CE Objectives

Continuing Education Credits:

Physician CME: The California Academy of Family Physicians designates this activity for 11 AMA PRA Category 1 ™ credits. (This pertains to Family Physicians and other care specialties.) 

Nursing CE: 11 units for the conference, an additional 2 if you attend the additional Clinical Training for Care at the Bedside.

Social Worker CEs: 11 units for the conference, an additional 2 if you attend the additional Clinical Training for Care at the Bedside.
NOTE: CEs provided by the National Association of Social Workers. Check to see if your state is covered.

Pharmacists: This is pending, but will likely be 2 units for pharmacist-related materials covered during the conference.

NOTE: All of our presenters have conflict-of-interest forms on file with our CME provider and none had any financial disclosures relevant to this event.

DAY ONE

February 14, 2020

SESSION NUMBER
1. 9:05 AM Medical Aid in Dying--An Introduction
Lonny Shavelson, M.D.
Board Chair, National Clinicians Conference on Medical Aid in Dying
Founding Partner, Bay Area End of Life Options

Thaddeus Mason Pope, JD, PhD
Health Law Professor & Bioethicist
Health Law Institute at Mitchell Hamline School of Law, St. Paul, Minnesota

Objectives
• Define the need for medical professional education about medical aid in dying.
• Discuss and describe inter-state differences in the practice of medical aid in dying.
• List current national demographics for aid in dying.

2. 9:45 AM Hospices and Aid in Dying: Evolution & Future

Moderator Thalia DeWolf, RN, CHPN.
Nursing Curriculum Director, National Clinicians Conference on Medical Aid in Dying
Clinical Coordinator, Bay Area End of Life Options

Laura Koehler, LCSW, ACHP-SW
Senior Clinical Director, Hospice by the Bay

Hope Wechkin, M.D.
Medical Director, Evergreen Health Hospice. Kirkland, WA

Gary Pasternak, M.D., MPH
Chief Medical Officer, Mission Hospice. San Mateo, California

Yelena Zatulovsky, LCAT, LPMT, MA, MT-BC, CCLS, HPMT
Vice President of Patient Experience, Seasons Healthcare. Rosemont, IL

Objectives

• Describe the evolving role of hospice for patients requesting aid in dying.
• Discuss and establish policies and processes that promote best practices and safety in the delivery of hospice services in a population of patients seeking aid-in-dying.

3. 11:00 AM The Pharmacology and Physiology of Aid in Dying

Lonny Shavelson, M.D.
Carol Parrot, M.D.
Attending & Consulting Physician, End of Life Washington. Seattle, WA

Objectives
• Describe the advantages and risks of different aid-in-dying medication protocols.
• Explain the relevance and presentation of respiratory vs. cardiac death in aid in dying patients.
• Optimize routes of self-administration for aid in dying medication across varied patient populations.

4. 1:00 PM Care at the Bedside: Monitoring and Guiding Eligible Patients

Moderator Thalia DeWolf, RN, CHPN.
Carol Parrot, MD.
Attending & Consulting Physician, End of Life Washington. Seattle, WA

Chris Fruitrich.
Volunteer, End of Life Washington. Seattle, WA

Bobbie Head, MD, PhD.
Oncologist, Marin Cancer Care, Greenbrae, CA.

Jessica Safra, MD
Hospice by the Bay, San Francisco

Molly Weiner, RN
Hospice by the Bay, Larkspur

Objectives
• Describe and contrast clinical roles and responsibilities for doctors, nurses, social workers, chaplains and others in the provision of bedside care for those participating in aid in dying.
• Provide support for families in the setting of an aid-in-dying death.
• Create policies that support hospice staff on the day of an aid-in-dying death.

5. 1:55 PM Evaluating Capacity and Prognosis

Case Presentation: Burton Presberg, M.D.
Cancer Psychiatrist, Oakland

Lawrence Kaplan, D.O.
Director, Consultation-Liaison Service, UCSF and Psycho-Oncology Psychiatry Department, UCSF Helen Diller Family Comprehensive Cancer Center. San Francisco, CA

Lynette Cederquist, M.D.
Clinical Professor of Medicine, Division of General Internal Medicine, Director of Clinical Ethics Program, University of California, San Diego

Objectives
• Describe challenges in assessing capacity for decision-making in terminally ill patients.
• List elements of a robust process for prognosis and capacity evaluations among patients inquiring about aid in dying.

6. 2:50 PM Ethical Challenges in Aid-in-Dying Care

Moderator Lonny Shavelson, M.D.

Margaret Pabst Battin, M.F.A., Ph.D.
Distinguished Professor of Philosophy, Program in Medical Ethics and Humanities, University of Utah

Ruchika Mishra, Ph.D.
Program Director, Bioethics, Program in Medicine and Human Values, Sutter Health Bay Area

Timothy Quill, M.D. MACP, FAAHPM
Professor of Medicine, Psychiatry, Medical Humanities, and Nursing,
Palliative Care Department of Medicine,
University of Rochester School of Medicine

Stuart J. Youngner, M.D.
Professor of Bioethics and Psychiatry
Case Western Reserve University

Objectives
• Describe three ethical challenges in current approaches to aid in dying.
• Discuss an approach to working with ethically complex cases at end of life and in aid in dying.

7. 3:50 PM Integrating Aid in Dying into Medical Practice

Moderator: Lonny Shavelson, M.D.

Ryan Spielvogel, M.D.
Family Medicine, Sutter Health, Sacramento, CA

Lowell Kleinman, M.D.
Palliative Care Medical Director, John Muir Medical Group, Walnut Creek, CA

Mindy Cooper, M.D.
Internal Medicine & Nephrology, Vail Health. Avon, CO

Bobbie Head, M.D., Ph.D.
Oncologist. Marin Cancer Care, Greenbrae, CA

Eric Walsh, M.D.
Emeritus Professor, Hematology-Oncology and Family Medicine, Oregon Health and Sciences University, Portland, OR

Gary Pasternak, M.D., MPH
Chief Medical Officer, Mission Hospice, San Mateo, California

Objectives
• Describe current status of the integration of aid in dying into the practice of end of life care.
• Describe how inquiries about aid in dying can be leveraged to promote excellence in end of life care.
• Describe two different models for integrating aid-in-dying care into medical practice.

8. 4:50 PM Evaluation and Management of High-Risk Patients

Lonny Shavelson, M.D.

Carol Parrot, M.D.

Objectives
• List red flag indicators for patients at high risk of complicated or prolonged dying.
• Describe an approach to evaluating and managing high-risk patients.

6:00-8:00 PM Aid in Dying: Clinical Training for Care at the Bedside (RNs, MSWs, Chaplains)

Thalia DeWolf, RN, CHPN

OBJECTIVES

  • Identify and clarify patients’ requests for information about medical aid in dying.
  • Provide support and guidance to patients and their families as they go through the process of becoming legally eligible for medical aid in dying.
  • Monitor patients who are preparing for aid in dying and communicate crucial assessment information to patients, families, and providers. 
  • Guide families and patients as they prepare for and manage the aid in dying procedure.
  • Care for families and patients during the active dying process (regardless of participation in aid in dying).
  • Provide appropriate postmortem care and bereavement referrals.

DAY TWO

February 15, 2020

9. 9:00 AM Race Matters: Ethnic, Cultural, and Spiritual Considerations in Aid in Dying

Moderator: Lonny Shavelson, M.D.

Terri Laws, Ph.D.
Assistant Professor, African American Studies
University of Michigan, Dearborn

Tracey Bush, MSW, LCSW
Regional Practice Leader, End of Life Option Act Program.
Kaiser Permanente, Southern California

Alan Elbaum, MS
Medical Student. UC Berkeley-UC San Francisco Joint Medical Program.
Co-author with LaVera Crawley: "Race and Physician-Assisted Death: Do Black Lives Matter?" (in press).

Objectives
• List factors contributing to inequity in healthcare and care received at end of life.
• For those requesting aid in dying, list personal and demographic factors that increase obstacles to care or contribute to individual and family challenges at the end of life.

10. 10:00 AM Managing Social Complexity in Patients and Families

Moderator Lonny Shavelson, M.D.

Including the topics:

Complex Grief in Medical Aid in Dying, and

Family conflicts and complexity in medical aid in dying requests

Deborah Schwing, LMFT; Leslie Dennett, LMFT
Hospice by the Bay Bereavement Department, San Francisco, CA

Jeremy Long, MD, MPH
Medical Director, Denver Health MAID

Objectives
• Describe the role of social determinants for health for patients pursuing aid in dying.
• Recognize & respond when social complexity creates challenges in care and complicates the grief process; provide patient, family and staff with support.

11. 11:00 AM Attending Deaths

Moderator: Thalia DeWolf, RN, CHPN

Emily Gorgen, R.N. case presentation

Hadas Rivera-Weiss, case presentation

Keith Seckel, ADN, RN, CHPN.
Director of Nursing, Timberhill Place Assisted Living, Corvallis, OR

Sara Tolchin, RN
Hospice by the Bay, Larkspur, CA

Bob Wood, MD
End of Life Washington

Chris Fruitrich.
Volunteer, End of Life Washington, Seattle

Objectives
• Site three benefits of having clinical staff at the bedside for an aid-in-dying death.
• Describe how fallback procedures might be used to ensure quality care at end of life for aid-in-dying patients and their families.
• Implement policies to avoid family confusion on the day of death.

12. 11:45 AM Plans Change: When Aid in Dying Cannot be Implemented

Moderator Thalia DeWolf, RN, CHPN

Timothy Quill, M.D. MACP, FAAHPM
Professor of Medicine, Psychiatry, Medical Humanities & Nursing
Palliative Care Department of Medicine, University of Rochester School of Medicine. Rochester, NY

Andrew, Holland RN
Hospice East Bay. Pleasant Hill, CA

Anne Marie Olson, LCSW
Hospice by the Bay

Patrick J. Macmillan, MD, FACP
Chief, Division of Palliative Medicine, University of California San Francisco (Fresno)

Objectives
• Discuss challenges individuals face in accessing information about care at the end of life.
• Describe and implement alternative care pathways for when aid in dying cannot be implemented.

13. 1:30 PM Practice Pragmatics: Creating an Efficient and Effective
Workflow for Aid in Dying

Lonny Shavelson, MD

Objectives
• Create effective work-flow processes for aid in dying.

14. 2:15 PM How to Talk About Aid in Dying
Moderator Lael Duncan, M.D.
Thalia DeWolf, RN, CHPN.
Elizabeth Semenova, MSW, MTS
Practice Director and Psychospiritual Guide Integrated MD Care. San Diego, CA

Objectives
• Recognize the various expressions used by patients and families when requesting information on aid in dying.
• Respond appropriately to requests for information across settings--Opt-in; Opt-out; Neutral; No-Access.

15. 3:00 PM Pharmacists: Compounding, Teaching & Informing

Eddie Lau, Pharm. D.
Feel Good Compounders Pharmacy, Pacifica, CA

Christy Harmon, PharmD, BCACP
Pharmacy Supervisor, University of Colorado Hospital. Aurora, CO

Laura De Simone, MS, RPh
Clinical Pharmacy Specialist for Death with Dignity, Pain Management
Kaiser Permanente, Portland, OR

Objectives

• Describe the role of expert pharmacists in care for aid-in-dying patient.
• List pharmacy procedures that contribute to quality care for the aid-in-dying patient and their families.

16. 3:30 PM The American Clinicians Academy on Medical Aid in Dying: The roles and functions of this newly formed Academy

Moderator: Lonny Shavelson, M.D.

Introduction: The Canadian Academy
Stefanie Green, MD
President, Canadian Association of Medical Aid in Dying Assessors and Providers (CAMAP)

Resident education
Evan Pulvers, M.D.
Founder of Aid-in-Dying Training
Contra Costa, CA, Family Medicine Residency

Ryan Spielvogel, M.D.
Family Medicine, Sutter Health, Sacramento, CA

Research and Data Gathering: 
Matthew Wynia, MD, MPH
Director, University of Colorado Center for Bioethics and Humanities

Objectives

• Describe how Standards of Care might be promoted and developed for aid in dying.
• Discuss ways to implement educational opportunities that will promote quality of care for the aid-in-dying population.
• Describe how data about inquiry, utilization and practice of aid in dying can assist efforts to improve end of life care