H&PM - Medically assisted dying and future job prospects

[----x----]

Would you recommend against someone going into hospice and palliative medicine as a specialty if they were unwilling to prescribe interventions in line with medically assisted dying (in other settings called doctor assisted suicide, euthanasia)?

Do you think an unwillingness to provide this service would prevent future job opportunities in this field?

---

Members don't see this ad.

 

[baileyfal]

It hasn’t impacted my career thus far. From what I understand, it’s something you have to seek out and not a requirement of most H&PM jobs.

It’s not uncommon for pt’s suffering with serious illness to express a desire to die/request you hasten their death; here are a couple of fast facts articles that discusses how to approach these pt’s:

Responding to a Request for Hastening Death - Palliative Care Network of Wisconsin

Background Requests for hastened death among terminally ill patients occur commonly (see Fast Fact #156). With good symptom management, psychological and spiritual support, most patient requests do not persist. This Fast Fact focuses on ways of responding to patients with persistent wishes...

www.mypcnow.org

Evaluating Requests for Hastened Death - Palliative Care Network of Wisconsin

Background A patient’s request to a health care professional to help hasten death is not uncommon. The motivation for this request is usually a combination of relentless physical symptoms, progressive debility, in combination with a loss of sense of self, loss of control, fear of the future...

www.mypcnow.org

Interested to hear from others

 

[DragonWell]

Short answer to your question is that your ethical beliefs on medical aid in dying (MAID) should have no impact on your job prospects at all. If a potential employer you're interviewing expresses a view that they'd be OK pressuring employees to provide care they're ethically opposed to, I would run from that place! Ira Byock comes to mind as a well known palliative care doc who doesn't support MAID.

The longer answer is that euthanasia, MAID, and requests for hastened death are three very different issues.

Euthanasia is killing someone to end their suffering—this is illegal in all 50 states.

MAID is providing medical support, in the form of lethal medication, at a patient's request, that they can voluntarily choose or not choose to ingest. The states in which MAID are legal have many safeguards in place to ensure that this process follows the law and remains patient-centered. For example, patients must administer or ingest the medicine under their own power—no one can push the medicine into a feeding tube, for example. The patient must do this alone, which can sometimes be challenging in advanced illnesses like ALS.

Practically, here in Oregon, I have observed that many physicians decide to not participate in MAID for various reasons. The relationships of physicians who do support MAID are separated into prescribing physicians and those who may support the process, but take a less active role, perhaps as a consulting physician. Many times, if there is a an existing relationship, such as a physician who is a hospice attending for a patient, they will specifically not be the prescribing physician, to avoid any potential appearance of a competing motivation. This seems to be pretty standard among the hospice providers I know. For multiple reasons (not the least of which is that most hospice funding comes from Medicare, a federal program), MAID and hospice care are kept clearly delineated and separated.

Requests for hastened death are extremely common in serious illness and, in my experience, rarely have anything to do with euthanasia or MAID. Some variation of "Tell me more..." is usually the response here and improved palliation of whatever symptom is making life unlivable is usually the next step.