The purpose of this course is to familiarize the learner with basic information concerning medical-aid-in-dying laws in the United States. We will discuss the history of the legislation and identify states where medical-aid-in-dying is legal. We will provide information on the legal requirements of medical-aid-in-dying laws along with an understanding of the step-by-step process people must follow to take advantage of their rights under the laws. The course will help individuals working in assisted living or residential care settings to identify ethical issues and potential policies or practices that may need to be considered in the context of medical aid in dying.
This is not an accredited course for professional license renewal. Florida CNAs may use this inservice toward meeting their annual inservice requirement.This activity is approved for 2.00 contact hours.
Outline:
I.Introduction to medical-aid-in-dying
a.Course description and objectives
b.A real account of medical-aid-in-dying
i.Brittany Maynard story
ii.Brittany Maynard video
c.Why medical aid in dying is important to healthcare professionals
d.Medical aid in dying and end-of-life care:relevant concepts and terms
i.Advance care planning(ACP)
ii.Advance directives
iii.Capacity to make medical decisions
iv.Death with dignity
v.DNR
vi.Euthanasia
vii.Hospice
viii.Medical-aid-in-dying medications
ix.Palliative care
x.Palliative sedation
xi.Physician-assisted suicide
xii.Refusal or withdrawal of medical treatment
xiii.State portable orders
xiv.Terminal illness
xv.Voluntary stoppage of eating and drinking(VSED)
e.Checkpoint 1
II.Medical aid in dying
a.Twentieth-century developments
i.Right to die:euthanasia
ii.Right to control decisions about medical care:advance directives
iii.DNR and the right to refuse CPR
iv.Access to specialized care:Hospice care and Medicare benefits
v.State portable orders
vi.Medical-aid-in-dying legislation and changing attitudes
vii.Technology and medical ethics
b.Case scenario:Jeff's story
c.Choices and support for the dying:palliative care
i.Pain and symptom management
ii.Hospice
iii.Voluntary stoppage of eating and drinking
iv.Withdrawal or refusal of healthcare treatment
v.Palliative sedation
d.Checkpoint 2
III.Medical aid in dying:legislation
a.State legislative processes
i.History of first state to enact legislation:Oregon
ii.Why people choose to use law
iii.States where medical aid in dying is legal:California, Colorado, Montana, Oregon, Vermont, Washington
iv.Insurance and medical aid in dying
v.Resources for understanding medical aid in dying in states where it is legal
vi.Summary of process(per legislation)
1.How to locate physicians willing to help
2.Oral requests
3.Physician responsibilities
a.Attending physician
b.Consulting physician
4.Psychological fitness
5.Waiting periods
6.Written request
7.How to obtain prescribed medications
vii.Checkpoint 3
b.California’s medical-aid-in-dying legislation
i.History and legislative efforts
ii.California End of Life Option Act
1.Passage in 2015;implementation on June 9, 2016
2.Statistics for first six months
iii.California process
1.Procedure for request
2.Physician's responsibilities
a.Prescribing process
i.Determination and discussion
ii.Specific counsel
iii.Provisions:withdrawal request, attestation form
3.Person’s responsibilities
a.Completion of attestation form(48 hours prior to planned death)
b.Self-ingestion while still capable
4.After death
iv.Checkpoint 4
IV.Important safeguards and considerations
a.Safeguards
b.Ethical considerations
i.Ethical issues in medical aid in dying
1.Introduction to ethics
a.Ethical principles
b.Religious ethics
2.Ethical principles
a.Respect for autonomy
b.Justice
c.Compassion
ii.Ethical issues in practice
1.Responsibilities of healthcare providers
2.Rights of persons in their care
c.How medical aid in dying applies to assisted living and residential care communities
i.Gladys’ story
ii.Explanation of salient issues
1.Choices and rights
2.
3.Determination of extent of participation
4.Development of policies and procedures
5.Communication and staff training
d.Workflow and coordination of care
i.Coordination of care
1.Hospice and other organizations
ii.Confidentiality and privacy
iii.Staff support
iv.Storage of medication
v.“Imminent threat process when not under hospice care
e.Checkpoint 5
V.Medical-aid-in-dying resources
a.National organizations
i.Compassion and Choices
ii.Death with Dignity National Center
b.State organizations
i.End of Life Choices Oregon, End of Life Washington, Patient Choices Vermont, Coalition for Compassionate Care of California
VI.Course summary
a.Conclusion
VII.Posttest
Cynthia McDaniel MSN RN, is a nurse and administrative consultant in long term care. She is the CEO of ElderWise Inc, a senior living consulting and education group. Cynthia has worked as a nurse consultant for the States of Oregon and Washington, a geriatric care manager, a regional director of clinical operations for a senior living company, and an assistant professor at Oregon Health & Science University School of Nursing. Her research in assisted living focused on the characteristics of residents in assisted living communities and the role of the nurse in assisted living. Cynthia holds a Master's of Science in Nursing from Gonzaga University in nursing education. She is a Fellow of the Sigma Theta Tau/John A. Hartford Foundation Geriatric Nursing Leadership Academy.
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