Tentative Curriculum List

Complex case reviews, medical  

  • Identify patients who are complex and/or high-risk for prolonged medical aid in dying or medical aid-in-dying complications.
  • Implement detailed Red Flag Check Lists for high-risk patients.
  • Modify plans, medication regimens and administration routes for complex patients.
  • Understand the timing of medical aid in dying: Physical and mental capacity.
  • Establish a consultation process for complex patients.

Complex case reviews, social

  • Establish criteria for working with family conflicts.
  • Work with underserved and/or medically indigent patients.
  • Analyze and manage psychological illness while caring for aid-in-dying patients.
  • Understand the timing of medical aid in dying: Social and emotional issues.
  • Establish a consultation process for complex patients.

Prolonged or complicated medical-aid-in-dying deaths

  • Recognize, manage and establish protocols for delayed sleep.
  • Recognize, manage and establish protocols for prolonged deaths.

Determining Prognosis

  • Determine prognosis for patients with multifactorial disease, medical frailty, neurodegenerative disorders or unknown/undiagnosed disease processes.
  • Discuss how prognosis estimation for patients with aid-in-dying requests might differ from other terminally ill or hospice patients.

The pharmacology and physiology of medical aid in dying

  • Explain how gastrointestinal physiology is altered in terminally ill patients.
  • Explain respiratory vs. cardiac deaths in medical aid-in-dying patients.
  • Describe the advantages and disadvantages of the different aid-in-dying medication protocols.
  • List and describe the varied potential routes of administration for aid-in-dying medications.
  • Understand the use of steroids and stimulants to support imminently terminal patients who continue to request medical aid in dying.

Capacity evaluations

  • Separate physical vs. decision-making capacity.
  • Define decision-making capacity for medical aid in dying.
  • Explain the role of depression in capacity evaluations.
  • Discuss difficult or ambiguous capacity evaluations.
  • Discuss the role of psychiatrists and psychologists in medical aid in dying capacity evaluations (vs. an evaluation by the attending and consulting physicians)

Supporting families through the eligibility period, and beyond

  • Describe and manage complex grief for families of patients who complete medical aid in dying.
  • Describe and manage complex grief for families when a loved one requested aid in dying but could not access it.

Preparing the patient, family and medical team for the day of medical aid in dying

  • Re-evaluate the patient’s capacity for self-administration
  • Assess and manage gastrointestinal and other symptoms.
  • Re-evaluate risk factors as medical aid in dying approaches.
  • Understand if/when to communicate any patient changes to the attending or other responsible physicians.
  • Discuss the roles hospice staff might take in preparing the patient for medical aid in dying.

Attending at the bedside on the day of medical aid in dying

  • Describe the roles of doctors, nurses, social workers, chaplains.
  • Create supportive policies for hospice staff on the day of medical aid in dying.
  • Discuss how attendance by trained volunteers might be implemented.

Palliative and hospice care for patients considering medical aid in dying

  • Describe how palliative care can change for the aid-in-dying patient.
  • Outline ethical considerations and policies for aid-in-dying patients in the hospice setting.
  • Navigate Medicare rules for aid-in-dying with hospice patients.
  • Discuss and establish best practices for palliative care for the aid-in-dying patient.

Poverty and medical indigence, homelessness, and poor access to quality palliative care

  • Identify patients with poor access to palliative care.
  • Describe barriers to accessing information about end of life care and medical aid in dying among medically indigent patients.
  • Discuss medical aid in dying for Medicaid patients—ethical and legal factors.
  • Describe how Medicaid patients, indigent patients or others might obtain costly aid-in-dying medications.
  • Describe and innovate services for homeless patients requesting medical aid in dying.

     Religion, spirituality and medical aid in dying

  • Discuss ethnic and spiritual differences that influence desires and requests for medical aid in dying.
  • Outline the role of spiritual counselors for patients who inquire about medical aid in dying.
  • Navigate and support a family’s religious or spiritual differences in the setting of medical aid in dying.
  • Recognize the role and the need to support the healthcare worker’s spirituality in caring for patients inquiring about medical aid in dying.

Supporting clinical staff

  • Utilize self-care and wellness interventions for clinicians and staff who must respond to requests for medical aid in dying in varied settings (Opt-in, Opt-out, No-Access).

Responding to patient and family inquiries about medical aid in dying

  • Recognize the various expressions used by patients and families when requesting aid-in-dying information. (HINT: They don’t ask for “medical aid in dying.”  
  • Respond appropriately to requests for information in any setting (Opt-in, Opt-out, Neutral, no access).
  • Support staff and formalize staff responses to requests for information on aid in dying.
  • Describe how practitioners might continue the conversation or reintroduce the topic to address unresolved patient questions or decision-making processes.
  • Implement an approach to caring for patients who want but can no longer have medical aid in dying (loss of capacity, unavailable, inappropriate).

Organization Administration

  • Organizational policies: Too strict, too loose, or in the sweet spot?
  • Keeping lists of participating aid-in-dying providers within or affiliated with your organization: Pros and Cons.
  • Aid-in-dying policies as risks or benefits to an organization's reputation.
  • Billing practices 
  • The electronic medical record and documentation standards.
  • Making specific referrals to practitioners in response to an aid-in-dying inquiry?  

Research and Data Collection on Medical Aid in Dying

  • What data is crucial to have?
  • When/how is data collection and reporting too burdensome?
  • Bringing academic centers and Institutional Review Boards into aid-in-dying research and data collection.

Codifying Standards of Care for Medical Aid in Dying

  • The role of the National Clinicians Conference on Medical Aid in Dying
  • Establishing the American Academy of Aid in Dying Clinicians

Training and Certification for RNs, MSWs, Chaplains

Clinical Staff Certification Course in Medical Aid in Dying: Two hours. RNs, SWs, Chaplains.