faye Girsch Endowed Lecture in Medical Aid in Dying at UCSD on May 22, 2026.

My title is Medical Aid in Dying: Evolution and Future of the California End of Life Option Act. Register for IRL or Zoom here.

Are Dementia VSED Advance Directives Ethical, and Should Clinicians Honor Them?

2026-05-05T00:30:00.000-05:00

Here is a 20-minute video of my recent presentation to the American Geriatrics Society: Point-Counterpoint - Are Dementia VSED Advance Directives Ethical, and Should Clinicians Honor Them?

This video includes only my own presentation. It does not other elements from the session include Dr. Ursula Braun's overview, Dr. Farr Curlin's devastating objections to dementia VSED advance directives, or the session Q&A.

VSED Advance Directive - Court Allows Lawsuit for Noncompliance

2026-05-04T00:30:00.000-05:00

I recently collected more than 20 recent court cases in which clinicians and healthcare institutions were held liable for failing to follow a patient's advance directive or POLST. There is no similar track record for VSED dementia advance directives because they have become prevalent only recently.

But that may be changing. The British Columbia Supreme Court has permitted Francis Leslie Dwyer to proceed with his lawsuit alleging that a care home failed to comply with the wishes or his wife, Janice Dawn Dwyer. In 2015 she directed no feeding in advanced dementia. And when she reached that state in 2020, Mr. Dwyer directed a "palliative diet."