AboutPaul D. Friedman, M.A., Ph.D., J.D. Expertise I have been a practicing civil trial attorney since 1989 dealing primarily with malpractice issues. I litigate very select medical malpractice cases on behalf of patients or their families. I am a Certified Civil Trial Specialist by the National Board of Trial Advocacy. I am also Certified in Injury and Wrongful Death by the Arizona State Bar Board of Legal Specialization.
In addition to my law degree, I received a Master of Arts in Bioethics and a Doctorate of Philosophy involving Medical Ethics. Because I am also an Adjunct Professor in Research and Medical Ethics at a medical school, I routinely consult with physicians and hospitals regarding medical ethics issues in an effort to improve patient care.
I can answer questions dealing with medical ethics principles. I can also respond to questions regarding potential malpractice issues.
Experience Experience in the area I have been a practicing trial attorney since 1989 and I have a masters degree in bioethics and a doctorate of philosophy regarding comparative ethics.
Organizations State Bar of Arizona
State Bar of Colorado (inactive)
District of Columbia Bar (inactive)
Federal Bar
Licensed in Arizona District Court
Licensed in Ninth Circuit Court of Appeals
licensed in the United States Supreme Court American Bar Association National Board of Trial Advocacy American Association for Justice Arizona Trial Lawyers Association American Society for Bioethics and Humanities Kennedy Institute of Ethics National Association of Realtors
Education/Credentials Bachelor of Arts 1985
Juris Doctorate 1989
Master of Arts in Bioethics 2004 Doctorate of Philosophy 2006
Awards and Honors Phi Beta Kappa
Multiple Who's Who
Publications A list of my copyrighted publications and presentations is contained at WWW.EXPERTETHICS.COM
Question QUESTION: My father was diagnosed with stage 4 pancreatic cancer 2 wks ago. His oncologist suggested non palliative chemo which may buy him a couple more months and will assist in pain reduction. My dads first treatment was this week. We called hospice and explained that my dad has 2 to 4 months to live, and if the chemo helps then a few more months. They said we should sign up with hospice sooner vs later, not only will they help my dad emtionally and physically but will offer guidance and support to his caregivers, which are us-his children. The oncologist office called today and said that they will drop him from chemo treatment if we start working with hospice as they said if my dad is getting chemo he is is not a candidate for hospice. We called hospice and again they verified he IS a candidate. The oncologist said he needs to choose one or the other and they said again they will stop treatment. I think what this comes down to is money, I think Dr's have to bill differently if a patient is in hospice care. I feel that if they pull his treatment that will buy him more time and help with his pain JUST because we are signing up for additional support emotionally and physically would be negligence? Please offer feedback, this is so distressing already on all of this. We do not want to have to choose one or the other it is heart breaking that he wouldnt be able to get cared for properly.
ANSWER: Les,
I am sorry to hear about your father. I am not sure what you are indicating about "negligence" for trying to get your father and family more support.
Hospice is correct that the earlier your father brings them in, the better the transition and support will become. A person on Hospice can still receive chemotherapy. Generally, chemotherapy is therapeutic and not palliative but this does not eliminate the services of Hospice.
I believe your father's oncologist is indicating that the primary care responsibilities will be assumed by a Hospice physician and the oncologist will not be able to proceed.
I suggest your family meet with a Hospice Administrator and discuss these events in detail to reach a meeting of the minds as far as how best to proceed.
As a side note, it is important that your father write down his directives in the form of a living will so that difficult decisions are made by him when he is still able.
I wish your father and your family the best.
Paul D. Friedman, M.A., Ph.D., J.D.
---------- FOLLOW-UP ----------
QUESTION: Thanks for your feedback. I do not think hospice is negligent but his oncologist is. I do not understand why the oncologist would threaten to stop my Dad's chemo if we sign up for hospice. Hospice said to proceed with hospice and that he could continue chemo so I am not sure what the big deal is. I think that once someone is on hospice, the doctors have to bill differently hence maybe less money. We just want to be sure my dad is getting the chemo treatment and the support of hospice but the oncologist will pull his treatment if we do have the support of hospice.
Thanks again for your feedback, we have started the living will process.
Wondering if I should contact a lawyer should the oncologist stop his chemo just because we are seeking additional support which will also help us all emotionally
Thanks again
Answer Les,
The oncologist is not acting negligent but may be acting intentionally and breaching the fiduciary duty of a physician in potentially abandoning a patient. I suggest you see if the hospice physician will continue the order for chemotherapy.
You may wish to contact an attorney who understands the responsibilities of a physician in your community.
