Healthcare systems have unique considerations when crafting a medical aid in dying policy. They typically care for patients throughout the life-course rather than just at the end of life, and different locations may have very different patient populations. This section will use multiple examples to illustrate the considerations for developing a patient-directed medical aid in dying policy in the context of a larger healthcare system.
University of California, San Diego Health (UCSD) is a large academic healthcare system offering primary, emergency, and specialty healthcare to patients in San Diego County. UCSD began supporting requests for medical aid in dying following implementation of the CA End of Life Option Act in 2016.
Memorial Sloan Kettering Cancer Center (MSK) is a health system based in New York and New Jersey. MSK is an academic medical center and the world's oldest and largest private cancer center, dedicated exclusively to cancer treatment, research and education. Headquartered in New York City, MSK operates a main hospital in Manhattan and over 16 outpatient locations across New York and New Jersey.
Hospices represent one of the primary sources of healthcare to individuals at the end of life, and one of the primary settings in which individuals may pursue medical aid in dying. This section features examples of hospices which have integrated medical aid in dying into their care, highlighting some of the unique considerations.
Eden Hospice, part of Eden Health, serves patients in Bozeman and surrounding communities in southern Montana. Eden Hospice has supported access to medical aid in dying since the option became available in Montana in 2009, and they are the only hospice in their community that participates.
Topkare provides personalized and holistic at-home hospice care to patients and their families in San Diego, California. Their care emphasizes holistic, compassionate, and patient-directed care by empowering patient choice and embracing alternative therapies.
Residential facilities, such as long-term care facilities and hospice houses, represent another environment where a policy for medical aid in dying should be considered. These facilities may or may not provide clinical care but are home to many individuals at the end of life, so their support makes a significant difference to the end-of-life experience.
Hopewell House is a residential care facility dedicated exclusively to caring for people at the end of life. Located in Portland, Oregon, it offers compassionate, person-centered care to hospice patients of all ages.
The participation of pharmacies is critical to ensure access to medical aid in dying. As a compounded mixture of several medications, aid-in-dying prescriptions can only be filled at a compounding pharmacy.
Advance Care Pharmacy (ACP) specializes in hospice, long term care and customized compounding, with a deep expertise in medications and specialty products for patients at the end of life. ACP is one of the few compounding pharmacies in Southern California that fills prescriptions for medical aid in dying.
The process to access medical aid in dying is time-consuming and can be confusing or burdensome. Care coordination services can be incredibly helpful, especially to those who may already be enrolled in a health system or hospice that has opted not to participate.
LA Patient Advocates offers care navigation and advocacy services to patients at the end of life. Founded in 2018,they serve patients in Los Angeles, Ventura, and Riverside Counties in southern California.
Whether you have already incorporated medical aid in dying into your practice or you're just getting started, we're interested in hearing from you! Click the button below to share your experiences with us or tell us more about how we can support you.
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