Surrogate Decision Making: Bernie Lo and Laurie Dornbrand
episode
GeriPal - A Geriatrics and Palliative Medicine Podcast
48 min
2 speakers
8 chapters
transcribed 9 hours ago
Transcript
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What is the historical significance of the Nancy Cruzan case for surrogate decision‑making?
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Welcome to the Jerry Pal podcast. This is Eric Quadero.
This is Alex
Smith. And Alex, who do we have with us today?
We are delighted, absolutely delighted to welcome a husband-wife team today. We are welcoming back Bernie Lowe, who's a general internist and bioethicist, and Professor Emeritus at UCSF, where he ran the program in medical ethics and is also past president of the Greenwald Foundation, which is a foundation dedicated to supporting bioethics research. And I was fortunate to have Bernie as my mentor in that program. Yeah. Bernie, we're delighted to welcome you back to the Jerry Pell podcast.
Great to be here.
And Lori Dornbrand, who's a geriatrician. She's a physician at Onlock at the IOA Center and the program for all inclusive care for the elderly, which is PACE, and has been there a long time. Estimates she's done thousands, maybe three plus thousands years of night call. Um and she's also a member of the Rides.
Right. Only feeled like years sometimes.
Three thousand nights. What did I say? Years. Yeah, three thousand nights. And it's also a member of the California Coalition for Compassionate Care. There's a lot of C's in that. Pulst Physicians Leadership Council. Lori, welcome to the Jerry Powell podcast.
Delighted to be here.
So we got a we got a lot to talk about today. This topic uh came up with uh Bernie uh published an article in New England Journal called Deciding for Patients Who Have Lost Decision Making Capacity, Finding Common Ground in Medical Ethics. We'll have a link to that article. But kind of stimulated this podcast where we're gonna talk a little bit about advanced directives, durable power attorney for healthcare, surrogate decision making, and the like. But before we do, we always have a song request. Who has the song request for Alex? Burning. Bernie.
I asked Alex to do Joni Mitchell's both sides now, uh particularly the last verse, uh, but I think it's all very relevant to trying to think of what you'd be like you'll be like in the future.
Mm. And Joni Mitchell's amazing story. Who she had a stroke, she had to relearn how to play the guitar. She's been performing recently. And this song is particularly poignant when she sings it, given her perspective.
Rows and flows of angel hair, and ice cream castles in the air. And feathered canyons everywhere. I've looked at clouds that way. But now they only block the sun. They rain and snow on every one, so many things I would have done. But clouds got in my way. I've looked at clouds from both sides now, From up and down, And still somehow It's cloud's illusions I recall. I really don't know clouds. Hello
That was lovely. Thank you. Very apropos of the subject at hand.
Very apropos. That's my Hawaiianized version and opening tuning 'cause I'm still playing with two fingers 'cause I'm recovering from broken hand, but Thank you for that choice, Bernie.
Thank you for playing it now. Bernie, I'm gonna take a big step back. Why are you interested in this as a subject? You write about this? You've written this New England Journal article, you've written past articles. I remember there was a archives article from or Annals, I forget it was probably called the Archives back then, Resuscitating Advanced Directives. What's the thing that makes you interested in this?
Cool. Decisions near the end of life. For people who can't make the decisions themselves. They're common. And they're really hard. And each case is a little different, each patient is different. But the rules that sort of shape How we make decisions, what's allowed, what's not allowed. Have really changed uh since when I started. shortly before the Cruise Anally to today, we've really gone a hundred eighty degrees on a lot of issues. And I think What strikes me is that Change is possible that Supreme Court rulings that are very unpopular. Don't always hold sway and can be overturned by research, by states acting, and by good clinical judgment. And we're going to do that.
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Chapters
8 chapters
1
What is the historical significance of the Nancy Cruzan case for surrogate decision‑making?
0:00–5:25
2
How have advance directive laws and practices changed since the Cruzan ruling?
5:25–11:02
3
Why are in‑the‑moment conversations now emphasized over paperwork?
11:02–17:34
4
What role should clinicians play in initiating serious‑illness conversations?
17:34–24:33
5
How useful is the POLST (Physician Orders for Life‑Sustaining Treatment) in practice?
24:33–30:46
6
Should the term “comfort measures” be retired and what does it really mean?
30:46–36:16
7
How can surrogates be better prepared for the emotional burden of decision‑making?
36:16–41:49
8
What future changes are expected in advance care planning documentation and law?
41:49–48:28
Speakers
2 identifiedMore from GeriPal - A Geriatrics and Palliative Medicine Podcast
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