Medically Challenging Cases: Complex gut function; self-administration by oral, rectal, PEG, and ostomy routes – American Clinicians Academy on Medical Aid in Dying

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For a patient with a bowel obstruction at the level of the mid transverse colon, the clinician should:*

Continue with oral administration because the medications are absorbed in the duodenum, so the distal bowel obstruction should have little effect.
Control nausea and vomiting with a venting gastric tube, and then use the oral route by briefly turning off the suction of the venting tube.
Give high-dose dexamethasone on the morning of aid in dying to decrease bowel swelling, then proceed with oral self-administration.
Recommend rectal self-administration of aid-in-dying medications.

In evaluating the rectum for administration of aid in dying medications in a patient with ovarian cancer treated with surgery two years prior to aid in dying, all of the below are essential except:*

Reviewing surgical notes if they can be obtained.
Reviewing available abdominal scans.
Placing pyridium in the rectum and checking for orange urine, to be sure the rectal mucosa has the ability to absorb medications.
Doing a digital rectal examination.

For an ALS patient, all of the above can be used for self-administration into a PEG tube, except:*

The patient can push a catheter-tip syringe plunger with his forehead while someone stabilizes the body of the syringe.
Any person can set up a gravity bag, add in the aid-in-dying medications, and the patient can release a clamp to start the flow.
Any person can set up a gravity bag, and if the gravity-pressure isn’t enough for the medicines to drain into the PEG tube, an assistant can squeeze the bag so the medicines can flow.
Using a suspended gravity bag containing the aid-in-dying medications, the patient can be given a kinked part of the tubing in her mouth, and start the medications by releasing the kinked section, which unfolds spontaneously and starts the flow.

When the powdered suspension of aid-in-dying medications are in a 60cc catheter-tip syringe, gradual pressure is recommended because if the patient pushes as hard as she can to rapidly administer the medications, the result may be:*

Sudden opening of the connection from the syringe, with spraying of the medications into the room.
Faster flow, but the patient will fatigue more quickly and may not finish the dose.
Faster flow, so the patient loses consciousness so rapidly she can’t complete the total dose
Faster flow, and that will facilitate the effect of the medications.

Pre-test Quiz, Medically Challenging, 2023