Red Flag checklist for potentially complicated and/or prolonged aid-in-dying deaths

(NOTE: This should be checked before prescribing medications, and again close to the aid-in-dying date. Conditions change.)

• Gut issues:
  • Severe cachexia and/or prolonged time with no oral nutrition—associated with duodenal villous atrophy and poor med absorption.
  • Gastroparesis (delayed gastric emptying)
    • Poorly controlled nausea/vomiting = gastroparesis
    • Anticholinergic medications (Compazine, Haldol, Benadryl, hyoscyamine, others) may improve central nausea, but they risk increasing gastroparesis
  • Severe constipation/obstipation
  • Partial or complete bowel obstructions.
  • GI disease, including pancreatic cancer, colon cancers, hepatic metastases
  • Tense ascites (peritoneal metastases and/or portal hypertension with concomitant bowel edema. For tense ascites, consider paracentesis the day before aid in dying.

• Swallowing concerns:
  • Too weak to actively swallow
  • Oropharyngeal or esophageal obstruction, even if partial
  • Intolerance to swallowing bitter or bad-tasting liquids.

• Medication-related concerns:
  • Very high opiate or benzo tolerance. Consider increasing diazepam and/or phenobarbital dosage in DDMAPh. There is probably no benefit in increasing the morphine dosage.

• General Factors:
  • Obesity
  • Extreme exercise history/cardiac fitness, even if remote in time.
  • Young,  <55 years, or very healthy other than the primary cause of death
  • EtOH, >fifth of liquor or case of beer/day—associated with sedative resistance

• Mental Health Concerns:
  • IV (or other) substance abuse disorder, recent or remote (may have inconsistent/incomplete  drug-use reporting)
  • Waxing and waning mental capacity, and/or ability to follow instructions.