First Conference on Clinician Training for Medical Aid in Dying

The conference was held in Berkeley, CA on 2/13-15/2020.   Some things discussed:

Drug protocols

Dr. Shavelson, in conjunction with anesthesiologist Carol Parrot, have researched why some people – ‘outliers’ take so long to die. They have developed a list of “red-flags” that indicate a death may take longer than normal.  They no longer give estimates of time to death.

5 Variations in Medical Aid in Dying Laws in the 10 U.S. jurisdictions where it is currently legal:

• the number of assessments required by law.
• the amount of time between oral requests
• language describing how the drugs are to be taken i.e., ingest, administer or take
• rules regarding the physician opting out
• rules regarding the facility opting out

This Medscape article is a very nice summary of Thaddeus Pope’s talk at the Berkeley Conference.

People who wanted MAiD are not receiving it:

• difficulties finding willing doctors
• structural delays in institutions that waste time while the patient deteriorates (Dr. Shavelson had good suggestions to address these issues).
• falling out of eligibility
• even (a case related by Dr. Shavelson) of the doctor deciding, AFTER the patient had fulfilled all requirements and had a prescription – waiting at the pharmacy – that the patient’s REASON for wanting to take the drug that day was not good enough – Dr. Shavelson considered the reason a palliative care issue and provided that palliative care.

Palliative sedation

• It is extremely time-intensive and probably one of the reasons it is used so infrequently
• Attorney Kathryn Tucker, from the End of Life Liberty Project,  during one of the infrequent Q&A sessions reminded attendees that it is a legally-protected right and clinicians can be held liable if a patient is not informed of this option.

Should Medical Aid in Dying Be Part of Hospice Care?

This February 26, 2020 Medscape article by Roxanne Nelson, RN, BSN, summaries this talk.

The threshold of certainty appears the same, but I think a lot of physicians would agree that the threshold of certainty for hospice benefit is lower than the one required to prescribe a lethal dose of medication.”
-Hope Wechkin, MD, medical director of Evergreen Health Hospice quoted in Should Medical Aid in Dying Be Part of Hospice Care? – Medscape – Feb 26, 2020.

Inexact Science: Is Patient Eligible for Medical Aid in Dying?

This February 25, 2020 Medscape article by Roxanne Nelson, RN, BSN, summarizes this talk.

“Capacity can be determined by the physician while competence is determined by the courts,” explained Kaplan, who also works in the Psycho-Oncology Department at the UCSF Helen Diller Family Comprehensive Cancer Center.
However, capacity doesn’t remain static. “Capacity can change within minutes, hours, days, or weeks,” he emphasized.
– Inexact Science: Is Patient Eligible for Medical Aid in Dying? – Medscape – Feb 25, 2020.

Physician Aid in Dying Used Mostly by White Patients

This March 4 2020 Medscape article by Roxanne Nelson, RN, BSN, summarizes this talk.