Month: October 2024

Shocking Article in Academic Medicine: Helping Patients Die: Implementation of a Residency Curriculum in Medical Aid in Dying

nancyvalko assisted suicide, culture, disability, education, end-of-life, euthanasia, media, medical ethics ,

“First, do no harm” is attributed to Hippocrates and is one of the principal precepts of bioethics that all healthcare providers are (or were) taught in school and is a fundamental principle throughout the world.

But today,  the Hippocratic Oath, the oldest and most widely known treatise on medical ethics that forbade actions such as abortion and euthanasia that medical students routinely took upon graduation, has now been revised or dropped at many medical schools.

So we should not be surprised that we now have an article in the August issue of Academic Medicine (lww.com) titled Helping Patients Die: Implementation of a Residency Curriculum in Medical Aid in Dying by Spielvogel, Ryan MD, MS; Schewe, Savannah MD

The authors state the need for such a program is because:

“As more states legalize medical aid in dying (MAID), there is an ever-increasing need of physicians trained in this type of end-of-life care. However, resident curricula in MAID have not been previously reported or assessed. The authors describe a residency curriculum in MAID and evaluate the resident outcomes of this program.” (Emphasis added)

They describe the program they started in California:

“Since 2018, the Sutter Family Medicine Residency Program in California has offered training in MAID to its residents. Residents attend lectures, evaluate patients for MAID, write prescriptions for aid-in-dying medications, and attend the planned deaths of their patients if desired. In February 2023, an anonymous branching survey was sent to graduates of the program from 2019 to 2022 to evaluate residency graduation year, receipt of MAID training, currently practicing MAID, how rewarding MAID is compared with other clinical responsibilities, how stressful MAID is compared with other clinical responsibilities, comfort discussing MAID with colleagues, comfort discussing end-of-life care generally, personal view of MAID as a practice, and works where MAID is permitted.”

RESULTS OF THE SURVEY

“The authors surveyed 28 graduates and collected data from 21 former residents (response rate, 75%). Of these 21 former residents, 17 (81%) reported having opted to receive training in MAID during residency. Of the 12 residents who received training and were currently practicing in a location that allowed MAID, 7 (58%) were still practicing aid-in-dying, and of these 7 residents, 5 (71%) reported that their aid-in-dying work was more rewarding than their other clinical responsibilities.” (Emphasis added)

The authors of this study conclude that there is:

“promising preliminary evidence that MAID training in residency may be an effective strategy in the long term at closing the suspected patient access gap that purportedly exists. This preliminary evidence can be inferred by the fact that 7 of the 21 responding graduates (33%) in this study reported actively practicing MAID compared with the 30 of approximately 5,000 physicians (approximately 0.6%) practicing MAID group-wide at the large institution described above.” (All emphasis added)

CONCLUSION

Ominously, an August Gallup poll titled ” Most Americans Favor Legal Euthanasia ” stated that ” 71% of Americans polled “believe doctors should be ‘allowed by law to end the patient’s life by some painless means if the patient and his or her family request it’.”

That is a change from polling in 1950 showing only 36% support for “ending a patient’s life through painless means”. (All emphasis added)

Tragically, too many Americans are falling for the lie that it is better to be made dead than disabled or dying. Assisted suicide laws are tragically wrong and I have personally testified against them. It’s not about politics. It’s about medical ethics and the need for trust in both our healthcare system and our healthcare providers.

When Food and Water Withdrawal is Recommended to Hasten Death

nancyvalko advance directives, Alzheimer's, assisted suicide, culture, dementia, disability, end-of-life, euthanasia, food and water, hospice, law, Living wills, medical ethics, VSED , , , ,

Recently, I was contacted by a man who was concerned about hospice care for his mother.

He wrote:

“I spoke to one hospice service that was recommended and asked about AHN (artificial hydration and nutrition) and I was basically told that if my mother became unconscious, they would not attempt to provide AHN. My mother has dementia and we’ve had a few scares where we were unsure she would recover. I’d like to understand what guideline I should expect the hospice to follow and whether hospice is even worth considering. Are there prescriptive standards of care that I can reference or could you tell me basically what routine care look like?”

I wrote back that I understood his concerns, especially since I recently lost a brother with dementia, diabetes and Crohn’;s disease after a second fall down stairs. H had trouble eating so the doctors recommended a feeding tube.

Unfortunately, a person from palliative care told my sister-in-law that he would not improve so she decided to refuse a feeding tube.

I told her that newer feeding tubes were more comfortable, could make him feel better and were worth a try but she rejected this. She said my brother told her he would not want to I’ve if he developed dementia- like our mother.

It took 4 long days for him to die.

I also told him that I have been writing about this problems for years, including my 2018 blot “‘Living Wills’ to Prevent Spoon Feeding at https://nancyvalko.com/?s=living+wills+to+prevent+spoon+feeding

I have seen the deterioration of medical ethics over 50 years as a nurse from requiring life-sustaining treatment unless it was medically futile or excessively burdensome to whatever is legal.

I would recommend to you two resources from the Healthcare Advocacy and Leadership Organization (HALO):

1, “The Food and Water Dilemma” at https://halovoice.org/wp-content/uploads/5.20.21-Making-a-Difference-8.pdf

2. “Making a Difference: A Guide for Defending the Medically Vulnerable” at https://halovoice.org/wp-content/uploads/5.20.21-Making-a-Difference-8.pdf

CONCLUSION

I have worked in hospice, critical care, etc. for decades and I was glad to be able to care for my patients, my mother and others so that they had dignity, comfort and emotional support at the end of life.

I hope these resources from HALO can help bring vital information, peace and comfort to others and their families.