Longer looks: Difficult end-of-life care discussions; Mississippi's last abortion clinic; rural docs

Every week Shefali S. Kulkarni selects interesting reading from around the Web.

Boston Globe: End-Of-Life Care Rarely Discussed
Precious final days for many Massachusetts residents are still not spent the way they would have chosen -; at home with loved ones -; but in a hospital. And health-care providers do not routinely discuss end-of-life care preferences with patients, said Dr. Lachlan Forrow, director of ethics and palliative care programs at Beth Israel Deaconess Medical Center, and chair of the expert panel [two years ago]. ... [The panel]suggested Massachusetts launch a high-visibility public education campaign about the need for advance end-of-life care planning. It recommended training for caregivers, who often receive little guidance about discussing the sensitive issue with patients. ... The panel also suggested Medicaid be revamped to ensure that all low-income patients have insurance coverage for hospice care, and state websites post information about end-of-life services available at each hospital. Budget cuts have stalled progress on many of the panel's recommendations (Kay Lazar, 1/21).

American Medical News: Death Certificates Present Final Medical Complication
Death certificates are vital documents that serve as the primary source of information for families, insurance companies and authorities about a patient's cause of death. The information also helps policymakers set public health goals and research funding priorities. But signing a death certificate is not always a straightforward process. Physicians often face uncertainties about an individual's cause of death or how to answer the portions of certificates they are responsible for. Although the basic format has changed little in the last few decades, doctors face difficulties as some states attempt to convert from paper to electronic certificates (Carolyne Krupa, 1/21).

National Review: Treat The 1 Percent: Our Mental-Health System Is Failing Those Most At Risk
Erika Menendez, the 31-year-old woman who is alleged to have pushed a man to his death beneath a subway train in New York City, represents everything that is wrong with America's system of treating the mentally ill. ... State mental-health officials declined to confirm that Menendez had been diagnosed with a psychiatric condition, invoking patient privacy. ... In truth, these invocations of patient privacy have little to do with the privacy of the patient -; federal law allows the release of information for issues of "serious threat to health and safety" and "public interest and benefit activities" -; and much to do with covering up the incompetence of the mental-health institutions (E. Fuller Torrey, 1/28).

Mother Jones: Inside Mississippi's Last Abortion Clinic
Jackson Women's Health Organization holds the dubious distinction of being Mississippi's only remaining abortion clinic. In 1981, there were 14, but thanks in part to increasingly repressive legislation, the others have closed. Last April, Republican Gov. Phil Bryant signed a new law requiring any doctor performing abortions in the state to have permission to admit patients at a local hospital. That's a problem for Jackson Women's Health, since neither of its two doctors-;both of whom fly into Mississippi to provide abortions-;has admitting privileges. ... The state requires abortion clinics to abide by many of the same building codes as hospitals, even though other medical offices don't have to follow these rules. ...The Center for Reproductive Rights has challenged the new law, and the state department of health has given the clinic until January to comply. If it fails, Michelle Movahed, an attorney at the center, worries that the closure could set off a domino effect, with more and more legislatures using red tape to close clinics-;in effect nullifying Roe v. Wade one state at a time (Kate Sheppard and Matt Eich, 1/22).

Los Angeles Times: Central Valley Physicians Dispense More Than Medical Care
Thirty years ago, Oscar (Sablan) and his wife, Marcia, made a plan: work in a rural area for three years and walk away without any medical school debt. So they moved from tropical Hawaii to dusty Firebaugh and started a practice in a trailer on the corner of O and 9th streets. They didn't intend to stay. They are still here, the only full-time doctors in town, treating many of the same families as when they arrived. ... But now Oscar is 61 and Maria is 65, and they realize they can't do this forever. ... But they're worried about what will happen to their patients. ... Much of inland California is made up of towns just like Firebaugh, where large swaths of the population are uninsured, where traveling to a hospital means a long drive, and where doctors and pharmacists are in short supply (Anna Gorman, 1/22).