Death with Dignity: Medical Aid-In-Dying and Death with Dignity Laws - California

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 & 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.  Disclosure: Cynthia McDaniel, MSN, RN has declared that no conflict of interest, Relevant Financial Relationship or Relevant Non-Financial Relationship exists.

Catherine Zimmerman is a licensed independent clinical social worker who has a private practice providing counseling services to people of all ages and all stages of their lives. She is a freelance healthcare writer and speaker specializing in mental health, ethics, hospice and palliative care, gerontological topics, substance misuse, caregiving, stress and trauma.  Zimmerman received her master's degree from Portland State University thirty years ago and is certified in clinical social work-Gerontology. Zimmerman supervises and mentors therapists seeking licensure in Oregon or Washington states. She is the current President of the Washington chapter of the National Association of Social Workers and has provided public presentations on over twenty topics and has numerous published works. Disclosure: Catherine Zimmerman, LICSW, ACHP-SW, CSW-G has declared that no conflict of interest, Relevant Financial Relationship or Relevant Non-Financial Relationship exists.