In the United States, Medical Aid in Dying (MAiD) is legal in 11 jurisdictions. Cancer is a common underlying disease process in MAiD requests and regardless of the stage of disease, distress is a common experience felt by patients (Riba et al. 2023). MAiD requests can stem from distress with a sense of loss including loss of autonomy, dignity and independence (Dees et al. 2011). With expanding state legislation across the country, hospital systems with regional satellite sites where MAiD is legal brings a complex ethical dynamic between patients, providers, and institutions. We discuss how Memorial Sloan Kettering Cancer Center (MSKCC), a New York City based cancer institution with regional sites in New Jersey navigates supporting their patients and clinicians when met with a MAiD request. Though MAiD is legal in New Jersey, MSKCC does not participate however providers, including psychiatrists, commonly encounter these requests. In an effort to support patients and clinicians, an advisory committee was established to help providers understand their patient’s request while upholding their ethical and professional obligations to ensure appropriate patient notification, referral and transfer of care.
Methods:
We will complete a retrospective analysis of patient charts who requested MAiD to their MSKCC provider. We will discuss data gathered from these requests including, but is not limited to: demographics, reason for request, referrals at time of request (psychiatry, palliative care, spiritual care services etc), level of symptom distress, time to MAiD referral after initial request, hospice involvement, and time to death after initial request.
Results:
The aim is to better understand patient concerns eliciting MAiD requests and inform best practices for our patients.
Discussion:
Since established in 2022, our MAiD Advisory Committee has helped support a growing number of clinicians and patients as they navigate conversations about MAiD. By doing so, providers can help optimize their patient’s care and facilitate referrals, as appropriate. The advisory committee is led by the Ethics department with a strong grounding of psychiatrists and a broad interdisciplinary team including members from palliative care, oncology specialties, ethics, social work, spiritual care services and patient representatives.
Conclusion:
In this presentation, we aim to present this unique committee, it’s educational initiatives and data obtained from patients who have requested MAiD through their MSKCC provider. The study is currently in progress and results will be presented at the ACLP 2024 annual meeting.
References: Dees, M. K., Vernooij-Dassen, M. J., Dekkers, W. J., Vissers, K. C., & van Weel, C. Unbearable suffering: a qualitative study on the perspectives of patients who request assistance in dying. Journal of Medical Ethics. 2011. 37(12), 727–734.
Riba, M. B., Donovan, K. A., Ahmed, K., Andersen, B., Braun, I., Breitbart, W. S., Brewer, B. W., Corbett, C., Fann, J., Fleishman, S., Garcia, S., Greenberg, D. B., Handzo, G. F., Hoofring, L. H., Huang, C. H., Hutchinson, S., Johns, S., Keller, J., Kumar, P., Lahijani, S., … Darlow, S. D. (2023). NCCN Guidelines® Insights: Distress Management, Version 2.2023. Journal of the National Comprehensive Cancer Network: JNCCN, 21(5), 450–457. https://doi.org/10.6004/jnccn.2023.0026
Presentation Eligibility: Not previously published or presented
Diversity, Equity, and Inclusion: The information presented in this abstract hopes to improve dissemination of MAiD information as well as palliative and hospice care. Overall, the aim is to help understand how providers can optimize patient care and protect patient autonomy. Disparity in accessing palliative care resources remains a prominent issue in healthcare internationally, and this data can help our institution identify when palliative and hospice care has been involved in patient care and could help to better identify disparities to enhance education and access to end-of-life supports.
