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Author: RNCoordJenn
Date: Jan 28, 2009 6:30 pm
Most of you most likely have yet to deal with this....but probably have thought about it in light of recent events. As I-1000, the Washington State Death with Dignity Act, has recently passed and will be put into effect on March 4 of this year, I'm sure we are not the only ones in a major planning phase. While our hospital has not firmly come out with a policy, one of the things we are looking at right now is who will be responsible for counseling/informing patients inquiring about this, then making the appropriate referrals. It has been recommended that it be the PC team that take on this role.

I'd like to know others opinions on whether or not they feel PC is the appropriate discipline to handle this information. In Oregon it is handled differently from hospital to hospital, depending on their policy. My fear is that this may further blur the lines between us and Hospice should we take on this role. Maybe I am off base.

Anyone?
Replies: order by [Date] [Author] [Subject]
Re:Opinions sought (by makeane on 01/28/2009)
My experience has been that Palliative Care is exactly the appropriate avenue for patients who are exploring "death with dignity". I have often found that the request to implement this option goes beyond the logistics of the legislative requirements, and presents a unique opportunity to explore the patient's deeper experience of facing a terminal illness. Who better than the skilled Palliative Care team to facilitate this process?
I'm happy to talk more off-line if you would find that helpful.
Mary Anne Keane, APRN, ACHPN
Sky Lakes Medical Center
Klamath Falls, Or
mkeane@skylakes.org
Re:Opinions sought (by Weissman on 01/28/2009)
I attended a very thoughtful lecture on this subject last year from Jos Pereira,MD, who had to grapple with this issue for his Pall Care team in Switzerland--he has strong feelings about the role of PC in this situation. I'd suggest you contact him, he is now at the University of Ontario.
+ Re:Opinions sought (by greggv on 01/28/2009)
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
Re:Opinions sought (by RNCoordJenn on 01/29/2009)
Appreciate the thoughtful and well written responses. The links were especially helpful, thank you. I will now be attending the February 23rd conference near SeaTac. Thank you for making me aware of it.

Also for Dr. Weissman; would love to get into contact with Dr. Pereira, tried to find him but was unsuccessful - do you have contact info you could email me by chance? Would greatly appreciate it as all of this is moving rather quickly.

Again, VERY MUCH appreciate all the help!

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