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NHPCO March ECHO Session - Shared screen with speaker view
Judith Adams
Would you put the case back up on screen?
Thaddeus Pope
The report to APS. Was that made by TL staff? Was that because there were concerns about whether the patient voluntarily chose VSED?
Dana Tarcatu
What were the efforts to identify the reason he was expressing a desire to die? And what is the connection between hastening death and not taking his usual medications (which in some situations could actually have a positive outcome)?
Syl Zucker
What about asking any pt who is demonstrating tiredness continuing living the general question if they are interested in knowing ones end of life options
Thaddeus Pope
Generally accepted (legal and professional) rules of informed consent require disclosing ALL options that a reasonable patient might find significant or important. Therefore, omitting some options should require special and overwhelming justification.
Judith Adams
Sorry. I need to leave early. Great conversation
Thaddeus Pope
Leslie Sutton - If the patient still had capacity when she asked for water, then EVEN a clear advance directive with Ulysses Clause may not have been sufficient. As you describe it, this was a revocation of the VSED plan. So, the DPOAHC no longer had authority to enforce the VSED plan since the patient herself no longer wanted that. Thank you.
Dana Tarcatu
Did the team take into consideration that this was a situation happening during the COVID -19 pandemic, when most people in ALFs and NH/SNFs were experiencing social isolation, which has a great impact on their outlook on life? And I agree VSED would have not been an appropriate recommendation to make.
Halley Harris, MSW
I would encourage education across the board both with clinicians and families. Some we use in WA State are www.endoflifewa.org or www.vsedresources.com
Thaddeus Pope
Halley is right and Washington State has some of the best resources anywhere. We (a physician, nurse, ethicist, and lawyer) just published a book length treatment of clinical, ethical, legal, and institutional issues re VSED https://global.oup.com/academic/product/voluntarily-stopping-eating-and-drinking-9780190080730?cc=ch&lang=en&
Syl Zucker
Often pts exercising VSED do not stop eating and drinking "cold turkey" but ease into it. We discuss with pts and families what a hard line VSED choice vs an easing into VSED might look like
Karuna Tamrakar
From Debra- Thank you Halley. Another resource compassionandchoices.org has a good discussion regarding VSED
Sean Murphy
In jurisdictions where assisted death is not yet legal, are there any resources for supporting staff who are facilitating VSED potentially for the first time?
Katie Adkison
Support the individual in their decision and respect explaining what the impact may be...
Heather Thornburg
We had a patient do this a few years ago & at that time, we didn't even know there was a name for it. It was just the patient choice and we supported him as he needed.
Sean Murphy
Thank you for the clarification, didn't mean to imply that VSED was aided death.
Katie Adkison
Thank you for this ECHO presentation and thoughtful discussion.
Heidi Seaberg, NP
Excellent case! Thank you all.
Tracy Larson-Benvenuti
Wonderful presentation thank you!
Bonita Westover
Thank you all very much! I thoroughly enjoy & learn so much from Project ECHO sessions.
Darci Reed
Thank You
Shannon Winters
Thank you
Tamilyn Little
thank you!
Tuesday Riegen
Thank you for a great session!
Ruth Blackman
A suggests for the future: if here are multiple excellent cases like these, could they be labeled 1,2,3 or A, B C for ease of reference during discussion?
Theresa Lynn
Thank you - very helpful!
Ashley Evans
Thank you
Thank you. This was a great topic!
Karuna Tamrakar
Thank you for participating in ECHO session! we value your feedbacks and sharing your knowledge and expertise.