(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:
- 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: