September 15, 2017 Medical Assistance in Dying - PowerPoint Presentation

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September 15, 2017

Medical Assistance in DyingCommunity of Practice

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Discussion forum to support :

Awareness of resources to enable HCP to meet their professional obligations when a patient makes an inquiry or request for MAIDSharing of lessons learned from local MAID cases

Identify regional and sub-region needs to support MAID requests

Identification of knowledge gaps requiring systemic education/ supportBrainstorm collaborative solutions to current challenges being experienced by Health Service Providers supporting requests for MAID

MAID

Community

of Practice (CoP) Webinars

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C

urrently dealing with a request for MAID, ORHave supported a request for MAID in the past, OR

Are considering supported a MAID request in the future

and / or

are

interested in engaging in a collaborative discussion with other health service providers to learn from local experiences in supporting access to MAID in WW.

This teleconference is open to all health service providers who are:3

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Provincial MAID Care Coordination Service Transitioning to the regions/LHINs WWLHIN will serve as the WW Regional MAID Care Coordination serviceCompleted a call for clinicians interested in supporting MAIDEducation, mentoring

Additional call for interested partners to join Regional MAID Clinical Working Group to support development of clinical tools/resources e.g. intake/referral form, MAID Supply List, IV

access support in LTCContact Emmi Perkins (emmi.perkins@lhins.on.ca) if you are interested in contributing to this working group

Updates

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WW MAID Regional Framework

DRAFT For Discussion (Sept 14,

2017)

Medical Assistance in Dying - CMA Joule Program for Physicians & NPs

In-person and On-line course optionsIn-person – 8 hour workshopOn-line 4-week courseTopics:Legal and Regulatory Concerns

Consent and capacity: clinical context and application to assisted dyingTechnical aspects of medical assistance in dying Case analysis and discussion

Medical

Assistance in Dying - CMA Joule Program

Provincial Landscape

Total number of cases completed in

Ontario as

of: July 31, 2017 =

617

616

physician-administered cases, 1 patient administered cases407 Cancer-Related, 44 ALS,

47

Other Neurological,

73

CV/Resp.,

46

Other

338 in hospital, 233 in private homes, 33 in LTC, 23 in retirement homesFemale: 295, Male: 322Average Age: 73 (range 27 -101)Number of Unique MAID Providers:Clinicians: 196 (Physicians 192 , NPs 4), Hospitals: 74

22 cases in WW (13 Wellington, 9 Waterloo)

MAID in WWLHIN

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WW Feedback to Provincial Coroner

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It took over 1 hour for the Coroner to respond. The physician, nurses and funeral home had to stay in the home waiting for the response. Family was okay with the wait, but it is not ideal. Procedure was at 0700h and therefore impacted the response of the coroner's office. Consider a pre-call to Coroner's office prior to the procedure when outside of office hours to perhaps prepare the office for the call."

Given these are known/planned death, and our efforts to optimize the experience of the providers and family members, how would your staff prefer to be notified (or not) of cases that may be outside of normal office hours to minimize the delay in responding (if possible).

Case #1

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Response from Provincial Coroner

The

team members all agree that callers should expect a response from the team within 30 minutes--so please provide guidance that if the clinician does not hear back within 30 minutes they should re-contact our Provincial Dispatch staff--1-855-299-4100. Having said that there may be occasional times when the team member will be unable to meet the time frame (travelling in a car, managing another case).

Other

procedure changes/opportunities include; The team now has a dedicated fax line/email account to enhance the transfer of documents; availability for secure email transfer of documents; and if it would be of assistance the clinician can scan the majority of the records into a pdf in advance(but not send to us) to allow easier and timelier transfer of records after the death.

Case #1 (cont’d)

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Response from Provincial Coroner

As

you are likely aware, the team is not at full complement given the rapid development and the initial need for contract positions. We are proceeding with posting for permanent positions which should allow us to be fully staffed over the next few months.

All

of this as background to answer the suggestion--Given the expectation that the team responds within 30 minutes unless there are extenuating circumstances, I do not believe that a pre-procedural call would make a significant difference. Given the sharing of work and transfer of call duties pre-procedural calls could in fact cause more difficulty.

Case #1 (cont’d)

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Family has decided that since funeral home is not an option and family not comfortable hosting, they have agreed to Stratford General being the site to receive MAID Tuesday October 3.

Case #2

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Patient transferred from Hospice Wellington to GGH for MAID procedure

Case #3

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Other Cases?

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Encourage early involvement of HPC Team especially regarding date of procedure

Recent Cases/Challenges/Opportunities

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Upon receipt of a report regarding a medically assisted death, the Coroner will determine whether the death ought to be investigated. If the Coroner determines that an investigation is not required, the attending physician or nurse practitioner who provided medical assistance in dying must complete the medical certificate of death. However, if the Coroner is of the opinion that the death ought to be investigated, the medical certificate of death must be completed by the Coroner

. As directed by the province, when completing the death certificate for a medically assisted death, the illness, disease, or disability leading to the request for medical assistance in dying must be recorded as the underlying cause of death. Physicians are to make no reference to medical assistance in dying, or the drugs administered to achieve medical assistance in dying, on the death

certificate.http://www.cpso.on.ca/Policies-Publications/Policy/Medical-Assistance-in-Dying

Completion of Death Certificate

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A period of at least 10 clear days22 must pass between the day on which the request for medical assistance in dying is signed by or on behalf of the patient, and the day on which medical assistance in dying is provided.In accordance with federal legislation, this timeframe may be shortened if both the physician(s) and/or nurse practitioner(s) agree that death or loss of capacity to provide consent is imminent.

Physicians must document the start and end-date of the 10-day reflection period in the medical record, and their rationale for shortening the 10-day reflection period if applicable.

http://www.cpso.on.ca/Policies-Publications/Policy/Medical-Assistance-in-Dying

10-day Reflection Period

Was this discussion valuable?

What else is required to support you with respect to MAID?18