Category Archive: Email

  1. Doctors for Dignity Bulletin – March 2017

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    We sent the following email, part of a monthly series, to our Doctors for Dignity last week:

    Hearings on U.S. Supreme Court nominee Neil Gorsuch begin on March 20. Author of The Future of Assisted Suicide and Euthanasia, Mr. Gorsuch has spent much of his career arguing against legalizing medical aid in dying based on the “inviolability” of human life. The U.S. Supreme Court last visited the issue in 2006 when it upheld (by a vote of 6-3) the ruling that states, not the federal government, have the authority to govern their residents’ end-of-life options.

    As lawsuits from patients and doctors in New York, Massachusetts and Vermont continue to progress, it is quite possible that a future U.S. Supreme Court would have the opportunity to weigh in on medical aid in dying.

    Watch for an Action Alert urging your Senators to vote against the Gorsuch confirmation.

    Monthly FAQ

    This month, Compassion & Choices’ National Medical Director Dr. David Grube answers the following:

    Q: Isn’t medical aid in dying inappropriate given that prognoses for life expectancy in terminally ill patients can be wrong by months or decades and end-of-life wishes to die can wax and wane?

    A: We doctors are much more likely to overestimate our patients’ length of survival than to underestimate. In fact, a study of physicians’ prognostic skills showed that sixty-three percent of us tend to overestimate by 500%.

    With cancer, the most common diagnosis among those seeking medical aid in dying, predictions about length of survival are clearer. For many reasons, oncologists, however, are often reluctant to tell patients their disease is not curable. A far greater problem is not informing patients when treatments are no longer likely to have a benefit. According to the National Hospice & Palliative Care Organization, in 2014, nearly half of all hospice patients were enrolled for fewer than 14 days. Similarly, in my experience, most patients request medical aid in dying in the very last days of their life, when the process cannot be accomplished. Clearly, we physicians hold out the hope for patients longer than may be in their own interest.

    It is important to remember that medical aid in dying is patient-centered care. The dying individual remains in control and determines if and when to ingest the medication. Of course, if their hospice care allows for them to improve for a time, or if a new and remarkable treatment prolongs their life in a way that they believe isdignified, enjoyable, and tolerable, they can then choose to delay aid in dying, or not opt to employ it. Most recent statistics from Oregon show that approximately 1 out of 3 patients who received a prescription for medication never used it.

     

    Monthly Resource

    Check out Physician-Assisted Suicide and Euthanasia in the ICU: A Dialogue on Core Ethical Issues

    In this article, twelve ethicists discuss core issues related to aid in dying in the ICU. All agree that conscientious objection should be respected, but did not reach consensus on the basic ethical dilemmas. This underscores the need for medical professional associations to adopt engaged neutrality as the preferred public policy position.

    If you find this resource useful, please forward to a colleague andencourage them to join Doctors for Dignity.

    Best regards,

    Rebecca

    Rebecca Thoman, M.D.
    Manager, Doctors for Dignity

  2. Doctors for Dignity Bulletin – February 2017

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    We sent the following email, part of a monthly series, to our Doctors for Dignity:

    Last week, Congressman Steve King (R-IA) introduced H.R. 410, an act that would exclude coverage for advance care planning under Medicare.The benefit, which took effect on January 1 of 2016, has helped thousands of seniors understand and prepare for end-of-life medical decisions. Despite its popularity and success, this benefit is at risk.

    No hearings on H.R.410 have been scheduled but when the bill comes before the Committee we’ll send you an action alert so you can urge your lawmakers to vote against this legislation.

    In the meantime, encourage your patients on Medicare to schedule appointments to update their health care directives. Our website provides information your patients need to begin planning their care.

    Monthly FAQ

    This month, Compassion & Choices’ National Medical Director Dr. David Grube answers the following:

    Q: Shouldn’t psychiatrists be involved in assessing capacity before a patient is approved for medical aid in dying?

    A: Every physician is not only fully trained to assess the capacity of all of the patients they treat on a regular basis, but is also required to document this assessment in the medical record. Shared medical decision-making requires a patient be able to understand medication side effects, treatments, and procedures, etc. This is accomplished through informed consent, and is a typical component of most medical care. Medical aid in dying should not be subject to capacity assessment requirements beyond the standard of care for any other health care decision. If a physician is concerned about a patient’s ability to understand instructions, make appropriate decisions, etc., she or he may seek a neurologic or psychologic evaluation to help determine capacity.

    Capacity is the patient’s ability to participate in decision-making and may vary over time. All hospice patients are assessed upon admission and regularly by the team of caretakers (social workers, chaplains, nurses, aids, medical directors, etc.). The physician who is present at the bedside determines whether the patient is able to make a particular health care decision given the circumstances and whether the patient’s reasoning is consistent with his/her values and preferences. If capacity is in question, a mental health professional’s expertise may be sought.

    Monthly Resource

    Check out the Centers for Medicare & Medicaid Services FAQ about PFS and CPT codes for advanced care planning.

    If you find this resource useful, please forward to a colleague andencourage them to join Doctors for Dignity.

    Best regards,

    Rebecca

    Rebecca Thoman, M.D.
    Manager, Doctors for Dignity

  3. Doctors for Dignity Bulletin – January 2017

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    We sent the following email, part of a monthly series, to our Doctors for Dignity:

    Dr. Pagan,

    Support for medical aid in dying continues to climb among physicians.

    Since 2010, when Medscape first began surveying U.S. physicians on their attitudes toward medical aid in dying, support has grown every year while opposition has declined. In its 2016 ethics report, Medscape found that 57% of physicians now support physician-assisted death for terminally ill patients (as compared to 46% in 2010 and 54% in 2014). Opposition has declined from 41% in 2010 to 29% in 2016.

    Physicians are catching up to the general public, which has solidly supported medical aid in dying since 1997.

    This is important for the movement for end-of-life choice, since doctors are some of the most influential voices in legislative debates about medical aid in dying.

    Monthly FAQ

    This month, Doctors for Dignity Manager Rebecca Thoman, M.D. answers the following:

    Q: Isn’t medical aid in dying a slippery slope to euthanasia as it is practiced in Belgium and the Netherlands?

    A: The concept of a slippery slope implies that, over time, the statutory guidelines for medical aid in dying will be either liberalized by elected officials or disregarded with impunity by practitioners. Both assumptions are incorrect. Since Oregon’s law took effect in 1997, there has been no attempt to broaden the scope of the law and no physician has been disciplined for practicing outside the scope of the law. Almost two decades of rigorously observed and documented experience in Oregon demonstrates that the law has worked as intended with no evidence of abuse.

    Slippery slope claims with regard to European countries are also misapplied. “Euthanasia” laws in Belgium and the Netherlands, for example, are less restrictive than American laws, but did not “slide” to their current form. Rather, the individual laws were developed with guidelines that differ from Oregon’s Death with Dignity Act (e.g. no self-administration requirement) in place from the law’s conception. While anecdotal stories of abuse of “euthanasia” laws abound, research indicates that cancer accounts for more than 70% of all cases of “euthanasia” in both Belgium and the Netherlands.

    Monthly Resource

    This article from the Annals of Internal Medicine argues that medical associations, regardless of their positions on medical aid in dying, must engage on the subject in order to meet the needs of our patients and our communities.

    Thanks, again, for all you did to make 2016 a success. We’re looking forward to a busy 2017.

    Best regards,

    Rebecca

    Rebecca Thoman, M.D.
    Manager, Doctors for Dignity

  4. Doctors for Dignity Bulletin – December 2016

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    We sent the following email, part of a monthly series, to our Doctors for Dignity:

    Doctors for Dignity made significant strides in 2016 thanks to physician leaders like you who engaged with organized medicine to re-evaluate outdated policy positions in opposition to medical aid in dying.

    This year, both the Colorado Medical Society and the Maryland State Medical Society conducted member surveys that found majorities in favor of medical aid in dying (56% and 65%, respectively). Both organizations withdrew opposition to “assisted suicide” adopting “studied neutrality” toward legislation to authorize medical aid in dying. The New York Academy of Family Physicians adopted a neutral stance and the American Academy of Hospice and Palliative Medicine reaffirmed its position of “studied neutrality.”

    We’ve also seen success in our outreach to medical professionals in multiple communities. GLMA: Health Professionals Advancing LGBT Equality and the National Council of Asian Pacific Islander Physiciansadopted positions in support of medical aid in dying.

    Finally, the American Medical Association House of Delegates voted to reassess its longstanding opposition to “assisted suicide” by instructing its Council on Ethical and Judicial Affairs to “study medical aid in dying as an end-of-life option” including review of data and experience from colleagues from authorizing states.

    Please help us continue this momentum by making a year-end contribution to Compassion & Choices.

    It’s hard to overstate the importance of this work: opposition from state medical societies is our biggest obstacle to passing medical aid-in-dying laws. And with the AMA considering changing its stance, we’ll need the resources to organize in medical societies at every level to support medical aid in dying.

    Your gift helps us recruit and mobilize physicians to engage in ongoing policy debates and ensures that all patients will have the freedom to choose from a full range of end-of-life options based on their personal values and beliefs.

    Make your gift today.

    Wishing you a healthy and happy holiday season,

    Rebecca,

    Rebecca Thoman, M.D.
    Campaign Manager, Doctors for Dignity

    P.S. If you had this message forwarded to you and you are not a member of Doctors for Dignity, please click here to join.

  5. Doctors for Dignity Bulletin – November 2016

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    We sent the following email, part of a monthly series, to our Doctors for Dignity in November:

    On November 8, Colorado voters will decide whether medical aid in dying should be authorized in their state. Lawmakers in Washington D.C. could vote to authorize medical aid in dying before the end of the year. The movement is approaching a tipping point.

    Now, more than ever, physicians and medical societies must engage in the conversation, educate ourselves and our peers and ensure the highest standards of care. A timely article published in the Annals of Internal Medicine makes the case for “engaged neutrality”:

    An organization’s political stance on [medical aid in dying] should be informed by its members’ views, but its level of engagement must answer to the needs of its patients. A state medical association’s response to legalization might have to account for both a divided membership and the opposition of its parent association, but the imperative to provide for the real needs of patients and the community justifies taking a position beyond rigid opposition or hands-off neutrality.

    Click here to read the full article.

    After reading, please forward the article to your state or local medical society, your specialty society and/or your AMA delegation. Doctor-to-doctor outreach is a crucial part of our strategy to neutralize medical society opposition to medical aid in dying. Click here for links to each state medical society.

    Thanks for doing your part,

    Rebecca

    Rebecca Thoman, M.D.
    Campaign Manager, Doctors for Dignity

    P.S. If you had this message forwarded to you and you are not a member of Doctors for Dignity, please click here to join.

     

  6. Doctors for Dignity Bulletin- October 2016

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    We sent the following email, part of a monthly series, to our Doctors for Dignity in October:

    Momentum is building for medical societies across the country to withdraw their opposition to medical aid in dying.

    Last month, at their annual meetings, the Colorado Medical Society (CMS) and the Maryland State Medical Society (MedChi) withdrew their opposition to medical aid in dying and adopted positions of neutrality. Doctors for Dignity commends our colleagues who helped lead the change.

    CMS President-elect Katie Lozano, MD, FACR, made this statement regarding the CMS position and the upcoming ballot initiative Proposition 106, which would authorize medical aid in dying in Colorado.

    The board of directors of the Colorado Medical Society, out of respect for the strongly held divergent, principled views of our colleagues regarding end-of-life assistance as proposed in Proposition 106, voted to take a neutral public stance. Our position was derived from extensive deliberation and consultation with the state’s leading clinical experts on palliative care, our appointed Council on Ethical and Judicial Affairs and a statewide survey of our members. Ultimately, Proposition 106 represents the most personal of decisions that must be left to our patients to determine in November. Should this measure pass we will continue to do our utmost to assure the highest standards and safeguards for our patients. If you would like to work with your state, local, or specialty society to develop a position of neutrality toward medical aid in dying, contact us for assistance at [email protected].

    Monthly FAQ

    This month, Compassion & Choices Medical Director David Grube, M.D. answers the following:

    Q: How is self-administration defined and practiced under the Oregon Death with Dignity Act?

    A: In all authorized states, medical aid in dying requires that the dying individual be mentally capable, volitional, and self-administer the medication that has been prescribed by the Attending Physician.

    The medication is ingested, which simply means it is introduced into the gastrointestinal tract. In most instances this means swallowing, but some individuals have a feeding tube (j-peg, etc.) and the medication can be introduced into the body through it. Preparation of the medication (opening capsules, mixing solutions, filling a reservoir or feeding tube) can be done by a family member, loved one, or nurse; however, volitional ingestion means that it is the dying person who must instigate the action (push a plunger, open a valve or clip, etc.) of ingestion.

    Some individuals (e.g. those with ALS) do not have use of their arms so volitional ingestion for them might mean sucking on a straw that is in the liquid medication. In this instance an assistant may hold the medication. Active vomiting is a contraindication to oral ingestion.

     

    Monthly Resource

    Compassion & Choices has created a series of educational videos for physicians about medical aid in dying. Choose the topic that interests you and watch the video on YouTube:

    The clinical practice of medical aid in dying

     

    How physicians should respond to requests for medical aid in dying

     

    Liability protections for physicians

     

    Informed consent and language

     

    Medication information for pharmacists

     

    The California End-of-Life Option Act


    Thanks for all you do,

    Rebecca Thoman, M.D.
    Campaign Manager, Doctors for Dignity

    P.S. If you had this message forwarded to you and you are not a member of Doctors forDignity, please click here to join.

  7. Doctors for Dignity Bulletin – September 2016

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    We sent the following email, part of a monthly series, to our Doctors for Dignity last week:

    A recent survey shows 54% of Maryland physicians support medical aid in dying. The survey was pursuant to a resolution from the Maryland State Medical Society House of Delegates. 65% percent favored a position of either support (50%) or neutrality (15%) toward Maryland legislation to authorize medical aid in dying. These results are consistent with physician surveys in other states and nationwide.

    Click here to read the full report, and check out the resource below to find out how you can influence your state’s medical society.

    Monthly Resource

    Medical Aid in Dying: A Handbook for Engaging State Medical Associations

    This new handbook will help you begin the conversations that lead to policy change within your state, local or specialty medical association. You’ll learn facts and tips that will help you communicate with confidence. The handbook includes a step-by-step guide to changing your society’s policy position.

    Monthly FAQ

    This month, Compassion & Choices Medical Director David Grube, M.D. answers the following:

    Q. In states where medical aid in dying is authorized some physicians choose not to participate. What is the physician’s professional responsibility to her or his patient?

    A: The definition of medical professionalism is to put the patient first.

    Shared medical decision making requires the competent and compassionate doctor to listen, to teach, to explain, and to offer standards of care to the patient. If a medical treatment or procedure does not fall within the personal beliefs of a practitioner, she or he is obliged to refer the patient to another physician for counsel and care. (An example in family medicine might be a referral for consideration for a circumcision if the attending physician does not believe that it is in the best interest of the child. Recall, the referral is not for the procedure, but for the consideration of it.)

    All referrals should be timely and urgent; if there is one thing that the dying patient does not have, it is time. If a terminal patient might consider medical aid in dying, I recommend that this patient and his or her family have a conversation about this with their personal physician well in advance of the need. They must be prepared for the possibility that their primary care physician will not support them. If a physician practices medicine within a limited religious ideology or institution, that should be disclosed to the patient at an early visit.

    Thanks for all you do,

    Rebecca

    Rebecca Thoman, M.D.
    Campaign Manager, Doctors for Dignity

    P.S. If you had this message forwarded to you and you are not a member of Doctors for Dignity, please click here to join.

  8. Doctors for Dignity: August 2016 Bulletin

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    Every month, Doctors for Dignity Campaign Manager Rebecca Thoman, M.D., sends a bulletin to all Doctors for Dignity. The following message was sent in August 2016:

    Friend,

    Last month, the New York State Academy of Family Physicians (NYSAFP) Congress of Delegates voted to remain neutral on “state or federal legislation regarding aid in dying by means of patient-directed, patient-administered prescription medication.” They are now the second state affiliate (after California Academy of Family Physicians) to adopt a neutral position.

    Doctors for Dignity commends our primary care colleagues in New York for respecting patient autonomy at the end of life.

    If you would like to introduce a similar resolution to your state or specialty society, Doctors for Dignity can help. Email [email protected] for more information.

    Monthly FAQ

    This month, Compassion & Choices Medical Director David Grube, M.D. answers the following:

    Doesn’t the Hippocratic Oath preclude physicians from helping patients die?

    Dr. Grube: The Hippocratic Oath is an ancient Greek document that is no longer used at any U.S. medical school graduation ceremony. It begins by asking for allegiance to Apollo and other mythical gods and goddesses. However, like the US Constitution, many of its important principles endure while the application of those ideals has evolved over time. The standards of 21st Century medical ethics can be found within it: Patient autonomy. Beneficence. Non-maleficence. Social justice. And most of all, duty to one’s patients and the patient’s desires and goals. As medical professionals, one of our greatest challenges is to respect our personal commitment to do no harm (professional integrity) in the face of the ambiguities resulting from advanced medical technology. While physicians can now prolong and extend life, thereby conflating the roles as healer and comforter, teacher and guide, shared medical decision making obliges the doctor to embrace full informed consent, especially in care at the end of life. Medical professionals can no longer simply fight disease at any cost, but must help patients weigh risks, benefits, and quality of life as they make their medical choices.

    Monthly Resource

    The Lown Institute’s Right Care Educator Program provides chief residents with training and support to implement Right Care Rounds in their home institutions. Right Care Rounds uses the familiar format of a case presentation, incorporating evidence-based discussions that explore the drivers of medical overuse and promote appropriate, patient-focused care. Goals for Right Care Rounds include teaching clinicians to: recognize and avoid overuse; consider both clinical and social needs of patients; and identify opportunities to improve the quality of care. Right Care Rounds may also address barriers to accessing care, how to care for patients without strong social networks, and failures in patient safety. Applications due August 15.

    Thanks for all you do,

    Rebecca

    Rebecca Thoman, M.D.
    Campaign Manager, Doctors for Dignity

    P.S. If you had this message forwarded to you and you are not a member of Doctors for Dignity, please click here to join.

  9. Massachusetts aid in dying bill needs your help

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    Check out the message we sent today to our supporters in Massachusetts:

    Friend,

    As you may know, the Compassionate Aid in Dying Act, which authorizes aid in dying in Massachusetts, is still under review by the Joint Public Health Committee of the state legislature.

    While the bill is being reviewed on Beacon Hill, we need your help to remind lawmakers that we stand with the 70% of Bay State voters and the millions of voters throughout the nation that support expanding choices at the end of life.

    Click here to tell your legislators that you support the Compassionate Aid in Dying Act.

    Lawmakers all across the state want to know where you stand. Join our citizen lobbying campaign by signing the petition that urges legislative support for this important human right.

    Supportive petitions and letters from voters played a huge role in last year’s passage of California’s End of Life Option Act. Let your voice be heard so that Massachusetts can be next.

    Help us keep the Compassionate Aid in Dying Act alive by communicating with your lawmakers. Click the link below to send the signed petition to your representatives:

    https://www.compassionandchoices.org/massachusetts/tell-your-lawmaker-support-aid-in-dying-in-massachusetts/

    Thank you for your ongoing commitment and support.

    Best,
    Marie

    Marie Manis
    Massachusetts Campaign Manager

    If you live in the Bay State or know people who do, make sure to take action and send this message to your friends!


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