American Clinicians Academy on Medical Aid in Dying

(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)
    • Severe constipation/obstipation
    • Partial  or complete bowel obstructions.
    • GI disease, including pancreatic cancer, colon cancers, hepatic metastases
    • Ascites that is tense (peritoneal mets, and/or portal hypertension with concomitant bowel edema and compression. (For tense ascites, recommend 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. (NOTE: no specific threshold, use judgment) 
  • 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) drug abuse, recent or remote (may have inconsistent/incomplete  drug- use reporting)
    • Waxing and waning mental capacity, and/or ability to follow instructions.

If significant Red Flags, revised AID plans, change in pharmacology and/or route of administration; other change:  

Family/Patient informed: