Neither Hastening nor Prolonging Death: Hospice in a State with Legalized Physician-Assisted Death (FR460)

Abstract

•After attending this session, participants will be able to analyze a relevant case regarding considerations of hospice organizations developing policies to respond to legalized physician-assisted death.•After attending this session, participants will be able to explain how hospices in Oregon and Washington responded to the legalization of physician-assisted death in their states.•After attending this session, participants will be able to list the specific challenges of legalized physician-assisted death in California. The End of Life Option Act, which gives patients with a terminal illness the ability to request medication to end their lives, went into effect in California in June 2016. This makes California the fifth state to legalize physician-assisted death (PAD), though legislation is under consideration in seventeen more. After PAD becomes legalized, health care organizations must develop new practices to respond to requests from patients. Since laws define the steps a physician must take to write a prescription, organizational responses typically focus on the early part of the process of requesting hastened death. However, evidence from Oregon and Washington suggests the vast majority of terminally ill individuals who request PAD are hospice patients. Hospices must consider issues such as managing communication with family, effects on interdisciplinary team members, and issues around ingestion, while accounting for a hospice philosophy that clinicians will neither hasten death nor prolong life. For clinicians and leaders in states that have recently legalized or may soon legalize physician assisted death, this concurrent session highlights the PAD-related policies and practices of hospice organizations in Oregon, Washington, and California. Dr. Harrison, a health policy researcher, will review the current nationwide policy context for PAD and engage the audience in a case discussion. Dr. Campbell, an expert in hospice ethics, will describe ethical dilemmas encountered by hospices in Oregon and Washington responding to legalized PAD. Dr. Petrillo, palliative care physician and organizer of the California End of Life Option Act Response Conference, will report on the challenges of legalized PAD in such a large and diverse state. Dr. Bourne, hospice Chief Medical Officer, will share the experiences of a consortium of Bay Area hospices eight months after California legalization. Ms. Koehler, hospice Director of Clinical Services, will describe the impact of legalized PAD on hospice interdisciplinary team dynamics.