This non-scientific non-representative survey for the American Clinicians Academy on Medical Aid in Dying is confidential. It is not possible for you or your hospice to be identified by the information below, but please fill out only the information you are comfortable with. Thank you!

Hospice aid-in-dying policy is Clearly Stated (written or verbal) to the patient on intake
Hospice is entirely opted out of all aid-in-dying work
Physicians can be Attending/Prescribing doctor
Physicians can be Consulting Doctor
Staff can only mention aid in dying if the patient first brings it up
Staff can mention aid in dying to the patient if clinically appropriate, even if they don't bring it up first
Hospice policy is for a nurse or other staff to be present on aid-in-dying day, if the patient wishes
Hospice policy is that clinical staff cannot be present on aid-in-dying day
Our hospice allows clnical staff to be present on aid-in-dying day, but two must attend
Our hospice allows clinical staff to attend, but they must leave the room for the moment of ingestion
Our hospice allows clinical staff to attend, and they can mix the medications
Our hospice can work with patients who require self-administration of rectal medications, including placement of the rectal catheter.
Our hospice can work with patients who require self-administration of medications by the rectal route, but a clinician outside of our hospice must place the catheter
Our hospice staff will not be present at a death if the patient requires self-administration by rectal catheter.
I believe our clinical staff is well-trained and knowledgeable about aid in dying and our hospice policies about aid in dying.