Center to Advance Palliative Care

Inquiries regarding PAD come at all points along the continuum of EOL care, so EOL care providers in all disciplines and settings should be prepared to respond when those questions emerge. That response initially involves more questions than answers, since discerning the patient's motivations and intent dictates how to most effectively develop an EOL care plan. Excellent PC will usually obviate the pt's desire to follow the process through to completion, so "counseling/informing" pt's who inquire about PAD primarily entails discussion of goals, fears, and EOL treatment alternatives -- all discusssions that fall under the purview of the PC team. Data from Oregon indicate that most patients who inquire about PAD never obtain a lethal Rx, and >1/3 of those who obtain the Rx do not take it. So those pt's who inquire may be the ones who most need our attention, hopefully allowing us to address their concerns in such a way that they don't follow through. For the small percentage of pt's who persist in their desire for PAD, your hospital's policy will define your options. If directly counseling or informing pt's about the specific steps to follow through with PAD falls outside your institutional policy or personal comfort zone, a practical next step would be to refer them to, or simply inform them about, Compassion and Choices of Washington.

Some resources that may be useful:
-- The Washington Hospice and Palliative Care Organization is sponsoring a day-long conference on I-1000 February 23 near SeaTac. (Info available at www.wshpco.org.)
-- The Washington State Hospital Association held a web seminar on I-1000, which may be especially useful for your hospital-based PC service. Those materials are available on their web site. (http://www.wsha.org/page.cfm?ID=webcasts)
-- The American Academy of Hospice and Palliative Medicine's position statement on PAD is excellent. (http://www.aahpm.org/positions/suicide.html)

Hope that helps!
Gregg VandeKieft
Olympia, WA