June 2021 Update: The Gift of Compassion

June 18, 2021

The Gift of Compassion

On June 18th the Elizabeth Whitefield End-of-Life Options Act goes into effect and medical aid in dying is authorized in New Mexico. The NM Legislature and the Governor have demonstrated their compassion and their responsiveness to so many New Mexicans who actively supported this initiative to expand the options and ease the worst fears of those who are concerned about their suffering at the end of life.

We join 11 other jurisdictions who have extended this option to terminally ill patients with less than six months to live, who have capacity to make an informed decision and have the ability to self-administer the medications to bring a peaceful death at a time and place of their choosing. Although it will be utilized by relatively few, medical aid in dying brings peace of mind to many who suffer from serious illness and may be facing a difficult death.  It is just one of several options available to terminal patients who wish to have a say in how they will die. Some will opt for full treatment until the very end.  And still others will stop treatment and let nature take its course. They all deserve our respect and our compassionate support.

As was explained in the last Update, for those of us who were involved in the statewide coalition of patients, community members, healthcare providers, etc. this is a time when many of us have switched from advocacy to assisting with the implementation of our new law. We passed our law and now we have the opportunity and the responsibility to help folks understand it and make it as accessible as possible.

As we anticipated, it has been extremely busy for the last six weeks or so.  We are beginning to operationalize our new non-profit corporation, End of Life Options New Mexico (EOLONM). Our state level paperwork is mostly filed and we are applying for our federal 501(c)3 designation so that we can receive grants and donations.

We have completed a strategic planning process with many of our former Steering Committee members and have formally adopted our vision, mission, and core values as reflected below. We have also established four major goals and related committees to do the developmental work of outreach and education/training for clinicians and the public, developing a system of outreach and individual support and resources using well trained volunteers, and managing and sustaining our new EOLONM non-profit corporation. We are fully committed to accomplishing this work, consistent with our mission and values.

End of Life Options New Mexico 

EOLONM Vision: New Mexicans have accurate information and caring support to choose their end-of-life options in a system that honors those choices.
EOLONM Mission: End of Life Options New Mexico provides information and support for all end-of-life options, including medical aid in dying.
EOLONM Values: Compassion, Inclusiveness, Respect, Non-judgmental, & Integrity
EOLONM Value Statement: The collective values that bring us to end-of-life work compel us to demonstrate:
COMPASSION for others’ experiences, and be
INCLUSIVE of our state’s diverse population, while showing
RESPECT for each individual’s end-of-life choices, supporting them in a
NON-JUDGMENTAL manner with steadfast
INTEGRITY.

An immediate high priority activity is that we are investing to upgrade our website which supported our advocacy efforts so well. Our revamped website (same web address: www.endoflifeoptionsnm.org) will eventually feature extensive resources and information about all end-of-life options, interactive forms to request assistance, application forms for potential volunteers, etc. It will take some time for all of this to stabilize and become fully functional, but in the meantime, we are doing the best we can to meet the needs of patients, families, healthcare entities, and clinical providers.

Of course, the tasks and challenges ahead are far greater than our new non-profit will be able to manage on its own. The implementation of medical aid in dying will be accomplished through collaboration with primary care and specialty clinicians, palliative care teams, hospice agencies, hospitals and well-trained volunteers who will provide information and support to all parts of the health care system…including patients. EOLONM has already partnered with the New Mexico Medical Society and the Hospital Association to put on introductory zoom training sessions. We are collaborating with the American Clinicians Academy on Medical Aid in Dying (ACAMAID) to put on training programs for clinicians, pharmacists and volunteers.  We will build upon the experience and expertise of similar statewide support organization in WA, OR, CA and other states that have been providing services for many years to hundreds of seriously ill and dying patients.

We will also continue to work closely with our national partners:  Compassion & Choices and the Death With Dignity National Center which have incredible resources and expertise that they generously share as new states come on board. They are also assisting in this first year with salary support for key personnel and even a mini-grant to help rebuild our website. Here in New Mexico, we have been granted full administrative support, free of charge for a year, from the Delta Management Group, a full-service firm dedicated to the management of non-profit organizations. We are very fortunate in so many ways…even though there is always so much more to do.

We will continue to keep you informed as progress is made on all of these fronts.  It is an uphill climb but we are ready for the challenge. So stay tuned, think about how you might wish to volunteer or support our efforts with generous donations, which will be critical to sustain our progress over time. As we shift our current funds to our new accounting system and obtain our official federal non-profit status, our website will be the primary vehicle for both accessing and supporting our services…and donating to the cause!  In the meantime, we will all do the best we can to build sustainable services and meet the immediate needs of patients who seek information, referrals, or support to assist their journey.

EOLONM Founding Board of Directors:

Barak Wolff
Jill VonOsten
MaryKay Brady

Accessing the End-of-Life Options Act

 To read, download or print the Elizabeth Whitefield End-of-Life Options Act which authorizes medical aid in dying as one of the end-of-life options for eligible New Mexicans, click here.

Eligibility criteria

To be eligible for the Elizabeth Whitefield End-of-Life Options Act, a person must be:

    1. An adult,
    2. Diagnosed with a terminal illness with a prognosis of six months of less to live,
    3. Mentally capable of making their own healthcare decisions.

A person must also meet the following requirements:

    • A resident of New Mexico
    • Acting voluntarily
    • Capable of self-administering the aid-in-dying medication

Steps for Using the Law

In addition to meeting the eligibility criteria, there is a process that must be followed in order to qualify for a prescription for aid-in-dying medication (excerpted from the Compassion and Choices handout: Elizabeth Whitefield End of Life Options Act: Information for New Mexico Residents).

    • In most cases, two licensed healthcare providers, one of which must be a physician (MD or DO), must confirm the terminal illness. Individuals are not eligible for medical aid in dying solely because of age or disability.
    • Individuals enrolled in hospice are considered terminal based on the standard of care and do not require a second confirmation if the prescribing provider is a physician. If the prescribing provider for an individual enrolled in hospice is an advanced practice nurse or a physician assistant, they must obtain written confirmation from the hospice physician or another consulting physician of 1) the patient’s mental capability to make end-of-life care decisions and 2) their ability to self-administer aid-in-dying medication before a prescription can be written.
    • If the prescribing provider for an individual not enrolled in hospice is an advanced practice nurse or physician assistant, they must obtain written confirmation from a consulting physician of 1) the patient’s terminal prognosis, 2) their mental capability to make end-of-life care decisions and 3) their ability to self-administer medical aid-in-dying medication before a prescription can be written.
    • In all cases, the prescribing provider must inform the requesting individual about all of their end-of-life care options, including hospice and pain and symptom management.
    • In all cases, if the provider has concerns about the individual’s mental capacity or ability to make an informed decision, they must make a referral to a mental health professional for an assessment. Medication cannot be prescribed until the requesting individual’s mental capacity is affirmed.
    • The individual must fill out the “Request to End My Life in a Peaceful Manner” form and present it to their qualified clinician.
    • There is a 48-hour waiting period before the aid-in-dying prescription can be filled for a qualified individual (dying patient), which a provider can waive if the patient is unlikely to survive the waiting period.

Talking to Your Healthcare Provider

It can be difficult to talk about death and dying. Some people also find it difficult to talk openly with their healthcare providers. But in order to get the kind of care you desire, it is important to discuss your end-of-life priorities with your healthcare provider. It’s also important to ask your provider directly if they will support your choices.

When it comes to medical aid in dying, it is critical to talk about this option with your provider as soon as possible, especially if you have been given a terminal diagnosis. Getting the process started sooner can give you peace of mind as the end draws near, even if you choose not to fill the prescription or take the medication at a later date.

So how do you begin the conversation with your healthcare provider?

This resource from our national partner Compassion and Choices can help you to frame the request to your provider in a way that clearly expresses you needs and priorities and that also generates the answers you need to proceed or to consider other options:

How to Talk to your Healthcare Provider about Medical Aid in Dying in New Mexico

Because this is a new option in New Mexico, your provider may need more information about the law and practice. Or they may not be aware of the responsibility they have as providers, made explicit in the law, to “inform a terminally ill patient of all reasonable options related to the patient’s care that are legally available to terminally ill patients that meet the medical standard of care for end-of-life care.”

As New Mexico healthcare providers, hospitals, hospices and health systems learn more about the End-of-Life Options Act, more New Mexicans should have access to this compassionate option in the future. If you would like to help your provider get informed about the Act, please see the resources for Provider Outreach & Education listed below and consider sending them this sample letter with helpful resources and support.

Letter for Your Healthcare Provider

 

Local Information and Support

As mentioned earlier, End of Life Options New Mexico has volunteers who understand the law and are available to support and inform New Mexicans about the Act. These vounteers will be able to assist with advance care planning, help individuals to navigate the steps to access medical aid in dying, assist with information about hospice, etc. For information and support, write to: info@endoflifeoptionsnm.org

 

Compassion & Choices End-of-Life Consultation Program

When someone calls the Compassion & Choices End-of-Life Consultation program (EOLC), the EOLC consultant provides information on the full range of options at the end of life. EOLC, and representatives of EOLC, do not provide medical advice, diagnosis or treatment, or any legal advice. Compassion & Choices does not endorse or encourage any particular plan or option, the goal is simply to educate people on the full range of their end-of-life options. Whether to implement a plan or make an end-of-life decision is each individual’s choice. Language interpreter services are available.

    • Call on the phone: (503)943-6504 and leave a message. Trained consultants return calls within 1-2 business days.
    • Or Email: eolc@compassionandchoices.org who will then follow up.

Health Care Provider Outreach and Education

In an effort to inform healthcare providers about the new law and connect qualified NM providers to training on the clinical and service aspects of providing medical aid in dying, EOLONM will be posting upcoming relevant trainings and resources for healthcare providers.

You can view the upcoming training opportunities here.

Many of these trainings are free and some may be open to the general public and other healthcare and services providers such as nurses, social workers, pharmacists, end-of-life doulas, chaplains, psychologists, etc. Some of the trainings make available Continuing Education credits (CE/CME) for professionals. So, check back to this webpage for more upcoming educational opportunities and make a plan to include end-of-life options and medical aid in dying to your educational list of To Do’s for this year.

Also, reach out to us at info@endoflifeoptionsnm.org if you would like to arrange a training for a group at your hospital, hospice, long-term care facility, professional association or medical practice. We would be happy to connect you, or your employer, with experienced and trained clinicians who have

For more information or to attend the following upcoming trainings contact,  info@endoflifeoptionsnm.org

  • ACAMAID Providers Clinical Meeting: New Mexico Providers Ask Questions,
    Monday, July 12, 2021 at 5:30 – 7:00 pm (MST).
  • New Mexico Association for Home and Hospice Care, Summer Conference: End of Life Options Update,
    Thursday, August 19, 2021 at 1 pm (MST)

 

Other Options for Provider Education

    • The American Clinicians Academy on Medical Aid in Dying (ACAMAID) informs and educates clinicians about medical aid in dying, from clinical discussions to evidence-based knowledge, from nursing care to the work of volunteers at the bedside, from medical ethics to pharmacology, and more. The Academy provides a Patient-to-Doctor Referral System; an Information Update and Discussion Listserv; a series of Video Interviews with leaders in the field discussing pressing issues and concerns; a Patient Information Portal; Research and Data Analysis; Resident and Medical Student Trainings; Certified Online Continuing Medical Education for Nurses, Social Workers, and Physicians. As well, the Academy will be providing expert consultations for clinicians facing complex bedside decisions about medical aid in dying.

A resource tailored to practicing clinicians, Doc2Doc offers free, confidential telephone consultation with one of our seasoned medical directors, each with years of experience in end-of-life medical care. The website includes CME information, sample forms, videos.  All qualified NM clinicians (MDs, Dos, APRNs, PAs) can access this free service.

This program provides direct access to experienced pharmacists who dispense aid-in dying medications and provide consultations to patients; medication formularies for medical aid in dying; protocols for taking aid-in-dying medications; current clinical practice guidelines; academic research and data on medical aid in dying in authorized states; communication with patients and family members about medical aid in dying; legal and medical issues; andlaws and administrative rules for each authorized state allowing medical aid in dying.

This tool currently identifies hospitals, medical clinics and hospices that have adopted policies that support patient end-of-life choice, including medical aid in dying in the states of California, Colorado, Hawai’i, Montana, New Jersey, Oregon and the District of Columbia. Now, providers in New Mexico can sign up to be included in this database. If you work for a health system, hospital, medical clinic, hospice or retirement community that is supportive of patient choice, including medical aid in dying, and you would like to see your facility added to this tool, please email info@compassionandchoices.org.

Resources and Support for Health Systems

Policy Development

Many New Mexico health systems, hospitals, hospices, and medical clinics are preparing for the End-of-Life Options Act by conducting training and writing policies to clearly articulate their position on providing the service, to guide their employees as to their duties and responsibilities under the Act, and to inform their patients of their options.

The Act has clear provisions that recognize and protect individual providers and health care entities who object to participating in the practice of medical aid in dying.  However, the law is clear that it is the responsibility of those providers and organizations to refer the individual requesting medical aid in dying “to a healthcare provider who is able and willing to carry out the individuals request or to another individual or entity to assist the requesting individual in seeking medical aid in dying.”

The decision of a health care entity to prohibit medical aid in dying or “opt-out” of providing the services comes with a duty to be transparent. The Act stipulates they must “accurately and clearly articulate” their position “in an appropriate location on any website maintained by the entity and in any appropriate materials given to patients…”

EOLONM is helping New Mexico health systems and providers understand the law and their responsibilities under the law. We have worked with our national partner, Compassion & Choices, to develop sample policies for hospitals, hospices and long-term care facilities. If you or your employer would like support in developing your company policy, please contact us at info@endoflifeoptionsnm.org.

Local Organizer Goes National – Thanks to New Mexico

Elizabeth Armijo, C&C National Advocacy Director

Thank you. Thank you. Thank you for being a part of this incredible journey.

I have been a long-time health promotion advocate and community organizer in New Mexico and have worked in different capacities with Compassion & Choices since 2012. I started as a contractor helping to grow a grassroots base of supporters in New Mexico and then worked on two legislative campaign initiatives. My responsibilities were then expanded across multiple states, across the western region, and now nationally as the Compassion & Choices National Advocacy Director.

My journey in New Mexico has led to incredible experiences across the country. I’ve taken what I have learned from all of you (supporters, volunteers, storytellers, patients, allied partners, and lawmakers) and have been able to apply it to other campaigns and other states. Each one of you has given me a special gift…and that’s a piece of your unique story. Thank you for helping me to grow and thank you for allowing me to be on this journey with you. I look forward to the next stage of implementation and access and will continue on as a senior advisor with End of Life Options New Mexico. See you soon.

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