MAID/ End of life Flashcards
Eligibility criteria for MAID?
7 criteria
Must meet ALL eligibility criteria for MAID
->18 years
-able to be covered through health care services
-has made a voluntary request that is not a result of external pressure
-has provided informed consent to receive MAID after having been informed of the means that are available to relieve their suffering, including palliative care
-has a serious and incurable illness, disease or disability
-advanced state of irreversible decline in capacity
-has enduring and intolerable physical or psychological suffering that cannot be alleviated under conditions the person considers acceptable
What are the two tracks for MAID?
Track 1- natural death is reasonably foreseeable \
Track 2- natural death is NOT reasonably foreseeable
What is natural foreseeable mean in track 1?
clinicians can continue to rely on the guidance previously provided by the court and the clinical community to inform their assessment of whether a patients natural death is reasonably foreseeable or not
What is the role of the 2nd clinician?
And what does independent mean as a second clinician
-must separately conduct an assessment to ensure that a pt meets ALL criteria
-to be independent means:
1. can’t be a mentor to the 2nd clinician or responsible for supervising their work
2. not beneficiary under the will
3. dont believe that they are connected to the second cliniican or to the pt requesting MAID in any other way that would affect their objectivity
What are the 3 safeguards in MAID?
- Written consent for MAID must be signed by one independent witness
- TWO independent clinicians must provide an assessment and confirm that all of the eligibility requirements are met
- “waiver of final consent” written arrangement
What happens if patients are Track 2? what is the process?
Patients need to undergo a 90 day assessment period before receiving MAID
Are patients obligated to inform family members of their decision to pursue MAID?
NO, pt is not obligated to inform family members of their decision
-family members cannot override pt decision for MAID
Symptoms of end of life in the last 1-2 weeks?
fatigue
wt loss
weakness
appetite loss
Symptoms of end of life in the last 48 hours?
noisy and moist breathing
urinary dysfunction
pan
restlessness and agitation
dyspnea
nausea/vomiting
sweating
jerking/twitching
Nonpharm for dyspnea in end of life
oxygen
pharm for dyspnea in end of life
FIRST LINE:
Opioids
-morphine 5-10 mg SC or IV Q30 min or Q4h with Q1h breakthrough
(if at home) Fentanyl 25-50 mcq
SECOND LINE
nonopioids
-Benzos (relieve anxiety)
-Phenothiazine (chlorpromazine) -> refractory cases
-corticosteroids (if COPD/ obstructive disorders)
Nonpharm for pain in end of life
there is none
supportive listening from family
pharm for pain in end of life
Stepwise approach
Mild pain
-nonopioid analgesics can be tried (NSAID, tylenol, ASA)
Palliative care
#1 - > Opioids (morphine/ hydromorph =mainstay)
Q4h dosing
Q1h breakthrough
educate pt and caregivers on side effects
Adjuvant
Bone pain -> NSAID with cytoprotection
Closed space pain -> Dexamethasone
Pleuritic Pain -> NSAID
Neuropathic pain -> Methotrimiprazine
Burning/ Dysesthetic -> add TCA Amytriptilline
Shock like -> add gabapentin 300 mg HS
or pregabalin 50-150 mg BID
What is the goal for therapeutic relief in end of life care?
achieve comfort, discontinue intervnetions that no longer serve in support of comfort (BW, VS, BG)
IV rehydration is best replaced with keeping pt comfortable (mouth care)
End of life care for nausea/ vomiting nonpharm approaches
if pt still eating; give smaller portions or snacks consisting of bland foods
avoid the smell and sight of food prn
