23: MAiD

Question 1

MAiD provision has _______ in Alberta

Answer 1

increased

Question 2

what age group has the highest usage of MAiD?

Answer 2

78-80yrs

Question 3

what is the main condition for which people apply for MAiD

Answer 3

cancer

Question 4

4 steps of MAiD process

Answer 4

pt’s request
pt assessment (2)
eligibility
provision (planning, schedule day)

Question 5

describe the general IV MAiD protocol

Answer 5

anxiolytic → opioid (optional PRN pain)→ local anesthetic → coma inducing → neuromuscular blocker

Question 6

what drugs are used in the IV MAiD protocol

Answer 6

Midazolam 2.5-10 mg 2min → fentanyl 25-500mcg 1-2min → lidocaine 40 mg 30s → propofol 1g 5min → rocuronium

Question 7

T or F: order of drug admin doesn’t matter in MAiD delivery

Answer 7

F- Order of administration important as some meds are unpleasant and site irritating (burns) - may give lido to decrease

Question 8

T or F: if a patient passes during MAiD protocol, you do not need to finish administration of all drugs

Answer 8

F- still finish

Question 9

3 pros of IV MAiD protocol

Answer 9

Prevents some complications (ex - due to emesis)
No bioavailability issues
Clinician present to tx SEs and complications

Question 10

3 cons of IV MAiD protocol

Answer 10

Less pt autonomy
Requires IV access- greater intervention
Clinician requires greater skill for IV access and med admin

Question 11

describe the steps in PO MAiD protocol

Answer 11

Gastric motility/ antiemetic → anxiolytic → coma inducing

Question 12

what drugs are used in the PO MAiD process

Answer 12

Haloperidol 2mg 1hr pre ingestion → lorazepam 0.25-0.5mg → DDMP2 1-2min

Question 13

what 4 sx may need management in PO MAiD

Answer 13

emesis
respiratory depression
seizures
pain or distrses

Question 14

5 pros of PO MAiD

Answer 14

Autonomy
Less medicalized
Not invasive, no IVs, etc
Admin at home or favorite location
Locus of control- can save med until things get really bad

Question 15

4 cons of PO MAiD

Answer 15

Requires ability to self administer
Associated with complications (delayed onset, pt doesn’t take as intended, N/V, etc)
May not be able to administer
May require clinical presence, IV back up

Question 16

which of the following is a major barrier for MAiD
1. patients often want more control
2. there is not a lot of research about the most efficacious way to use drugs for MAiD
3. complications are common in both IV and PO MAiD protocols, requiring back ups
4. protocol lacks standardization for PO process

Answer 16

2

Question 17

T or F: the pharmacist may be involved in the MAiD consent process

Answer 17

F

Question 18

what are 3 pharmacist responsibilities in MAiD

Answer 18

medication supply
teamwork
documentation

Question 19

in “A Hospital Pharmacist’s Experience with MAiD- A Qualitative Study”
1. many participants experienced MAiD in a similar way
2. participants found themselves distancing themselves and personal lives from the MAiD experience
3. Pharmacists mainly experienced medication focused roles
4. Participants found that limiting emotion was best to carry out the process
5. none of the above

Answer 19

5
Each participant experienced MAiD practiced in a unique way
Participants viewed MAiD and their role in relation to themselves, the pts, the pharmacy and HC teams, and their family, friends, and community
Roles in MAiD were primarily med focused, yet experienced as a caring role
Experiences in MAiD involved a range of emotions